The effectiveness of Internet-delivered treatment for generalized anxiety disorder: An updated systematic review and meta-analysis

Evaluation of an online-based self-help program for patients with generalized anxiety disorder - A randomized controlled trial

Objectives

This study aimed to evaluate the effects of an online self-help intervention for generalized anxiety disorder (GAD). Our primary outcomes were generalized anxiety symptoms, measured using the Generalized Anxiety Disorder - 7 (GAD-7; Spitzer et al., 2006), and wellbeing based on the World Health Organization Wellbeing Index - 5 (WHO-5; Topp et al., 2015).

Methods

A total of 156 German-speaking patients aged 18 to 65 with a diagnosis of GAD and internet access were included in this randomized controlled trial. The intervention group (N = 78) received access to a 12-week online self-help program, while the waitlist control group (N = 78) received access after the 12-week waiting period.

Results

The intervention group showed a significant improvement in generalized anxiety symptoms compared to the control group (t(df = 123.73) = 4.52, p < .001) with a large effect size (d = 0.88, 95 %-CI: 0.50; 1.26). Additionally, the intervention group demonstrated a significant increase in wellbeing compared to the control group (t(df = 87,86) = 3.48, p < .001), with a moderate effect size (d = 0.62, 95 % CI: 0.27; 0.98). However, no significant effects were observed for secondary outcomes of functional impairments, work productivity, mental health literacy, and healthcare demands. For exploratory outcomes, improvement was found for anxiety and worry symptoms.

Conclusions

These findings suggest that an online-based self-help intervention effectively reduces GAD symptoms and improves overall wellbeing. Future research should explore the long-term effects of this intervention and investigate potential mechanisms underlying its efficacy.

Public health implications

Online-based self-help programs provide a promising treatment option for individuals with GAD who face barriers to traditional face-to-face therapy.

A meta-analysis on the efficacy of low-intensity cognitive behavioural therapy for generalised anxiety disorder

BACKGROUND

Low-intensity cognitive behavioural therapy (LICBT) has been recommended as a primary intervention in the tiered care for mild to moderate generalised anxiety disorder. However, LICBT for generalised anxiety disorder are markedly diverse and efficacy data on various outcomes have not been systematically reviewed. This meta-analysis aimed to synthesise effect sizes of three NICE-recommended LICBT for generalised anxiety disorder: non-facilitated self-help, guided self-help, and psychoeducational groups.

METHODS

A systematic literature review of randomised controlled trials (RCTs) examining LICBT for generalised anxiety disorder in the last 23 years (2000-2023) was conducted. Efficacy data for anxiety, depression, and worry outcomes were separately meta-analysed. The study was reported following the PRISMA guidelines.

RESULTS

The systematic review identified 12 RCTs out of 1205 papers. The three meta-analyses consisted of 12 (anxiety), 11 (depression), and 9 (worry) effect sizes respectively, including total sample sizes of 1201 (anxiety), 1164 (depression), and 908 (worry). The adjusted effect sizes for reductions in anxiety (g = -0.63), depression (g = -0.48), and worry (g = -0.64) were all in the medium range, favouring LICBT over control conditions. Between-study heterogeneity was significant on anxiety and worry, with no specific moderators identified by meta-regression.

CONCLUSIONS

LICBT has shown promise as an effective and efficient treatment modality for individuals with generalised anxiety disorder. Future research comparing various LICBT subtypes and treatment components will further inform clinical practice.

TRIAL REGISTRATION

This systematic review protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO; record ID CRD42021285590).

Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial

OBJECTIVE

Untreated mental disorders are important among low- and middle-income country (LMIC) university students in Latin America, where barriers to treatment are high. Scalable interventions are needed. This study compared transdiagnostic self-guided and guided internet-delivered cognitive behavioral therapy (i-CBT) with treatment as usual (TAU) for clinically significant anxiety and depression among undergraduates in Colombia and Mexico.

