The role of self-help in the treatment of mild anxiety disorders in young people: an evidence-based review

Figures & data

Figure 1 Prisma flow diagram.

Table 1 Study characteristics

Study	Sample	Intervention	Design	Attrition	Main findings
Cukrowicz and Joiner^Citation87	Undergraduate psychology students Age 95% between 18–21 years (M = 19.2, SD = 1.9) Beck anxiety inventory scores ≤18; and Beck depression inventory scores ≤19 n = 231 (169 female, 69 male)	CBASP 6 × 20 minutes sessions completed in one 2-hour time frame (with a 10-minute break half way through) Weekly emails for 8 weeks following intervention reminding participants to practice learned skills Note. Although intervention was completed individually, all participants were in the same lab when completing the program	RCT CBASP intervention Educational program as control	90% return rate	Significantly lower scores on measures of depression and anxiety for intervention group when compared to control group at follow-up. Cohen’s d effect sizes ranged from small to medium for outcome measures.
Cunningham et al^Citation15	Age 14–16 years Primary diagnosis of anxiety disorder n = 5 (4 female, 1 male)	“Cool Teens” CD-ROM 8 sessions over 12-week period 15–30 minutes per session Fortnightly phone contact with psychologist questioned progress and understanding of material, provided motivation and clarified issues	Case series	4/5 completed at least 6 of the 8 modules	After completion, 40% (n = 2) were at subclinical levels for anxiety, 2 showed some improvement, and 1 showed no change. At 3 months, 40% (n = 2) did not meet anxiety diagnosis criteria. All participants were generally satisfied with program. Participants identified “finding time” as a completion barrier.
Kenardy et al^Citation84	First year psychology students (M = 19.92 years) Diagnosis of anxiety (scored >24 on Anxiety Sensitivity Index) n = 83 (43 intervention, 40 control)	“Online Anxiety Prevention Program” Based on SERENA software for palmtop computers 6 sessions over 6 weeks	RCT Wait-list control Intervention group		Significant improvements on the Agoraphobic Cognitions Questionnaire, Catastrophic Cognitions Questionnaire-Modified, and the Centre for Epidemiologic Studies Depression Scale when compared to control group. No significant differences on the Anxiety Sensitivity Index or the Body Sensations Questionnaire. Improvements on Agoraphobic Cognitions Questionnaire, Catastrophic Cognitions Questionnaire-Modified, and Centre for Epidemiologic Studies Depression Scale remained at 6-month follow-up (53% retained in intervention group and 61% in control group at follow-up).
Sethi et al^Citation83	First year undergraduate students Age 18–23 years (M = 19.47, SD = 1.57) Diagnosis of low to moderate depression or anxiety n = 38 (25 female, 13 male)	“MoodGYM” 5 sessions over 3 weeks 30–45 minutes per session	RCT Face-to-face CBT MoodGYM in conjunction with face-to-face CBT MoodGYM alone Wait-list control		Significant reductions in anxiety as rated by the Depression Anxiety Stress Scale (DASS-21) in the combined MoodGYM and face-to-face CBT group when compared to all other groups. Significant improvements in DASS-21 scores for both face-to-face CBT and MoodGYM alone when compared to control group. Differences between groups non-significant No improvements pre- to post-on the DASS-21 for the control group.
Tillfors et al^Citation86	High school students Age 15–21 years (M = 16.5, SD = 1.6) n = 19 (17 female, 2 male)	Internet delivered CBT program 9 modules over 9 weeks Weekly email feedback from therapist If no contact from participant in 2-week time frame the therapist phoned the participant to assess reasons why	RCT Treatment group Wait-list control	Follow-up measures obtained from 15 participants Only 4 participants completed 3 or more modules 1 participant completed 5–6 modules No participant completed 7 or more modules	Significant improvements on measures of social anxiety when compared to control group. Non-significant findings for measures of social avoidance and quality of life.
Wolitzky-Taylor and Telch^Citation88	College students moderate levels of academic worry n = 113	Expressive writing, worry exposure or audio-photic stimulation 12 sessions of 20 minutes Participants instructed to self-administer treatment	RCT Guided worry exposure Expressive writing Audio-photic stimulation Wait-list control	84 participants completed at least 1/3 of the recommended home sessions On average only half of participants completed all home expressive writing sessions	All three treatment conditions reduced academic worry and general anxiety Slightly better outcomes for worry exposure. Delayed outcome for expressive writing Outcomes maintained at 3-month follow-up.

Abbreviations: CBASP, cognitive-behavioral analysis system of psychotherapy; RCT, randomized controlled trials; CBT, cognitive-behavioral therapy.

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