Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety: a randomized controlled trial

Blake F. Dear*, Judy B. Zou, Shehzad Ali, Carolyn N. Lorian, Luke Johnston, Joanne Sheehan, Lauren G. Staples, Milena Gandy, Vincent J. Fogliati, Britt Klein, Nickolai Titov

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    57 Citations (Scopus)

    Abstract

    There is preliminary support for internet-delivered cognitive behaviour therapy (iCBT) as a way of improving access to treatment among older adults with anxiety. The aim of this randomized controlled trial (RCT) was to examine the efficacy, long-term outcomes, and cost-effectiveness of an iCBT program for adults over 60. years of age with anxiety. Successful applicants were randomly allocated to either the treatment group (n= 35) or the waitlist control group (n= 37). The online treatment course was delivered over 8. weeks and provided with brief weekly contact with a clinical psychologist via telephone or secure email. Eighty-four percent of participants completed the iCBT course within the 8. weeks and 90% provided data at posttreatment. Significantly lower scores on measures of anxiety (Cohen's d=. 1.43; 95% CI: 0.89 - 1.93) and depression (Cohen's d=. 1.79; 95% CI: 1.21 - 2.32) were found among the treatment group compared to the control group at posttreatment. These lower scores were maintained at 3-month and 12-month follow-up and the treatment group rated the iCBT treatment as acceptable. The treatment group had slightly higher costs ($92.2; 95% CI: $38.7 to $149.2) and Quality-Adjusted Life-Years (QALYs. =. 0.010; 95% CI: 0.003 to 0.018) than the control group at posttreatment and the intervention was found to have a greater than 95% probability of being cost-effective. The results support iCBT as an efficacious and cost-effective treatment option for older adults with symptoms of anxiety.

    Original languageEnglish
    Pages (from-to)206-217
    Number of pages12
    JournalBehavior Therapy
    Volume46
    Issue number2
    DOIs
    Publication statusPublished - 1 Mar 2015

    Keywords

    • anxiety
    • older adults
    • internet
    • cognitive behavior therapy (CBT)
    • cost-effectiveness

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