METHOD

1,319 anxious, as determined by the Generalized Anxiety Disorder-7 (GAD-7) = 10+ and/or depressed, as determined by the Patient Health Questionnaire-9 (PHQ-9) = 10+, undergraduates (mean [SD] age = 21.4 [3.2]); 78.7% female; 55.9% first-generation university student) from seven universities in Colombia and Mexico were randomized to culturally adapted versions of self-guided i-CBT (n = 439), guided i-CBT (n = 445), or treatment as usual (TAU; n = 435). All randomized participants were reassessed 3 months after randomization. The primary outcome was remission of both anxiety (GAD-7 = 0-4) and depression (PHQ-9 = 0-4). We hypothesized that remission would be higher with guided i-CBT than with the other interventions.

RESULTS

Intent-to-treat analysis found significantly higher adjusted (for university and loss to follow-up) remission rates (ARD) among participants randomized to guided i-CBT than either self-guided i-CBT (ARD = 13.1%, χ12 = 10.4, p = .001) or TAU (ARD = 11.2%, χ12 = 8.4, p = .004), but no significant difference between self-guided i-CBT and TAU (ARD = -1.9%, χ12 = 0.2, p = .63). Per-protocol sensitivity analyses and analyses of dimensional outcomes yielded similar results.

CONCLUSIONS

Significant reductions in anxiety and depression among LMIC university students could be achieved with guided i-CBT, although further research is needed to determine which students would most likely benefit from this intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An internet-based behavioral intervention for adults with autism spectrum disorder - A randomized controlled trial and feasibility study

Background

The increased prevalence of Autism Spectrum Disorder (ASD) diagnoses in combination with psychiatric comorbidity, has led to an increased need for effective interventions. The evidence for internet-based interventions for several mental health problems is established but has not been evaluated for adults with ASD.

Objective

The aim of this randomized controlled trial is to evaluate the feasibility and effects of an internet-based intervention targeting quality of life and psychiatric symptoms (depression and anxiety) in adults with ASD.

Methods

84 participants were randomly allocated to intervention (n = 42) or control (n = 42). The 18-week internet-based intervention covered a range of themes related to difficulties common in ASD, and exercises based on cognitive behavioral strategies. Participants were provided with individual feedback following each module and were invited to regular chat sessions with peer participants. The primary outcomes were subjective quality of life and sense of coherence, and secondary outcomes were symptoms of depression and anxiety. All outcomes were measured at five occasions and analysed with linear mixed effect models. Participant satisfaction and adherence was also analysed.

Results

Participant satisfaction and adherence was satisfactory but no significant interaction between group and time was found for any outcome measure. Autistic traits were negatively related to quality of life and sense of coherence and positively related to anxiety and depressive symptoms.

Conclusions

This internet-based intervention showed feasibility regarding adherence and participant satisfaction. However, no significant effects on quality of life, sense of coherence or psychiatric symptoms were found, likely due to limitations in the design and methodology of this specific trial in combination to the heterogeneity of the group. Individuals with ASD may require interventions that are flexible and individually tailored in regard to both format, content and therapeutic support. The current trial provides useful information and suggestions for the future research on internet-based interventions for ASD.

Deep learning for the prediction of clinical outcomes in internet-delivered CBT for depression and anxiety

In treating depression and anxiety, just over half of all clients respond. Monitoring and obtaining early client feedback can allow for rapidly adapted treatment delivery and improve outcomes. This study seeks to develop a state-of-the-art deep-learning framework for predicting clinical outcomes in internet-delivered Cognitive Behavioural Therapy (iCBT) by leveraging large-scale, high-dimensional time-series data of client-reported mental health symptoms and platform interaction data. We use de-identified data from 45,876 clients on SilverCloud Health, a digital platform for the psychological treatment of depression and anxiety. We train deep recurrent neural network (RNN) models to predict whether a client will show reliable improvement by the end of treatment using clinical measures, interaction data with the iCBT program, or both. Outcomes are based on total improvement in symptoms of depression (Patient Health Questionnaire-9, PHQ-9) and anxiety (Generalized Anxiety Disorder-7, GAD-7), as reported within the iCBT program. Using internal and external datasets, we compare the proposed models against several benchmarks and rigorously evaluate them according to their predictive accuracy, sensitivity, specificity and AUROC over treatment. Our proposed RNN models consistently predict reliable improvement in PHQ-9 and GAD-7, using past clinical measures alone, with above 87% accuracy and 0.89 AUROC after three or more review periods, outperforming all benchmark models. Additional evaluations demonstrate the robustness of the achieved models across (i) different health services; (ii) geographic locations; (iii) iCBT programs, and (iv) client severity subgroups. Results demonstrate the robust performance of dynamic prediction models that can yield clinically helpful prognostic information ready for implementation within iCBT systems to support timely decision-making and treatment adjustments by iCBT clinical supporters towards improved client outcomes.

