Efficacy of a brief online intervention in reducing excessive worry and improving daily functioning: A randomized trial with mediation analysis

TL;DR

A brief online intervention effectively reduced excessive worry and improved daily functioning, regardless of whether it was guided or unguided.

Contribution

The study demonstrates that both guided and unguided online interventions can reduce worry and improve functioning, with mediation effects confirmed.

Findings

The online intervention significantly reduced worry compared to a waiting list at week 5.

Improvements in daily functioning were mediated by reductions in excessive worry.

Both guided and unguided formats of the intervention were equally effective.

Abstract

Excessive worry is common among treatment-seeking individuals in primary care and has a negative impact on daily functioning, which may also lead to other mental health problems. The current study tested whether a worry-focused online intervention – provided in both a guided and an unguided format – was efficacious in reducing worry-related symptoms and if these effects were specifically linked to improvements in daily functioning. A total of 82 participants were randomized to intervention with therapist support (guided; n = 28), intervention without therapist support (unguided; n = 27) or to waiting list (n = 27). Results showed that the online intervention was more effective than waiting list in reducing worry at week 5 (between-group d = 0.96). The intervention was effective against waiting list irrespective of whether it was provided in a guided (between-group d = 0.90) or unguided format (between-group d = 1.07) with sustained results at the 7-week follow-up. Reduction in worry mediated improvement in daily functioning (between-group d = 0.58; indirect effect estimate = −1.06 [95 % CI: −1.76 to −0.51], 66 % mediated effect). The mediation effects were fairly robust to mediator-outcome confounding, with residual correlation values set to r = 0.3 in a sensitivity analysis. The results provide further evidence that it is beneficial to provide a low-threshold, easy access intervention to patients with excessive worry, irrespective of primary diagnosis. Clinical implications are discussed.

•This trial showed that a brief online intervention was effective in reducing degree of excessive worry.•The intervention reduced worry both in guided- and unguided format.•Reductions in excessive worry mediated improvements in daily functioning.

This trial showed that a brief online intervention was effective in reducing degree of excessive worry.

The intervention reduced worry both in guided- and unguided format.

Reductions in excessive worry mediated improvements in daily functioning.

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