Effectiveness of General Practitioner Referral Versus Self-Referral Pathways to Guided Internet-Delivered Cognitive Behavioral Therapy for #depression, Panic Disorder, and Social #anxiety Disorder: Naturalistic Study
Background: Therapist guided internet-delivered cognitive behavioral therapy (guided ICBT) #Appears to be efficacious for #depression, panic disorder (PD) and social #anxiety disorder (SAD) in routine care clinical settings. However, implementation of guided ICBT in specialist #MentalHealth services is limited partly due to low referral rates from general practitioners (GP), which may stem from lack of awareness, limited knowledge of its effectiveness, or negative attitudes toward the treatment format. In response, self-referral systems were introduced in #MentalHealth care about a decade ago to improve access to care. Yet, little is known about how referral pathways may affect treatment outcomes in guided ICBT. Objective: This study aims to compare the overall treatment effectiveness of GP-referral and self-referral to guided ICBT for patients with #depression, PD or SAD in a specialized routine care clinic. This study also explores if the treatment effectiveness varies between referral pathways and the respective diagnoses. Methods: This naturalistic open effectiveness study compares treatment outcomes from pre-treatment to post-treatment and from pre- to 6-month follow-up across two referral pathways. All patients underwent module based guided ICBT lasting up to 14 weeks. The modules covered psychoeducation, working with negative or automatic thoughts, exposure training, and relapse prevention. Patients received weekly therapist guidance through asynchronous messaging, with therapists spending an average of 10–30 minutes per patient per week. Patients self-reported symptoms before, during, immediately after, and 6-months post-treatment. Level and change in symptom severity were measured across all diagnoses. Results: In total 460 patients met inclusion criteria, 305 GP-referred (GP), and 155 self-referred (Self). Across the total sample about 60% were female, mean age 32 years, average duration of disorder 10 years. We found no significant differences in pre-treatment symptom levels between referral pathways, across the diagnoses. Estimated effect sizes based on Linear Mixed Modelling showed large improvements from pre- to post-treatment and from pre- to follow-up across all diagnoses, with statistically significant differences between referral pathways (GP: 0.97 - 1.22, Self: 1.34 - 1.58, P: