Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review.
BACKGROUND
Self-help interventions for psychiatric disorders represent an increasingly popular alternative to therapist-administered psychological therapies, offering the potential of increased access to cost-effective treatment.


OBJECTIVE
To determine the efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders.


METHODS
Randomised controlled trials (RCTs) of self-help interventions for anxiety disorders were identified by searching nine online databases. Studies were grouped according to disorder and meta-analyses were conducted where sufficient data were available. Overall meta-analyses of self-help v. waiting list and therapist-administered treatment were also undertaken. Methodological quality was assessed independently by two researchers according to criteria set out by the Cochrane Collaboration.


RESULTS
Thirty-one RCTs met inclusion criteria for the review. Results of the overall meta-analysis comparing self-help with waiting list gave a significant effect size of 0.84 in favour of self-help. Comparison of self-help with therapist-administered treatments revealed a significant difference in favour of the latter with an effect size of 0.34. The addition of guidance and the presentation of multimedia or web-based self-help materials improved treatment outcome.


CONCLUSIONS
Self-help interventions appear to be an effective way of treating individuals diagnosed with social phobia and panic disorder. Further research is required to evaluate the cost-effectiveness and acceptability of these interventions.
Department of Psychological Medicine, Cardiff University, Cardiff, UK. LewisCE7@cf.ac.uk
Catrin
C
Lewis
Jennifer
J
Pearce
Jonathan I
JI
Bisson
D001008:Anxiety Disorders / Q000191:economics / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003362:Cost-Benefit Analysis; D016206:Databases, Bibliographic; D006297:Health Services Accessibility; D006801:Humans; D008605:Mental Health Services / Q000191:economics / Q000600:supply & distribution*; D010342:Patient Acceptance of Health Care; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000191:economics / Q000379:methods* / Q000523:psychology; D016896:Treatment Outcome; D014850:Waiting Lists