Wahlund Tove, Spångberg Fredrik, Vadenmark Viktor, Andersson Erik
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Internet Interv. 2025 Jun 10;41:100842. doi: 10.1016/j.invent.2025.100842. eCollection 2025 Sep.
Excessive worry is common among treatment-seeking individuals in primary care and has a negative impact on daily functioning, which may also lead to other mental health problems. The current study tested whether a worry-focused online intervention - provided in both a guided and an unguided format - was efficacious in reducing worry-related symptoms and if these effects were specifically linked to improvements in daily functioning. A total of 82 participants were randomized to intervention with therapist support (guided; = 28), intervention without therapist support (unguided; = 27) or to waiting list (n = 27). Results showed that the online intervention was more effective than waiting list in reducing worry at week 5 (between-group = 0.96). The intervention was effective against waiting list irrespective of whether it was provided in a guided (between-group = 0.90) or unguided format (between-group = 1.07) with sustained results at the 7-week follow-up. Reduction in worry mediated improvement in daily functioning (between-group = 0.58; indirect effect estimate = -1.06 [95 % CI: -1.76 to -0.51], 66 % mediated effect). The mediation effects were fairly robust to mediator-outcome confounding, with residual correlation values set to = 0.3 in a sensitivity analysis. The results provide further evidence that it is beneficial to provide a low-threshold, easy access intervention to patients with excessive worry, irrespective of primary diagnosis. Clinical implications are discussed.
过度担忧在寻求初级保健治疗的人群中很常见，会对日常功能产生负面影响，还可能导致其他心理健康问题。本研究测试了一种以担忧为重点的在线干预措施——以有指导和无指导两种形式提供——在减轻与担忧相关症状方面是否有效，以及这些效果是否与日常功能的改善有特定关联。共有82名参与者被随机分为接受有治疗师支持的干预组（有指导；n = 28）、无治疗师支持的干预组（无指导；n = 27）或等待列表组（n = 27）。结果显示，在第5周时，在线干预在减轻担忧方面比等待列表组更有效（组间差异 = 0.96）。无论干预是以有指导（组间差异 = 0.90）还是无指导形式（组间差异 = 1.07）提供，与等待列表组相比均有效，且在7周随访时有持续效果。担忧的减轻介导了日常功能的改善（组间差异 = 0.58；间接效应估计值 = -1.06 [95%置信区间：-1.76至-0.51]，中介效应为66%）。在敏感性分析中，将中介变量与结果变量的混杂残差相关值设定为0.3时，中介效应相当稳健。结果提供了进一步的证据，表明为过度担忧的患者提供低门槛、易于获取的干预措施是有益的，无论其初步诊断如何。文中讨论了临床意义。
