Outcomes and experiences of DIALOG+ provided remotely for patients with anxiety disorders—A non-controlled pilot trial

TL;DR

A pilot trial found that a remote version of the DIALOG+ intervention improved quality of life and symptoms for patients with anxiety disorders.

Contribution

This is the first study to test DIALOG+ in patients with anxiety disorders and to deliver it remotely.

Findings

DIALOG+ significantly improved quality of life, general symptoms, and social situation in patients with anxiety disorders.

Patients reported positive experiences despite technical challenges with remote delivery.

The study suggests remote DIALOG+ is feasible and beneficial in routine mental health care.

Abstract

Low-cost interventions in routine care are needed to reduce the burden of anxiety disorders. DIALOG+ is an evidence-based intervention specifically designed to make routine patient-clinician meetings in mental health care therapeutically effective. It has been shown to be beneficial in a range of studies, but so far not been tested in patients with a primary diagnosis of anxiety disorders.

We conducted a non-controlled pilot trial in an out-patient service in Buenos Aires, Argentina. DIALOG+ was applied five times over a six-month period. Because of the pandemic all sessions had to be delivered remotely which had not been originally planned. At baseline and after the intervention, we assessed as outcome criteria subjective quality of life on the Manchester Short Assessment of Quality of Life, general symptoms on the Brief Psychiatric Rating Scale and the objective social situation on the Social Outcomes Index. Patient experiences were explored in semi-structured interviews.

Forty patients completed the study. All outcome criteria, quality of life (4.1±0.5 to 5.0±0.5; p<0.001), general symptoms (33.0±9.3 to 25.9±7.6; p<0.001) and the objective social situation (5.2±0.9 to 5.6±0.5; p=0.008) showed significant improvements. Patient reported largely positive experiences despite frequent technical problems with the online arrangements.

The findings suggest that DIALOG+ is feasible and beneficial for patients with anxiety disorders in routine care and that a remote delivery is a feasible realistic option for administering it. Future research should assess implementation methods and effectiveness in larger controlled trials and identify the effective mechanisms in DIALOG+.

The trial was pre-registered (https://www.isrctn.com/ISRCTN38851969) on 16/12/2019.

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