Guided Digital Cognitive Behavioral Program for Anxiety in Primary Care: Propensity-Matched Controlled Trial

Area of Science:

• Digital health interventions
• Anxiety disorder treatment
• Primary care mental health

Background:

• Cognitive behavioral therapy (CBT) is a leading treatment for adult anxiety disorders.
• Scalable delivery of CBT in clinical settings remains a challenge.

Purpose of the Study:

• To assess the feasibility, acceptability, and effectiveness of a coach-facilitated digital CBT program.
• To evaluate the program's impact on anxiety, quality of life (QoL), and healthcare utilization in primary care patients.

Main Methods:

• An open trial included 593 patients screening positive for anxiety (GAD7 score ≥5) offered the digital CBT program.
• Outcomes measured over 6 months included anxiety, QoL, and ambulatory medical use.
• Intent-to-treat (ITT) and modified intent-to-treat (mITT) analyses were performed, with comparisons to a usual care (CAU) control group (n=316).

Main Results:

• Over half of patients downloaded the app, with ~60% engagement (≥3 techniques completed).
• The active group showed medium effect sizes for reducing anxiety (d=0.44) and improving mental (d=0.49) and physical (d=0.39) QoL.
• The active group had significantly reduced outpatient medical care utilization (OR=0.49), though not significantly better than CAU on primary outcomes.

Conclusions:

• A coach-facilitated digital CBT program is feasible and acceptable for primary care patients with anxiety.
• The program led to significant improvements in anxiety, QoL, and reduced medical utilization, even in patients with comorbidities.
• While primary outcomes didn't significantly exceed usual care, engaged participants showed reduced healthcare use and improved secondary outcomes.