Abstract
BackgroundAnxiety disorders and depression (emotional disorders) are highly prevalent mental disorders. Extensive empirical evidence supports the efficacy of cognitive behavioral therapy (CBT) for the treatment of these disorders. However, there are still some barriers related to their dissemination and implementation, which make it difficult for patients to receive these treatments, especially in public health care settings where resources are limited. Recent advances in improving CBT dissemination encompass different perspectives. One is the transdiagnostic approach, which offers treatment protocols that can be used for a range of emotional disorders. Another approach is the use of the internet to reach a larger number of people who could benefit from CBT.ObjectiveThis study aimed to analyze the effectiveness and acceptability of a transdiagnostic internet-delivered protocol (EmotionRegulation) with human and automated guidance in patients from public specialized mental health care settings.MethodsA 2-armed randomized controlled trial (RCT) was conducted to compare the effectiveness of EmotionRegulation with treatment as usual (TAU) in specialized mental health care. In all, 214 participants were randomly assigned to receive either EmotionRegulation (n=106) or TAU (n=108). Measurement assessments were conducted at pre- and postintervention and at a 3-month follow-up.ResultsThe results revealed the superiority of EmotionRegulation over TAU on measures of depression (d=0.41), anxiety (d=0.35), and health-related quality of life (d=−0.45) at posttreatment, and these gains were maintained at the 3-month follow-up. Furthermore, the results for expectations and opinions showed that EmotionRegulation was well accepted by participants.ConclusionsEmotionRegulation was more effective than TAU for the treatment of emotional disorders in the Spanish public mental health system. The implications of this RCT, limitations, and suggestions for future research are discussed.Trial RegistrationClinicalTrials.gov NCT02345668; https://clinicaltrials.gov/ct2/show/NCT02345668
Highlights
Disorder-Specific Cognitive Behavioral Therapy for Emotional DisordersAnxiety and depressive disorders, known as emotional disorders (EDs) [1], have the highest prevalence rates among psychological disorders [2,3], and are associated with substantial costs [4,5] and disability [6,7]
The results revealed the superiority of EmotionRegulation over treatment as usual (TAU) on measures of depression (d=0.41), anxiety (d=0.35), and health-related quality of life (d=−0.45) at posttreatment, and these gains were maintained at the 3-month follow-up
The findings showed that the transdiagnostic internet-delivered protocol tested in this randomized controlled trials (RCTs) was more effective than TAU for the treatment of anxiety and depressive disorders in public specialized mental health care
Summary
Disorder-Specific Cognitive Behavioral Therapy for Emotional DisordersAnxiety and depressive disorders, known as emotional disorders (EDs) [1], have the highest prevalence rates among psychological disorders [2,3], and are associated with substantial costs [4,5] and disability [6,7]. Because disorder-specific treatment protocols focus on treating a specific diagnosis, the accompanying comorbid disorders do not receive therapeutic attention [17,18] This problem becomes clearer when we take into account research linking comorbidity to aspects such as greater severity [3], increased chronicity rates [19], and a worse clinical course [20]. Another problem with disorder-specific treatments is that subthreshold symptoms that do not meet diagnostic thresholds for a particular disorder, but might be important to treat, normally go untreated [17].
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