Internet-based CBT proves effective

Customised internet-based CBT is effective in the treatment of anxiety – even though the patient must do frightening exercises on their own.
A number of studies over the past 15 years have demonstrated the efficiency of internet-based cognitive behavioural therapy (CBT) for a large number of psychiatric conditions. But treatment manuals often only address a single diagnosis, and in the case of anxiety the person often suffers from multiple anxiety disorders (as well as depression) at the same time.

“For this reason we investigated the effect of customising internet-based CBT for patients with one or more diagnoses, for instance social anxiety disorder, panic disorder and depression,” says Lise Bergman Nordgren who recently completed her doctoral thesis on this subject, at Linköping University.

Improvement in quality of life

Lise Bergman Nordgren and her colleagues customised treatments to suit the background and clinical picture of every patient. Self-recruited patients and patients referred from healthcare centres and student health centres experienced, on average, an improvement in quality of life and symptom reduction after treatment. The effects lasted up to two years after treatment was concluded.

“The effect is equal to the improvement experienced by a patient in face-to-face therapy – even though the patient ‘owns’ their treatment”, says Dr Bergman Nordgren.

Every week the patient gets a new module to read, and in consultation with their online treater they decide new exercises. But the treater’s work, which includes support and feedback by email, is just 15 minutes per week. The modules have been lifted from existing treatment programmes, and been partially rewritten.

Successes are their own

But in addition to training in how and why anxiety symptoms arise, the CBT programme also contains exposure exercises. The patient must subject him- or herself to something that frightens them – at increasing levels. In normal therapy, often the treater initially takes a supportive roll in the exposure exercises. However in ICBT (Internet-based CBT) the patient must subject him- or herself to frightening situations.

“This can actually be one of the reasons why it works so well. The patient chooses situations that are realistic and relevant to their everyday life, and it’s difficult to cheat or fool oneself. And later, the successes, when they successfully handle a situation, are their own and no one else’s.”

Dr Bergman Nordgren cites another benefit of ICBT: after the treatment is finished, the patient has comprehensive documentation, which they can return to if the problems should reappear.

“Further benefits are that despite the shortage of CBT therapists, more patients can get treatment, regardless of where in the country they live. This reduces suffering and cuts queues to mental health care.”

Lise Bergman Nordgren defended her doctoral thesis, entitled "Individually tailored internet-based cognitive behavioural therapy for anxiety disorders", on 20 december 2013 at Linköping University.