title: Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: a 12-month follow-up of a randomised controlled trial.
abstract: BACKGROUND
  A recent paper reported the outcomes of a study examining a new self-guided internet-delivered treatment, the Wellbeing Course, for symptoms of anxiety or depression. This study found the intervention resulted in significant symptom reductions. It also found that automated emails increased treatment completion and clinical improvements in a subsample with elevated anxiety and depression.
  
  
  OBJECTIVE
  To examine the clinical outcomes and the effect of automated emails at 12 months post-treatment.
  
  
  METHODS
  Participants, who were randomly allocated to a Treatment Plus Automated Emails Group (TEG; n = 100), a standard Treatment Group (TG; n = 106) or delayed-treatment Waitlist Control Group (Control; n = 51), were followed up at 12 months post-treatment. Eighty-one percent, 78% and 87% of participants in the TEG, TG and treated Waitlist Control Group provided symptom data at 12-month follow-up, respectively. The primary outcome measures were the Patient Health Questionnaire-9 Item Scale (PHQ-9) and the Generalized Anxiety Disorder-7 Item Scale (GAD-7).
  
  
  RESULTS
  Significant improvements in symptoms of anxiety and depression were observed over time in both the TEG and TG (Fs >69, ps <.001) these were sustained from post-treatment to 12-month follow-up (ps >.05), and were associated with large effect sizes. No statistically significant differences in symptoms were found between the TEG and TG at post-treatment, 3-month or 12-month follow-up. Previously reported symptom differences between TEG and TG participants with comorbid symptoms were no longer present at 12-month follow-up (ps >.70).
  
  
  CONCLUSIONS
  The overall benefits of the Wellbeing Course were sustained at 12-month follow-up. Although automated emails facilitated Course completion and reductions in symptoms for participants with comorbid anxiety and depression from pre-post treatment, these differences were no longer observed at 12-month follow-up. The results indicate that automated emails promote more rapid treatment response for people with elevated and comorbid symptoms, but may not improve longer term outcomes.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ACTRN12610001058066.
authors.affiliation: Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
authors.forename: Nickolai
authors.initials: N
authors.lastname: Titov
authors.affiliation: Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
authors.forename: Blake F
authors.initials: BF
authors.lastname: Dear
authors.affiliation: Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
authors.forename: Luke
authors.initials: L
authors.lastname: Johnston
authors.affiliation: Centre for Clinical Interventions and School of Psychology, UWA, Perth, Australia.
authors.forename: Peter M
authors.initials: PM
authors.lastname: McEvoy
authors.affiliation: Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
authors.forename: Bethany
authors.initials: B
authors.lastname: Wootton
authors.affiliation: Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Terides
authors.affiliation: Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
authors.forename: Milena
authors.initials: M
authors.lastname: Gandy
authors.affiliation: Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Fogliati
authors.affiliation: Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
authors.forename: Rony
authors.initials: R
authors.lastname: Kayrouz
authors.affiliation: Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Rapee
mesh_terms: D001008:Anxiety Disorders / Q000628:therapy*; D016022:Case-Control Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D055118:Medication Adherence; D009520:New Zealand; D017060:Patient Satisfaction; D011379:Prognosis; D011613:Psychotherapy; D013813:Therapy, Computer-Assisted; D013997:Time Factors