Improving Adherence and Clinical Outcomes in Self-Guided Internet Treatment for Anxiety and Depression: Randomised Controlled Trial

<div><p>Background</p><p>Depression and anxiety are common, disabling and chronic. Self-guided internet-delivered treatments are popular, but few people complete them. New strategies are required to realise their potential.</p><p>Aims</p><p>To evaluate the effect of automated emails on the effectiveness, safety, and acceptability of a new automated transdiagnostic self-guided internet-delivered treatment, the Wellbeing Course, for people with depression and anxiety.</p><p>Method</p><p>A randomised controlled trial was conducted through the website: <a href="http://www.ecentreclinic.org" target="_blank">www.ecentreclinic.org</a>. Two hundred and fifty seven people with elevated symptoms were randomly allocated to the 8 week course either with or without automated emails, or to a waitlist control group. Primary outcome measures were the Patient Health Questionnaire 9-Item (PHQ-9) and the Generalized Anxiety Disorder 7-Item (GAD-7).</p><p>Results</p><p>Participants in the treatment groups had lower PHQ-9 and GAD-7 scores at post-treatment than controls. Automated emails increased rates of course completion (58% vs. 35%), and improved outcomes in a subsample with elevated symptoms.</p><p>Conclusions</p><p>The new self-guided course was beneficial, and automated emails facilitated outcomes. Further attention to strategies that facilitate adherence, learning, and safety will help realise the potential of self-guided interventions.</p><p>Trial Registration</p><p><a href="https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336276" target="_blank">Australian and New Zealand Clinical Trials Registry ACTRN12610001058066</a></p>