An observational treatment study of metacognition in anxious-depression

Prior studies have found metacognitive biases are linked to a transdiagnostic dimension of anxious-depression, manifesting as reduced confidence in performance. However, previous work has been cross-sectional and so it is unclear if under-confidence is a trait-like marker of anxious-depression vulnerability, or if it resolves when anxious-depression improves. Data were collected as part of a large-scale transdiagnostic, four-week observational study of individuals initiating internet-based cognitive behavioural therapy (iCBT) or antidepressant medication. Self-reported clinical questionnaires and perceptual task performance were gathered to assess anxious-depression and metacognitive bias at baseline and 4-week follow-up. Primary analyses were conducted for individuals who received iCBT (n=649), with comparisons between smaller samples that received antidepressant medication (n=82) and a control group receiving no intervention (n=88). Prior to receiving treatment, anxious-depression severity was associated with under-confidence in performance in the iCBT arm, replicating previous work. From baseline to follow-up, levels of anxious-depression were significantly reduced, and this was accompanied by a significant increase in metacognitive confidence in the iCBT arm (β=0.17, SE=0.02, p<0.001). These changes were correlated (r(647)=-0.12, p=0.002); those with the greatest reductions in anxious-depression levels had the largest increase in confidence. While the three-way interaction effect of group and time on confidence was not significant (F(2, 1632)=0.60, p=0.550), confidence increased in the antidepressant group (β=0.31, SE = 0.08, p<0.001), but not among controls (β=0.11, SE = 0.07, p=0.103). Metacognitive biases in anxious-depression are state-dependent; when symptoms improve with treatment, so does confidence in performance. Our results suggest this is not specific to the type of intervention.

Altered Functional Brain Network Structure between Patients with High and Low Generalized Anxiety Disorder

To investigate the differences in functional brain network structures between patients with a high level of generalized anxiety disorder (HGAD) and those with a low level of generalized anxiety disorder (LGAD), a resting-state electroencephalogram (EEG) was recorded in 30 LGAD patients and 21 HGAD patients. Functional connectivity between all pairs of brain regions was determined by the Phase Lag Index (PLI) to construct a functional brain network. Then, the characteristic path length, clustering coefficient, and small world were calculated to estimate functional brain network structures. The results showed that the PLI values of HGAD were significantly increased in alpha2, and significantly decreased in the theta and alpha1 rhythms, and the small-world attributes for both HGAD patients and LGAD patients were less than one for all the rhythms. Moreover, the small-world values of HGAD were significantly lower than those of LGAD in the theta and alpha2 rhythms, which indicated that the brain functional network structure would deteriorate with the increase in generalized anxiety disorder (GAD) severity. Our findings may play a role in the development and understanding of LGAD and HGAD to determine whether interventions that target these brain changes may be effective in treating GAD.

Update on treatments for anxiety-related disorders

PURPOSE OF REVIEW

This review examines recent evidence that informs the treatment of anxiety-related disorders.

RECENT FINDINGS

In addition to selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines, agomelatine has demonstrated efficacy in treating generalized anxiety disorder (GAD). Other novel products, such as ketamine, psilocybin and cannabidiol, are in the process of gathering evidence in support of the treatment of anxiety disorders. In psychological therapy, various psychological treatments for anxiety disorders, such as mindfulness-based intervention, acceptance and commitment therapy, psychodynamic therapy, emotion-focused therapy and dialectical behavioural therapy, have been tried. Still, most therapies have not proven superior to cognitive behavioural therapy (CBT). In very preliminary findings: Repetitive transcranial magnetic stimulation (rTMS) was effective in GAD; transcranial direct current stimulation (tDCS) was effective for social anxiety disorder (SAD) and GAD and augmented exposure therapy for specific fears. Internet and mobile-based interventions have comparable efficacy to face-to-face therapy.

