Effectiveness and cost-effectiveness of web-based treatment for phobic outpatients on a waiting list for psychotherapy: protocol of a randomised controlled trial

A randomised controlled trial will be conducted among 244 Dutch adult patients recruited from waiting lists of outpatient clinics for face-to-face psychotherapy for phobic disorders. Patients suffering from at least one DSM-IV classified phobic disorder (social phobia, agoraphobia or specific phobia) are randomly allocated (at a 1:1 ratio) to either a five-week internet-based guided self-help program followed by face-to-face psychotherapy, or a control group followed by face-to-face psychotherapy. Waiting list status and duration are unchanged and actual need for further treatment is evaluated prior to face-to-face psychotherapy. Clinical and economic self-assessment measurements take place at baseline, post-test (five weeks after baseline) and at 3, 6, 9 and 12 months after baseline.Offering pre-treatment internet-based guided self-help efficiently uses time otherwise lost on a waiting list and may increase patient satisfaction. Patients are expected to need fewer face-to-face sessions, reducing total treatment cost and increasing speed of recovery. Internet-delivered treatment for phobias may be a valuable addition to psychotherapy as demand for outpatient treatment increases while budgets decrease.Netherlands Trial Register NTR2233Anxiety disorders have a pooled lifetime prevalence of 19.8% [1]. This makes these disorders the most prevalent mental disorders for women, and the second most prevalent for men. Specific phobias are the most common form of anxiety disorders for both genders, with a total 12-month prevalence of 7.1%, followed by social phobia (4.8%) and agoraphobia without panic disorder (1.2%). Phobias are characterised by an excessive fear of situations or objects and are often treated by gradual exposure to the fear-inducing stimulus and/or cognitive behavioural therapy.The economic burden of these conditions is considerable [2], as is the negative impact on quality of life and psychosocial functioning [3], especially if the patient is often confront