title: Stepped Care Versus Direct Face-to-Face Cognitive Behavior Therapy for Social Anxiety Disorder and Panic Disorder: A Randomized Effectiveness Trial.
abstract: The aim of this study was to assess the effectiveness of a cognitive behavioral therapy (CBT) stepped care model (psychoeducation, guided Internet treatment, and face-to-face CBT) compared with direct face-to-face (FtF) CBT. Patients with panic disorder or social anxiety disorder were randomized to either stepped care (n=85) or direct FtF CBT (n=88). Recovery was defined as meeting two of the following three criteria: loss of diagnosis, below cut-off for self-reported symptoms, and functional improvement. No significant differences in intention-to-treat recovery rates were identified between stepped care (40.0%) and direct FtF CBT (43.2%). The majority of the patients who recovered in the stepped care did so at the less therapist-demanding steps (26/34, 76.5%). Moderate to large within-groups effect sizes were identified at posttreatment and 1-year follow-up. The attrition rates were high: 41.2% in the stepped care condition and 27.3% in the direct FtF CBT condition. These findings indicate that the outcome of a stepped care model for anxiety disorders is comparable to that of direct FtF CBT. The rates of improvement at the two less therapist-demanding steps indicate that stepped care models might be useful for increasing patients' access to evidence-based psychological treatments for anxiety disorders. However, attrition in the stepped care condition was high, and research regarding the factors that can improve adherence should be prioritized.
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen. Electronic address: tine.nordgreen@psykp.uib.no.
authors.forename: Tine
authors.initials: T
authors.lastname: Nordgreen
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital.
authors.forename: Thomas
authors.initials: T
authors.lastname: Haug
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen; Stockholm University; Karolinska Institutet.
authors.forename: Lars-Göran
authors.initials: LG
authors.lastname: Öst
authors.affiliation: Karolinska Institutet; Linköping University.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Stockholm University.
authors.forename: Per
authors.initials: P
authors.lastname: Carlbring
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen.
authors.forename: Gerd
authors.initials: G
authors.lastname: Kvale
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen.
authors.forename: Tone
authors.initials: T
authors.lastname: Tangen
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital; Institute of Clinical Medicine, University of Oslo.
authors.forename: Einar
authors.initials: E
authors.lastname: Heiervang
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen.
authors.forename: Odd E
authors.initials: OE
authors.lastname: Havik
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D016584:Panic Disorder / Q000628:therapy*; D010698:Phobic Disorders / Q000628:therapy*; D011369:Professional-Patient Relations; D011615:Psychotherapy, Group / Q000379:methods; D057566:Self Report
keywords: effectiveness; panic disorder; social anxiety disorder; stepped care