title: The efficacy and pattern of use of a computer-assisted programme for the treatment of anxiety: a naturalistic study using mixed methods in primary care in Spain.
abstract: BACKGROUND
  Naturalistic studies to assess the efficacy and pattern of use of computer-delivered psychotherapy programmes in real daily clinical conditions are infrequent. Anxiety disorders are the most common mental disorders, and many of them do not receive adequate management, especially in primary care settings. The objective of this study is to assess the efficacy of an internet-delivered programme for anxiety in primary care.
  
  
  METHODS
  Multicentre, naturalistic study. Patients with generalised anxiety disorder were recruited (N=229). The generalised anxiety disorder 7-item scale (GAD-7) was the only outcome measured. Qualitative methods were used to analyse patient-therapist interactions.
  
  
  RESULTS
  Only 13.5% of patients completed the programme. Analysis per intent-to-treat using Last Observation Carried Forward showed a significant GAD-7 decrease post-treatment (-2.17: SD=4.77; p=0.001) (Cohen׳s d=0.43) with a correlation between the number of sessions and decrease in anxiety (Rho=-0.34, p=0.001). The analysis per protocol showed significantly decreased GAD-7 (-4.13; SD=6.82; p=0.002) (d=0.80). Withdrawal was related to low programme friendliness, lack of a partner, and higher education. Only 17.47% of the patients consulted their therapists. Facilitators were patient demand for information and sufficient time. Barriers were lack of motivation and lack of connection with the programme.
  
  
  CONCLUSIONS
  The main limitations of this study included the use of an open trial design, the lack of follow-up, and the inclusion of only one outcome (GAD-7).
  
  
  CONCLUSIONS
  To our knowledge, this is the first study with computer-delivered psychotherapy (CDP) on GAD. CDP for anxiety is efficacious in naturalistic environments. Specific facilitators and barriers should be considered.
authors: Universidad de Zaragoza, Spain; Red de Investigación en Atención primaria (REDIAPP) (RD12/0005/0006), Instituto Aragonés de Ciencias de la Salud, Spain. Electronic address: herrerampaola@gmail.com.
authors: Paola
authors: P
authors: Herrera-Mercadal
authors: Universidad de Zaragoza, Spain; Red de Investigación en Atención primaria (REDIAPP) (RD12/0005/0006), Instituto Aragonés de Ciencias de la Salud, Spain. Electronic address: jmontero@unizar.es.
authors: Jesús
authors: J
authors: Montero-Marin
authors: EduQTech R&D&I Group, Department of Electronics and Communications Engineering, Universidad, Zaragoza, Teruel, Spain.. Electronic address: inmap@unizar.es.
authors: Inmaculada
authors: I
authors: Plaza
authors: EduQTech R&D&I Group, Department of Electronics and Communications Engineering, Universidad, Zaragoza, Teruel, Spain.. Electronic address: ctmedra@gmail.com.
authors: Carlos
authors: C
authors: Medrano
authors: Unidad Epidemiología Clínica, Hospital 12 de Octubre, CIBER Epidemiología y Salud Pública, Madrid, Spain. Electronic address: eandres@h12o.es.
authors: Eva
authors: E
authors: Andrés
authors: Red de Investigación en Atención primaria (REDIAPP) (RD12/0005/0006), Instituto Aragonés de Ciencias de la Salud, Spain. Electronic address: ylopez.iacs@gmail.com.
authors: Yolanda
authors: Y
authors: López-Del-Hoyo
authors: Red de Investigación en Atención primaria (REDIAPP) (RD12/0005/0006), Instituto Aragonés de Ciencias de la Salud, Spain; Institut Universitari d׳Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain. Electronic address: mgili@uib.es.
authors: Margalida
authors: M
authors: Gili
authors: Red de Investigación en Atención primaria (REDIAPP) (RD12/0005/0006), Instituto Aragonés de Ciencias de la Salud, Spain; Miguel Servet, University Hospital, University of Zaragoza, Spain. Electronic address: jgarcamp@gmail.com.
authors: Javier
authors: J
authors: García-Campayo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D011320:Primary Health Care; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000379:methods*; D013030:Spain; D013813:Therapy, Computer-Assisted
keywords: Anxiety; Barriers; Facilitators; Naturalistic study; Primary care