Efficacy of a transdiagnostic guided internet-delivered intervention for anxiety, depression, trauma and stress-related symptoms: A randomized controlled trial

Abstract

OBJECTIVE: There is strong evidence that online transdiagnostic interventions are effective in treating anxiety and depression, and contribute to improving patients' quality of life. This study aimed to evaluate the efficacy and acceptability of an internet-guided transdiagnostic intervention (guided UP) versus a self-guided internet-based transdiagnostic intervention (unguided UP) for the transdiagnostic treatment of emotional disorders targeting the Mexican community. METHODS: A randomized clinical trial was conducted to compare therapist-supported online transdiagnostic treatment with an unguided version and a waiting list control group. 247 individuals aged 18 to 70 years were assessed at four time points (before and after treatment, three and six months follow- up) to identify levels of anxiety, depression, trauma and stress-related symptoms. Participants who qualified and decided to participate were randomly assigned to one of three conditions. RESULTS: Higher levels of acceptability, satisfaction, and suitability were reported for the intervention with therapeutic support compared to the UP-unguided condition. After treatment, significant mean differences were found between the waitlist group and both the UP-guided and unguided groups in anxiety, depression, trauma and stress-related symptoms, and general distress, as well as in emotional dysregulation for the guided group only, all with large effect sizes. Direct comparisons between the UP-guided and unguided groups showed significant differences favoring the UP-guided treatment at post-test for depression and emotional dysregulation. However, at the 3- and 6-month follow-ups, the UP-unguided group continued to improve, whereas the UP-guided group tended to remain stable. As a result, by the end of the follow-up period, the UP-unguided group showed significantly lower levels of anxiety, PTSD symptoms, and emotional dysregulation. CONCLUSIONS: The study supports the preliminary evidence of the clinical utility of UP online interventions in a specific sample recruited for the treatment of anxiety, depression, trauma and stress-related symptoms with the advantage of reaching a larger number of people. Even though the UP-unguided intervention showed clinical utility, the support of a therapist in an online intervention could offer an advantage that improves treatment adherence and, in particular, resulted in a greater reduction in symptoms of depression and emotional dysregulation, making it the superior option from a clinical perspective.