title: Prevention of generalized anxiety disorder using a web intervention, iChill: randomized controlled trial.
abstract: BACKGROUND
  Generalized Anxiety Disorder (GAD) is a high prevalence, chronic disorder. Web-based interventions are acceptable, engaging, and can be delivered at scale. Few randomized controlled trials evaluate the effectiveness of prevention programs for anxiety, or the factors that improve effectiveness and engagement.
  
  
  OBJECTIVE
  The intent of the study was to evaluate the effectiveness of a Web-based program in preventing GAD symptoms in young adults, and to determine the role of telephone and email reminders.
  
  
  METHODS
  A 5-arm randomized controlled trial with 558 Internet users in the community, recruited via the Australian Electoral Roll, was conducted with 6- and 12-month follow-up. Five interventions were offered over a 10-week period. Group 1 (Active website) received a combined intervention of psycho-education, Internet-delivered Cognitive Behavioral Therapy (ICBT) for anxiety, physical activity promotion, and relaxation. Group 2 (Active website with telephone) received the identical Web program plus weekly telephone reminder calls. Group 3 (Active website with email) received the identical Web program plus weekly email reminders. Group 4 (Control) received a placebo website. Group 5 (Control with telephone) received the placebo website plus telephone calls. Main outcome measures were severity of anxiety symptoms as measured by the GAD 7-item scale (GAD-7) (at post-test, 6, and 12 months). Secondary measures were GAD caseness, measured by the Mini International Neuropsychiatric Interview (MINI) at 6 months, Centre for Epidemiologic Studies-Depression scale (CES-D), Anxiety Sensitivity Index (ASI), Penn State Worry Questionnaire (PSWQ), and Days out of Role.
  
  
  RESULTS
  GAD-7 symptoms reduced over post-test, 6-month, and 12-month follow-up. There were no significant differences between Group 4 (Control) and Groups 1 (Active website), 2 (Active website with telephone), 3 (Active website with email), or 5 (Control with telephone) at any follow-up. A total of 16 cases of GAD were identified at 6 months, comprising 6.7% (11/165) from the Active groups (1, 2, 3) and 4.5% (5/110) from the Control groups (4, 5), a difference that was not significant. CES-D, ASI, and PSWQ scores were significantly lower for the active website with email reminders at post-test, relative to the control website condition.
  
  
  CONCLUSIONS
  Indicated prevention of GAD was not effective in reducing anxiety levels, measured by GAD-7. There were significant secondary effects for anxiety sensitivity, worry, and depression. Challenges for indicated prevention trials are discussed.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number (ISRCTN): 76298775; http://www.controlled-trials.com/ISRCTN76298775 (Archived by WebCite at http://www.webcitation.org/6S9aB5MAq).
authors.affiliation: Black Dog Institute, University of New South Wales, Sydney, Australia. h.christensen@blackdog.org.au.
authors.forename: Helen
authors.identifier: http://orcid.org/0000-0003-0435-2065
authors.initials: H
authors.lastname: Christensen
authors.forename: Philip
authors.identifier: http://orcid.org/0000-0002-4547-6876
authors.initials: P
authors.lastname: Batterham
authors.forename: Andrew
authors.identifier: http://orcid.org/0000-0003-0831-9801
authors.initials: A
authors.lastname: Mackinnon
authors.forename: Kathleen M
authors.identifier: http://orcid.org/0000-0003-1556-0708
authors.initials: KM
authors.lastname: Griffiths
authors.forename: Kanupriya
authors.identifier: http://orcid.org/0000-0002-1825-0097
authors.initials: K
authors.lastname: Kalia Hehir
authors.forename: Justin
authors.identifier: http://orcid.org/0000-0001-9475-8450
authors.initials: J
authors.lastname: Kenardy
authors.forename: John
authors.identifier: http://orcid.org/0000-0003-4831-0190
authors.initials: J
authors.lastname: Gosling
authors.forename: Kylie
authors.identifier: http://orcid.org/0000-0003-4160-492X
authors.initials: K
authors.lastname: Bennett
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000517:prevention & control*; D001315:Australia; D015928:Cognitive Behavioral Therapy; D005260:Female; D006293:Health Promotion; D006801:Humans; D020407:Internet; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D017216:Telemedicine / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: Internet; anxiety disorders; cognitive behavioral therapy; early intervention; online systems; prevention