Abstract
Aim: Guided Internet-delivered therapy has shown to be an effective treatment format for anxiety disorders. However, not all patients experience improvement, and although predictors of treatment outcome have been identified, few are consistent over time and across studies. The current study aimed to examine whether treatment self-efficacy (self-efficacy regarding the mastery of obstacles during treatment) in guided Internet-delivered therapy for anxiety disorders in adults could be a predictor of lower dropout rates and greater symptom reduction.Method: The analyzed data comes from an open effectiveness study including 575 patients receiving guided Internet-delivered therapy for panic disorder or social anxiety disorder. Treatment self-efficacy was measured at pre-treatment. Symptom reduction was measured at 10 measurement points, including a 6-month follow-up. A mixed linear model was applied in the analysis.Results: The results showed that high treatment self-efficacy was a predictor of both lower dropout rates and greater symptom reduction. Significant interaction effects between time and treatment self-efficacy were found for several of the nine modules that constitutes the treatment program, suggesting that treatment self-efficacy could be a moderator of symptom reduction. Three of nine modules in the panic disorder treatment and six of nine in the social anxiety disorder treatment showed significant interaction effects.Conclusion: The results suggest that measuring treatment self-efficacy may be a valuable tool to identify patients at risk of dropping out, and that treatment self-efficacy could be a predictor and moderator of symptom reduction in guided Internet-delivered therapy. The implications of the results are discussed.
Highlights
Anxiety disorders are chronic, disabling disorders with a worldwide presence
Results from Cognitive Behavioral Therapy (CBT) studies for Panic disorder (PD) suggest that self-efficacy might be a predictor of symptom reduction in PD
A systematic review claim that, several methodological issues exist, the literature provide some support for panic selfefficacy as a mediator of outcome in CBT for PD (Fentz et al, 2014)
Summary
Anxiety disorders are chronic, disabling disorders with a worldwide presence. Anxiety disorders were the sixth leading cause of disability across countries, measured through years of life lived with disability (Baxter et al, 2014). Panic disorder (PD) and social anxiety disorder (SAD) are both among the most prevalent anxiety disorders with lifetime prevalence of, respectively, 1.6–5.2% and 2.8–13% (Bandelow and Michaelis, 2015). Both disorders are associated with reduced social function, increased risk of dropout from school and work, and increased risk of comorbid illnesses such as major depressive disorder and substance abuse (Wittchen, 1988; Klerman et al, 1991; Furmark, 2002; Goodwin et al, 2005; Stein and Stein, 2008)
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