Internet-Delivered CBT for Anxiety Disorders in Open Community Versus Clinical Service Recruitment A Meta-Analysis

Course overview

Course Description: This course uses an empirical analysis to compare the effectiveness of internet delivered CBT for anxiety disorders based upon how clients were recruited. It has implications for the overall effectiveness of the intervention. This course is based upon material published in the Journal of Medical Internet Research and is available as an open access article. Abstract: Ample studies have shown the effectiveness of internet-delivered cognitive behavioral therapy (iCBT) for anxiety disorders. These studies recruited their participants mainly from the community and, to a lesser extent, from within routine care services. Little is known about whether different recruitment strategies lead to different treatment effects. This meta-analysis compared clinical results obtained in trials with recruitment from the community versus results obtained in trials with clinical service recruitment and explored factors that may mediate differences in treatment outcome. We included randomized controlled trials in which the clinical effects of iCBT for anxiety disorders were compared with a control condition (waitlist controls or face-to-face cognitive behavioral therapy). We classified trials as open recruitment trials (recruitment from the community) or clinical service recruitment trials (recruitment through outpatient clinics). Pooled effect sizes based on measures examining anxiety symptoms, depressive symptoms, and quality of life were computed for each type of trial. Subgroup analyses examined whether clinical results from open recruitment trials differed from those obtained in clinical service recruitment trials. Additional analyses explored which demographic, clinical, and treatment-related factors contributed to differences in effect sizes of open recruitment versus clinical service recruitment trials. We included 42 studies with 53 comparisons (43 open recruitment comparisons and 10 clinical recruitment comparisons). Analyses of anxiety measures revealed, first, that iCBT open recruitment studies with waitlist control comparators showed a significantly higher effect size for decrease in anxiety symptoms than did those with clinical recruitment. This association between recruitment method and effect size was no longer significant in a multivariate meta regression with treatment adherence and exclusion of patients with depressive symptoms entered as additional predictors of effect size. Second, effect size for decrease in anxiety symptoms did not differ significantly between clinical recruitment and open recruitment studies with face-to-face cognitive behavioral therapy comparators. The effects of open recruitment trials and clinical recruitment trials did not differ significantly for the secondary outcomes, compared with face-to-face cognitive behavioral therapy and waitlist controls. This course on the internet delivered CBT for anxiety disorders is designed for social workers, professional counselors, psychologists, nurses, and substance abuse counselors, who do clinical work. This course is appropriate for beginning, intermediate and advanced level practitioners who wish to develop their understanding of the internet delivered CBT for anxiety disorders. The course material includes a literature review of iCBT and face-to-face CBT for anxiety disorders. It may also be useful for licensed clinicians who require clinical continuing education courses for license renewal. The course is based on a journal article which includes research. It contains statistical analysis and data that some clinicians enjoy reading and others do not. A major benefit of reading research-based articles for continuing education is they provide practitioners with the latest findings in their field. Authors: Romjin, Batelaan, Kok, Koning, Van Balkom, Titov, Riper