Counselor-Supported Online Cognitive Behavioral Therapy For Adult Anxiety Disorders

Anxiety is one of the most common mental health conditions in the United States, and many people experience its symptoms. As a highly treatable condition, over 62% of Americans seek professional support each year. Cognitive-behavioral therapy (CBT), which can be administered in person and online, is an effective treatment for anxiety and related mental disorders. Through a licensed therapist, you can receive treatment that supports you in managing and moving forward from any symptoms distressing you.

Types of anxiety disorders

A few anxiety disorders are often diagnosed through routine clinical practice, each of which may develop from various causes. Common causes of anxiety could include:

• Environmental stressors 
• Genetics
• Individual brain chemistry 
• Physical conditions 
• Mental health conditions 
• Traumatic events 

At times, anxiety may have no known cause. The five major types of anxiety disorders include the following. 

Generalized anxiety disorder (GAD) 

General anxiety disorder is often characterized by chronic worrying, restlessness, concentration difficulties, and a persistent feeling that the worst-case scenario will happen. It may also lead to poor sleep quality and lower mood. 

Social anxiety disorder 

Social anxiety often presents as chronic stress and worrying regarding social situations. It may be generalized or specific to certain types of events. 

Post-traumatic stress disorder (PTSD)

Although previously categorized as an anxiety disorder, post-traumatic stress disorder, or PTSD, is classified as a stress-related disorder in the DSM-5, meaning it is not an official disorder. However, anxiety can be a symptom of PTSD.

PTSD results from witnessing or experiencing a traumatic event and can happen at any age. It may include symptoms such as hyperawareness of surroundings, anxiety, mood changes, nightmares, and recurring memories. In PTSD, all signs are related to singular or multiple traumatic events. 

Obsessive-compulsive disorder (OCD) 

OCD can range in severity and is characterized by obsessive thoughts that may accompany urges to perform certain rituals or compulsions. For example, someone living with OCD may have obsessive thoughts about loss and a desire to repeat a sequence of numbers to feel relief or that the loss won't occur. 

Panic disorder 

Panic disorder can lead to sudden episodes of intense fear and physical symptoms such as increased heart rate, dizziness, lightheadedness, trouble breathing, and chest pain. These episodes are often referred to as panic attacks. 

CBT options for anxiety disorders

Because of the diversity of origin and presentations of anxiety disorders, therapeutic interventions are often developed to support people with various symptoms and lifestyles. CBT has shown significant promise in treating adult anxiety disorders. Much research has been done on how online-based interventions and mental health services may also successfully treat anxiety disorders. 

To capitalize on the benefits of CBT without running into barriers, therapist-supported internet-based behavioral therapy (ICBT) programs have become more popular among adults with anxiety disorders. Traditional counseling can come at a high cost and pose time limitations, among other obstacles, leading some people to turn to Internet interventions for their cost-effectiveness and proven results. 

To further investigate the ability of these internet-based counseling programs to bring the same treatment benefits as traditional programs, recent research has looked at the results from adult patient populations with anxiety who have completed therapist-guided ICBT programs. These studies show positive changes in disorder-specific anxiety symptoms, generalized anxiety symptoms, and quality of everyday life.

The effectiveness of ICBT for adults with anxiety

Traditionally delivered CBT is one of the primary treatment methods for reducing adult anxiety symptoms. Common barriers include the high cost of face-to-face counseling, geographical limitations, and the time commitment of traveling to and from lengthy appointments. Internet-based CBT has shown promise in eliminating these barriers due to the ability to complete the programs at home in a self-paced manner.

To explore the efficacy of these programs, researchers looked at therapist-supported ICBT programs and their effect on symptoms of anxiety disorders in adults. The adults in the sample were compared to adults with similar diagnoses and symptoms who did not participate in the online CBT. In addition to these factors, participants were assessed on their satisfaction with the program and their quality of life before and after treatment. 

The questions aimed to be answered by this research study included:

• Is therapist-guided ICBT more effective than no treatment?
• Is therapist-guided ICBT more effective than face-to-face CBT?
• Is therapist-guided ICBT more effective than unguided CBT?
• Is there adequate research available on the effectiveness of ICBT for adults with anxiety?

ICBT research study design for adults with anxiety disorders

In ICBT-based research studies, selective outcome reporting and treatment adherence are two ways in which a study may become biased. When interpreting study results, it is important for researchers to ensure the study maintains internal and external validity. Looking for randomized controlled trials and peer-reviewed journal publications are two ways to minimize this potential bias.