SUMMARY

Pharmacotherapy of anxiety disorders is expanding to novel products. Despite trying other psychological therapies for anxiety disorders, most therapies were comparable to but not superior to CBT. rTMS and tDCS were also used and show early promise for GAD, but further studies are needed. Most internet or mobile app based psychological therapies were based on CBT, and some can be considered as alternatives to in-person face-to-face therapy.

A meta-analytic review of randomized clinical trials of online treatments for anxiety: Inclusion/exclusion criteria, uptake, adherence, dropout, and clinical outcomes

Over the last decade there has been rapid growth in the number of clinical trials examining internet-delivered interventions for anxiety. While there have been numerous analyses of treatment efficacy, few studies have examined treatment engagement. The current meta-analysis examined participant eligibility, uptake, adherence, and drop-out in clinical trials of internet-delivered treatments for anxiety. This meta-analysis used random effects models to obtain estimates of participant inclusion, uptake, adherence, drop-out, and within-group treatment effect size. Moderator analyses examined the effects of anxiety disorder type, treatment type, and level of clinician guidance. After screening, 140 trials with 199 treatment arms (N = 11,021) were included. An average of 46% (95% CI 42, 50) of interested people were included in the clinical trials. In the active treatment arms, 98% (95% CI 97, 99) of participants began treatment, 81% (95% CI 78, 85) of the assigned treatments were completed, 21% (95% CI 18, 23) of individuals dropped out at post-treatment based on questionnaire non-completion, and an overall within-group effect size of g = 1.03 (95% CI 0.94, 1.13) was obtained. Several moderators of interest were significant (e.g., clinical guidance, anxiety disorder type), and there was substantial heterogeneity in estimates. In conclusion, a large number of inclusion and exclusion criteria have been used in trials of internet-delivered treatments for anxiety. Once recruited into a trial, however, most people appear to begin, adhere, and complete internet-delivered treatment for anxiety. Further research exploring various eligibility criteria and their impact on engagement and efficacy is warranted.

Text Topics and Treatment Response in Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder: Text Mining Study

Background

Text mining methods such as topic modeling can offer valuable information on how and to whom internet-delivered cognitive behavioral therapies (iCBT) work. Although iCBT treatments provide convenient data for topic modeling, it has rarely been used in this context.

Objective

Our aims were to apply topic modeling to written assignment texts from iCBT for generalized anxiety disorder and explore the resulting topics’ associations with treatment response. As predetermining the number of topics presents a considerable challenge in topic modeling, we also aimed to explore a novel method for topic number selection.

Methods

We defined 2 latent Dirichlet allocation (LDA) topic models using a novel data-driven and a more commonly used interpretability-based topic number selection approaches. We used multilevel models to associate the topics with continuous-valued treatment response, defined as the rate of per-session change in GAD-7 sum scores throughout the treatment.

Results

Our analyses included 1686 patients. We observed 2 topics that were associated with better than average treatment response: “well-being of family, pets, and loved ones” from the data-driven LDA model (B=–0.10 SD/session/∆topic; 95% CI –016 to –0.03) and “children, family issues” from the interpretability-based model (B=–0.18 SD/session/∆topic; 95% CI –0.31 to –0.05). Two topics were associated with worse treatment response: “monitoring of thoughts and worries” from the data-driven model (B=0.06 SD/session/∆topic; 95% CI 0.01 to 0.11) and “internet therapy” from the interpretability-based model (B=0.27 SD/session/∆topic; 95% CI 0.07 to 0.46).

Conclusions

The 2 LDA models were different in terms of their interpretability and broadness of topics but both contained topics that were associated with treatment response in an interpretable manner. Our work demonstrates that topic modeling is well suited for iCBT research and has potential to expose clinically relevant information in vast text data.

