Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety: a randomized controlled trial

Behav Ther. 2015 Mar;46(2):206-17. doi: 10.1016/j.beth.2014.09.007. Epub 2014 Oct 17.


There is preliminary support for internet-delivered cognitive behaviour therapy (iCBT) as a way of improving access to treatment among older adults with anxiety. The aim of this randomized controlled trial (RCT) was to examine the efficacy, long-term outcomes, and cost-effectiveness of an iCBT program for adults over 60 years of age with anxiety. Successful applicants were randomly allocated to either the treatment group (n=35) or the waitlist control group (n=37). The online treatment course was delivered over 8 weeks and provided with brief weekly contact with a clinical psychologist via telephone or secure email. Eighty-four percent of participants completed the iCBT course within the 8 weeks and 90% provided data at posttreatment. Significantly lower scores on measures of anxiety (Cohen's d=1.43; 95% CI: 0.89 - 1.93) and depression (Cohen's d=1.79; 95% CI: 1.21 - 2.32) were found among the treatment group compared to the control group at posttreatment. These lower scores were maintained at 3-month and 12-month follow-up and the treatment group rated the iCBT treatment as acceptable. The treatment group had slightly higher costs ($92.2; 95% CI: $38.7 to $149.2) and Quality-Adjusted Life-Years (QALYs=0.010; 95% CI: 0.003 to 0.018) than the control group at posttreatment and the intervention was found to have a greater than 95% probability of being cost-effective. The results support iCBT as an efficacious and cost-effective treatment option for older adults with symptoms of anxiety.

Trial registration: Australian and New Zealand Clinical Trials Registry: ACTRN12611000929909;

Keywords: anxiety; cognitive behavior therapy (CBT); cost-effectiveness; internet; older adults.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anxiety / diagnosis
  • Anxiety / economics
  • Anxiety / therapy*
  • Australia
  • Cognitive Behavioral Therapy / economics
  • Cognitive Behavioral Therapy / methods*
  • Cost-Benefit Analysis*
  • Female
  • Follow-Up Studies
  • Humans
  • Internet*
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Quality-Adjusted Life Years
  • Stress, Psychological / diagnosis
  • Stress, Psychological / economics
  • Stress, Psychological / therapy
  • Telemedicine / economics
  • Telemedicine / methods*
  • Treatment Outcome

Associated data

  • ANZCTR/ACTRN12611000929909