Effectiveness of a Transdiagnostic Guided Internet-Delivered Protocol for Emotional Disorders Versus Treatment as Usual in Specialized Care: Randomized Controlled Trial

Alberto González-Robles, Amanda Díaz-García, Azucena García-Palacios, Pablo Roca, Josep Antoni Ramos-Quiroga, Cristina Botella, Alberto González-Robles, Amanda Díaz-García, Azucena García-Palacios, Pablo Roca, Josep Antoni Ramos-Quiroga, Cristina Botella

Abstract

Background: Anxiety 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.

Objective: This 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.

Methods: A 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.

Results: The 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.

Conclusions: EmotionRegulation 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 registration: ClinicalTrials.gov NCT02345668; https://ichgcp.net/clinical-trials-registry/NCT02345668.

Keywords: anxiety; cognitive behavioral therapy; depression; emotional disorders; internet; specialized care; transdiagnostic.

Conflict of interest statement

Conflicts of Interest: None declared.

©Alberto González-Robles, Amanda Díaz-García, Azucena García-Palacios, Pablo Roca, Josep Antoni Ramos-Quiroga, Cristina Botella. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.07.2020.

Figures

Figure 1
Figure 1
Flowchart of participants. ED: emotional disorder; DSM-IV-TR; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; ITT: intention-to-treat.
Figure 2
Figure 2
Percentages of participants recovered, improved, did not change, and deteriorated on depression scores (Beck depression inventory-II) in EmotionRegulation (outer circle) and treatment as usual (inner circle). F/U: follow-up.
Figure 3
Figure 3
Percentages of participants recovered, improved, did not change, and deteriorated on anxiety scores (Beck anxiety inventory) in EmotionRegulation (outer circle) and treatment as usual (inner circle). F/U: follow-up.

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