Relationship between anxiety and internet searches before percutaneous ultrasound-guided diagnostic procedures: A prospective cohort study

Invasive procedures guided by ultrasound (US) are part of routine medical diagnostic investigation. The lack of knowledge surrounding the technical aspects of such procedures can lead patients to seek complementary information on the Internet, which may in turn trigger anxiety. However, the intersection between the fields of Radiology and Psychology is poorly studied. Here, we identify the profile of an anxious patient before an US-guided intervention. We prospectively studied 133 patients undergoing image-guided procedures. The State-Trait Anxiety Inventory (STAI) was applied for psychometry. Significantly higher anxiety scores were observed in female patients (p = .001), those who believed they had received inadequate information from their referring physician (p = .006), and in patients who considered online information unreliable or difficult to access (p = .007 and p = .001, respectively). Participants who defined themselves as proactive online reported lower anxiety levels (p = .003).

Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts

INTRODUCTION

Generalized anxiety disorder (GAD) is common and disabling. Different versions of cognitive behavioral therapy (CBT) have been tested, but no treatment works for everyone. Therefore, researchers have attempted approaches to enhance CBT.

AREAS COVERED

The current narrative review examines meta-analyses and individual trials of CBT-based treatments for GAD. We focus on CBT and its cognitive and behavioral components as well as efforts to enhance CBT and its dissemination and generalizability. Enhancement efforts included interpersonal and emotional processing therapy, mindfulness-based CBT, emotion regulation therapy, intolerance of uncertainty therapy, the unified protocol, metacognitive therapy, motivational interviewing, and contrast avoidance targeted treatment. Emerging strategies to enhance dissemination have focused on technologically based treatments. Attempts at generalizability have included examination of efficacy within diverse racial and ethnic groups.

EXPERT OPINION

We conclude that CBT is efficacious, and a number of enhancement efforts have shown some promise in improving upon CBT in single trials. However, more research is needed, particularly efforts to determine which enhancements work best for which individuals and what are the mechanisms of change. Furthermore, few technological interventions have been compared to active treatments. Finally, much more attention needs to be paid to ethnic and racial diversity in randomized controlled trials.

Effectiveness of the internet-based Unified Protocol transdiagnostic intervention for the treatment of depression, anxiety and related disorders in a primary care setting: a randomized controlled trial

Background

Research has shown that internet-based cognitive behavioural therapy (iCBT) can be a very promising solution to increase access to and the dissemination of evidence-based treatments to all of the population in need. However, iCBT is still underutilized in clinical contexts, such as primary care. In order to achieve the effective implementation of these protocols, more studies in ecological settings are needed. The Unified Protocol (UP) is a transdiagnostic CBT protocol for the treatment of emotional disorders, which includes depression, anxiety and related disorders, that has shown its efficacy across different contexts and populations. An internet-based UP (iUP) programme has recently been developed as an emerging internet-based treatment for emotional disorders. However, the internet-delivered version of the UP (iUP) has not yet been examined empirically. The current project seeks to analyse the effectiveness of the iUP as a treatment for depression, anxiety and related emotional disorders in a primary care public health setting.

Methods

The current study will employ a parallel-group, randomized controlled trial design. Participants will be randomly assigned to (a) the internet-based Unified Protocol (iUP), or (b) enhanced waiting list control (eWLC). Randomization will follow a 2:1 allocation ratio, with sample size calculations suggesting a required sample of 120 (iUP=80; eWLC=40). The Mini-International Neuropsychiatric Interview (M.I.N.I.) will be used for assessing potential participants. The Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS) as well as other standardized questionnaires will be used for assessments at baseline, 4 weeks, 8 weeks and 12 weeks from baseline and for the iUP condition during the follow-up.

Discussion

Combining the advantages of a transdiagnostic treatment with an online delivery format may have the potential to significantly lower the burden of emotional disorders in public health primary care setting. Anxiety and depression, often comorbid, are the most prevalent psychological disorders in primary care. Because the iUP allows for the treatment of different disorders and comorbidity, this treatment could represent an adequate choice for patients that demand mental health care in a primary care setting.

Trial registration

ISRCTN18056450 10.1186/ISRCTN18056450.

