title: Effectiveness and cost-effectiveness of web-based treatment for phobic outpatients on a waiting list for psychotherapy: protocol of a randomised controlled trial.
abstract: BACKGROUND
  Phobic disorders are highly prevalent and constitute a considerable burden for patients and society. As patients wait for face-to-face psychotherapy for phobic disorders in outpatient clinics, this time can be used for guided self-help interventions. The aim of this study is to investigate a five week internet-based guided self-help programme of exposure therapy in terms of clinical effectiveness and impact on speed of recovery in psychiatric outpatients, as well as the cost-effectiveness of this pre-treatment waiting list intervention.
  
  
  METHODS
  A randomised controlled trial will be conducted among 244 Dutch adult patients recruited from waiting lists of outpatient clinics for face-to-face psychotherapy for phobic disorders. Patients suffering from at least one DSM-IV classified phobic disorder (social phobia, agoraphobia or specific phobia) are randomly allocated (at a 1:1 ratio) to either a five-week internet-based guided self-help program followed by face-to-face psychotherapy, or a control group followed by face-to-face psychotherapy. Waiting list status and duration are unchanged and actual need for further treatment is evaluated prior to face-to-face psychotherapy. Clinical and economic self-assessment measurements take place at baseline, post-test (five weeks after baseline) and at 3, 6, 9 and 12 months after baseline.
  
  
  CONCLUSIONS
  Offering pre-treatment internet-based guided self-help efficiently uses time otherwise lost on a waiting list and may increase patient satisfaction. Patients are expected to need fewer face-to-face sessions, reducing total treatment cost and increasing speed of recovery. Internet-delivered treatment for phobias may be a valuable addition to psychotherapy as demand for outpatient treatment increases while budgets decrease.
  
  
  BACKGROUND
  Netherlands Trial Register NTR2233.
authors.affiliation: Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands. r.n.kok@vu.nl
authors.forename: Robin N
authors.initials: RN
authors.lastname: Kok
authors.forename: Annemieke
authors.initials: A
authors.lastname: van Straten
authors.forename: Aartjan
authors.initials: A
authors.lastname: Beekman
authors.forename: Judith
authors.initials: J
authors.lastname: Bosmans
authors.forename: Manja
authors.initials: M
authors.lastname: de Neef
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000191:economics / Q000379:methods*; D020407:Internet; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D018579:Patient Selection; D010698:Phobic Disorders / Q000191:economics / Q000523:psychology / Q000628:therapy*; D019114:Remote Consultation / Q000191:economics / Q000379:methods*; D012107:Research Design; D013813:Therapy, Computer-Assisted / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome