Short-term effectiveness of web-based guided self-help for phobic outpatients: Randomized controlled trial

Background: internet-based guided self-help has been successfully used in the general population,but it is unknown whether this method can be effectively used in outpatient clinics for patients waiting for face-to-face psychotherapy for phobias. objective: the aim was to assess the clinical effectiveness of phobias under control,an internet-based intervention based on exposure therapy with weekly guidance. methods: we conducted a randomized controlled trial,recruiting 212 outpatients scheduled to receive face-to-face psychotherapy for any type of phobia at an outpatient clinic. participants suffering from at least 1 dsm-iv or icd-10 classified phobia (social phobia,agoraphobia with or without panic disorder,and/or specific phobia as ascertained by a telephone interview at baseline) were randomly allocated to either a 5-week internet-based guided self-help program based on exposure therapy with weekly student support followed by face-to-face psychotherapy (n=105) or a wait-list control group followed by face-to-face psychotherapy (n=107). primary outcome was the fear questionnaire (fq). secondary outcomes were the beck anxiety inventory (bai) and center of epidemiological studies-depression scale (ces-d). assessments took place by telephone at baseline (t0) and on the internet at posttest (t1,self-assessment at 5 weeks after baseline). missing data at t1 were imputed. results: at posttest,analysis of covariance on the intention-to-treat sample showed significant but small effect sizes between intervention and control groups on the fq (d=0.35,p=.02),ces-d (d=0.34,p=.03),and a nonsignificant effect size on the bai (d=0.28. p=.05). although initial acceptance was good,high nonresponse was observed,with 86 of 212 participants (40.5%) lost to follow-up at t1 and only 14 of 105 (13.3%) intervention participants finishing all 5 weeks. conclusions: phobias under control is modestly effective in lowering phobic and depressive symptoms in a relatively short period and may be clinically beneficial when implemented in routine outpatient practice. trial registration: netherlands trial register ntr2233; http://www.trialregister.nl/trialreg/admin/rctview.asp?tc=2233 (archived by webcite at http://www.webcitation.org/6o2iooqss).