Internet-Delivered Interventions for Depression and Anxiety Symptoms in Children and Young People: Systematic Review and Meta-analysis

BACKGROUND

Mental health difficulties in children and adolescents are highly prevalent; however, only a minority receive adequate mental health care. Internet-delivered interventions offer a promising opportunity to increase access to mental health treatment. Research has demonstrated their effectiveness as a treatment for depression and anxiety in adults. This work provides an up-to-date examination of the available intervention options and their effectiveness for children and young people (CYP).

OBJECTIVE

In this systematic review and meta-analysis, we aimed to determine the evidence available for the effectiveness of internet-delivered interventions for treating anxiety and depression in CYP.

METHODS

Systematic literature searches were conducted throughout November 2020 using PubMed, PsycINFO, and EBSCO academic search complete electronic databases to find outcome trials of internet-delivered interventions treating symptoms of anxiety and/or depression in CYP by being either directly delivered to the CYP or delivered via their parents. Studies were eligible for meta-analysis if they were randomized controlled trials. Risk of bias and publication biases were evaluated, and Hedges g between group effect sizes evaluating intervention effects after treatment were calculated. Meta-analyses used random-effects models as per protocol.

RESULTS

A total of 23 studies met the eligibility criteria for the systematic review, of which 16 were included in the meta-analyses, including 977 participants in internet-delivered treatment conditions and 1008 participants in control conditions across 21 comparisons. Random-effects models detected a significant small effect for anxiety symptoms (across 20 comparisons; Hedges g=-0.25, 95% CI -0.38 to -0.12; P<.001) and a small but not significant effect for depression (across 13 comparisons; Hedges g=-0.27, 95% CI -0.55 to 0.01; P=.06) in favor of internet-delivered interventions compared with control groups. Regarding secondary outcomes, there was a small effect of treatment across 9 comparisons for impaired functioning (Hedges g=0.52, 95% CI 0.24-0.80; P<.001), and 5 comparisons of quality of life showed no effect (Hedges g=-0.01, 95% CI -0.23 to 0.21; P=.94).

CONCLUSIONS

The results show that the potential of internet-delivered interventions for young people with symptoms of anxiety or depression has not been tapped into to date. This review highlights an opportunity for the development of population-specific interventions and their research to expand our current knowledge and build an empirical base for digital interventions for CYP.

TRIAL REGISTRATION

PROSPERO CRD42020220171; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=220171.

The Acceptability and Initial Effectiveness of “Space From Money Worries”: An Online Cognitive Behavioral Therapy Intervention to Tackle the Link Between Financial Difficulties and Poor Mental Health

Background

Previous research has shown a strong relationship between financial difficulties and mental health problems. Psychological factors such as hope and worry about finances appear to be an important factor in this relationship.

Objective

To develop an online based psychological intervention (Space from Money Worries) to tackle the psychological mechanisms underlying the relationship between poor mental health and financial difficulties, and to conduct an initial evaluation of the acceptability and preliminary efficacy of the intervention.

Materials and Methods

30 participants accessing Increasing Access to Psychological Therapies (IAPT) services completed GAD-7 to measure anxiety and PHQ-9 to measure depression upon signing up to the online intervention and again 4 to 8 weeks after this. Participants also completed a measure of perceived financial distress/wellbeing and a “Money and Mental Health Scale” constructed for the evaluation.

Results

Overall, 77% (n = 23) completed the intervention and follow-up assessments. Intent to Treat Analysis showed that there were statistically significant improvements in symptoms of depression, anxiety, improved perceived financial wellbeing and reduced scores on the money and mental health scale. The vast majority of participants rated each module positively.

Conclusions

Space from Money Worries appears to be acceptable and may lead to improvements in mental health, perceived financial wellbeing and a reduced relationship between financial difficulties and poor mental health. However, future research with a larger sample and a control group are needed to confirm that these changes are due to the intervention.

Technological and Digital Interventions for Mental Health and Wellbeing: An Overview of Systematic Reviews

Background: Research increasingly shows how selective and targeted use of technology within care and welfare can have several advantages including improved quality of care and active user involvement.

Purpose: The current overview of reviews aims to summarize the research on the effectiveness of technology for mental health and wellbeing. The goal is to highlight and structure the diverse combinations of technologies and interventions used so far, rather than to summarize the effectiveness of singular approaches.

