Guided, internet-based self help can play a major role in mental health care for people with anxiety disorders, according to Prof Pim Cuijpers from the Vrije Universiteit Amsterdam who addressed delegates on Tuesday at the 2008 International Anxiety Disorders Symposium in Cape Town.
Cuijpers pointed to the fact that anxiety disorders are highly prevalent, and are associated with a marked impairment in quality of life and a huge economic cost to society. In the Netherlands, for example, anxiety disorders account for the second highest disease burden after heart disease. This means that, as a group, anxiety disorders such as generalised anxiety disorder (GAD), social anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) are more prevalent than depression in this country.
"Unfortunately, a considerable number of people who struggle with anxiety do not seek or receive adequate treatment. Self-help interventions have been proposed to constitute a relatively cheap, effective, efficient and low-threshold intervention," Cuijpers, who is head of the Department of Clinical Psychology at the university, noted.
How it worksAccording to Cuijpers, a 2006 meta-analytic study of self-help interventions for anxiety disorders clearly indicated that guided self-help can be just as effective as individual and group treatment – with the added advantages that it requires less treatment time, briefer waiting lists, and no appointments with therapists.
A technique in which patients use an internet website to work through exercises and assignments aimed at treating their anxiety was proposed. Guidance by a professional counsellor, either face-to-face or via telephone or e-mail, can then be added to help the patient in making the most of this treatment process. If self help isn't effective, psychotherapy and medication could follow.
Cuijpers said that guided self-help could be particularly useful in patients with milder disorders – particularly in those that wouldn't otherwise have seeked treatment. It has been shown that only 26.5% of people with mild anxiety disorders seek help and that 90% of people who suffer from anxiety disorders have a mild to moderate form of the condition.
"It's important to develop treatments that are easily available to many people. I think that internet interventions can help in this way."
Cuijpers also pointed to the downsides. These include the fact that self-help through the internet won't be acceptable to all, that counsellors who communicate via the phone or e-mail won't be able to pick up subtle non-verbal and verbal signals, that the internet isn't accessible to all, and that it won't be an option for "technophobic" patients.
Research shows, however, that unguided self-help (in other words, where there isn't a facilitator) isn't as effective as individual or group treatment for anxiety disorders.
- (Carine van Rooyen, Health24, March 2008)