To examine objective findings, researchers utilized the Cochrane Depression, Anxiety, and Neurosis Review Group Specialized Register (CCDANCTR) when looking for randomized trials and other relevant studies. This register included randomized controlled trials from EMBASED, MEDLINE, and PsycINFO. Additionally, researchers searched online clinical trial registries and reference lists. 

After studies were identified, they were assessed for inclusion criteria by two authors. To be included, studies had to meet these criteria:

1. The study was a randomized controlled trial
2. Therapists supported the intervention
3. The intervention study group was compared to a waitlist control group, unguided CBT group, or face-to-face CBT group.
4. Adults in the study had a diagnosed anxiety disorder defined by the DSM III, III-R, IV, or IV-TR or the ICD 9 or 10

ICBT research study results for adults with anxiety disorders

Thirty studies, including 2181 participants, were included in this analysis. The breakdown was as follows:

• 11 studies looked at social phobia
• Eight studies centered around the panic disorder, with or without agoraphobia
• Four studies focused on generalized anxiety disorder
• One trial looked at post-traumatic stress disorder (PTSD) 
• One trial centered around a specific phobia
• Five trials looked at a range of anxiety disorder diagnoses

The studies were performed in Sweden, Austria, Switzerland, and the Netherlands. To compare the results group with the control group, the studies looked at the intervention participants versus those who partook in: 

• No treatment program 
• Unguided internet CBT 
• Face-to-face CBT 

The main results in these categories were as follows. In general, the primary outcome measure looked at whether participants experienced a reduction in symptom severity following treatment.

Therapist-Supported ICBT Compared To Face-to-Face CBT

There were no significant differences in disorder-specific or general anxiety symptom severity post-treatment from online counseling to in-person counseling. However, the quality of life at post-treatment measures showed a difference between the groups, with the internet CBT showing a higher quality of life for participants post-treatment.

Therapist-supported ICBT compared to unguided CBT

For the internet-based intervention group, there were minor improvements in disorder-specific anxiety symptom severity post-treatment. The quality of life in the post-treatment measure showed no difference between the groups.

Therapist-supported ICBT compared to no-treatment controls

There were significant improvements in disorder-specific anxiety symptom severity post-treatment in the ICBT group and moderate improvements in generalized anxiety symptoms. The quality of life at the post-treatment measure showed an average difference between the groups, with the internet-based group having a higher quality of life score.

Overall, the results show that therapist-guided iCBT for anxiety shows significant promise in supporting adults living with anxiety disorders in reducing symptoms and improving the quality of everyday life. 

However, the quality of evidence ranged from moderate to low. This rating was due to the strength of the associations found when comparing the participants of ICBT to the control groups. Researchers note that more studies need to be completed to fully understand the effects of therapist-guided CBT on adults with anxiety disorders. They emphasize that this research should focus on comparing in-person and online CBT and further examine the therapist's role in these therapies. 

If you are interested in looking for additional studies, the Journal of Medical Internet Research (JMIR) provides a resource to find leading peer-reviewed publications.

Reducing symptoms of anxiety in adults: Next steps

Results from this meta-analysis show there is significant evidence that internet-based behavioral therapy has the potential to help adults with anxiety achieve a clinically significant reduction in their anxiety symptoms. Therapist-supported ICBT also showed no significant difference from unguided CBT or face-to-face cognitive behavioral counseling groups, indicating it is just as effective as traditional counseling. 

There is a growing body of evidence pointing to the efficacy of ICBT for adults with anxiety. Through online cognitive behavioral therapy interventions, adults with pressure can avoid common barriers to care, reduce symptoms, and improve their quality of everyday life.       

Online therapy options 

If you are experiencing anxiety-related symptoms and are interested in seeing how online therapy may improve them, you might consider an online platform like BetterHelp. You can be matched with one of over 30,000 therapists through the platform and choose between phone, video, and live chat sessions. 

Online therapy can treat various mental health conditions like anxiety and depression (sometimes diagnosed as major depressive disorder). One study found evidence supporting the acceptability and effectiveness of guided ICBT for treating depression and anxiety symptoms in routine care. Researchers found that ICBT reduced symptoms of stress as well as their severity. If you experience severe depression alongside anxiety, mental health professionals at BetterHelp can make additional ICBT treatment recommendations based on depression severity and depressive symptoms present.