Methods: The current overview includes reviews published in the past five years with a focus on effectiveness of digital and technological interventions targeting mental health and wellbeing.

Results: A total of 246 reviews could be included. All reviews examined the effectiveness of digital and technological interventions in the context of care and welfare. A combination of two taxonomies was created through qualitative analysis, based on the retrieved interventions and technologies in the reviews. Review classification shows a predominance of reviews on psychotherapeutic interventions using computers and smartphones. It is furthermore shown that when smartphone applications as stand-alone technology are researched, the primary focus is on self-help, and that extended reality is the most researched emerging technology to date.

Conclusion: This overview of reviews shows that a wide range of interventions and technologies, with varying focus and target populations, have been studied in the field of care and wellbeing. The current overview of reviews is a first step to add structure to this rapidly changing field and may guide both researchers and clinicians in further exploring the evidence-base of particular approaches.

An Internet Based Intervention for Adults With Autism Spectrum Disorder-A Qualitative Study of Participants Experiences

Background: Adults with autism spectrum disorder face several barriers to accessing evidence-based care, including difficulties in communicating needs, social anxiety or in traveling to a health care unit. In recent years, several forms of internet-based treatments have shown to be effective for a variety of psychiatric conditions. Internet-based treatment alternatives allow convenient and flexible formats, and therefore have the potential to increase access to health care for individuals with autism spectrum disorder. However, knowledge about how internet-based treatment features may suit the needs of individuals with autism is limited. The aim of this study was to explore the participant experiences of an internet-based intervention for adults with autism spectrum disorder. The primary focus of the investigation was on autism-specific needs in relation to the features unique to the online format. Methods: In this qualitative study, semi-structured telephone interviews were conducted with 14 participants who had completed a text-based internet-based intervention for adults with autism spectrum disorder. We used an inductive approach and analyzed the data using qualitative content analysis. Results: Five main categories were identified: (1) implications of the online format, (2) the fixed non-individualized model, (3) therapist interaction, (4) interacting with other participants, and (5) making use of the treatment content. Overall, participants appreciated the availability and that they could work on their treatment independent of time or location. Among those participating in group-based chat-sessions with the other participants, it was considered a generally positive experience. Furthermore, most participants felt safe and relaxed in relation to the therapist and appreciated the text-based format. However, several participants felt that the format and content of the treatment was not sufficiently adapted to their individual life situation. Conclusion: In conclusion, this internet-based treatment constitutes an accessible and energy-saving treatment alternative for adults with autism. Further, integrating group-based components seems feasible in an otherwise individual internet-based treatment for individuals with autism. However, group-based components do require a clear purpose and rationale. Future studies should develop and evaluate treatment adaptations tailored to individual needs.

The effectiveness of Internet-delivered treatment for generalized anxiety disorder: An updated systematic review and meta-analysis

BACKGROUND

Generalized anxiety disorder (GAD) is a highly prevalent, chronic disorder associated with impaired quality of life, societal burden, and poor treatment rates. Internet-delivered interventions may improve the accessibility of treatments and are increasingly being used. This study aimed to update a previous meta-analysis to determine the effectiveness of available Internet-delivered interventions in treating symptoms of GAD.

METHOD

Systematic literature searches were conducted (through April 2020) using Embase, PubMed, PsychINFO, and Cochrane to find randomized controlled trials of Internet-delivered interventions for GAD. Risk of bias was evaluated, and Hedge's g was calculated at posttreatment and follow-up.

RESULTS

Twenty studies met eligibility criteria and were included in the meta-analysis. Random-effect models detected large effect sizes for primary outcomes of anxiety (g = 0.79) and worry (g = 0.75), favoring treatment. Effect sizes for depression, functional impairment, and quality of life were moderate to large. Maintenance of effects at follow-up seems likely.

CONCLUSIONS

Results support the effectiveness of Internet-delivered treatments for GAD. Considerable heterogeneity between studies appeared moderated by variability in the interventions themselves, highlighting the importance of further investigation into the characteristics that may optimize treatment outcomes. Overall, Internet-delivery appears to be a viable mode of treatment for GAD with potential to relieve existing gaps in the provision of treatment.