A TRANSDIAGNOSTIC INTERVENTION PROGRAM DELIVERED ONLINE IN ANXIETY AND DEPRESSION: A RANDOMIZED CONTROLLED NON-INFERIORITY TRIAL
Keywords:
cognitive-behavioral intervention, anxiety, depression, self, online intervention.Abstract
Background and Aims: In the last years, the therapeutic programs delivered online have started to develop more and more. However, there are not many clinical trials that have compared the effectiveness of two clinical interventions, both delivered online. The primary aim of this study was to investigate the efficacy and acceptability of a guided internet delivered transdiagnostic intervention, targeting mild to moderate clinical symptoms of anxiety and depression and emphasizing the changes taking place at the level of the structures of the self. The secondary aim was to compare this intervention with a “golden standard” transdiagnostic intervention in anxiety and depression in a randomized non-inferiority trial. Method: A total of 284 participants were randomly assigned to one of the two interventions. The effectiveness of a transdiagnostic cognitive-behavioral treatment was compared with an another version of it, in which new intervention techniques were added, pointing out the importance of improving some self-concept dimensions in reducing symptoms of anxiety and depression. In order to prove this, the study design included two active intervention groups.
A standard transdiagnostic intervention protocol was delivered to one group (n=141) and an improved version of the same transdiagnostic protocol was delivered to the other group (n=143). The new added techniques targeted some self-concepts, namely self-compassion, unconditional self-acceptance and self-esteem. So the main goal of the study was to concurrently test effectiveness of these two transdiagnostic approaches in reducing symptoms of anxiety and depression and improving the above-mentioned self-concepts. Results: Both intention-to-treat and completers analysis yielded no significant between-group difference for any of the post-interventions measurements. At post-treatment both intervention conditions revealed significant symptom changes compared to before the intervention. Within-group effect sizes for anxiety (GAD7) in one intervention group (d=0.92) and in the other intervention group (d=1.28) can be considered large. Within-group effect sizes for depression (BDI-II) in one intervention group (d=1.34) and in the other intervention group (d=1.47) can also be considered large. At 6-months follow-up, results remained stable in both intervention groups.
Conclusions: We did not find statistically significant differences between the two intervention groups in either the post-test or follow-up measurements, so the increase in the level of self concepts occurs in both situations: if we make a direct intervention in this regard or if we conduct a classic intervention in clinical anxiety and depression.
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