As noted in previous sections, there has been an expansion of research into e-health and telehealth interventions, with growing evidence to support their use in managing and treating various disorders. Many smartphone apps exist for the treatment of anxiety as a single disorder and have been shown to be effective at reducing symptoms compared to waitlist or online peer support controls [1188]. A systematic review and a meta-analysis found no differences between videoconferencing or face-to-face therapy in the treatment of anxiety as a single disorder [1189, 1190]. Further, a systematic review and meta-analysis examining e-health interventions for GAD found significant post-treatment improvements for generalised anxiety and pathological worry [1191]. Indeed, the efficacy of e-health interventions was found to be equivalent to that of CBT interventions delivered face-to-face. For these reasons, the RANZCP guidelines recommend either face-to-face or digital CBT as first line treatment options for GAD, panic disorder, and SAD [1158]. The Richards et al. [1191] review further concluded that online CBT-based interventions have a stronger evidence-base and greater efficacy compared to online psychodynamic-based interventions.
Wolitzky-Taylor and colleagues developed a group-based computerised CBT program for people with co-occurring anxiety and AOD use disorders [1192]. Evaluated among a small sample of people with GAD, SAD, panic disorder, agoraphobia or specific phobia attending AOD treatment, those randomised to receive six-sessions demonstrated greater reductions in anxiety symptoms and substance use compared to those attending AOD treatment only, with reductions in anxiety maintained up to six-months [1192]. With the exception of Wolitzky-Taylor and colleagues [1192], only one other e-health intervention has been developed for addressing co-occurring anxiety and AOD use. Stapinski and colleagues [1193] developed Inroads, based on an integrated evidence-based CBT program for social anxiety and alcohol use (previously discussed in relation to SAD [1194]). Inroads is a five-module web-based integrated intervention for young adults aged 17 to 24 years, with personalised weekly therapist support provided in addition to two optional text/phone sessions following modules one and four [1194]. Evaluated among a small community-based sample of young adults with moderate to severe anxiety symptoms and high levels of alcohol use, those randomised to receive Inroads demonstrated significantly greater reductions in relation to social anxiety symptoms, as well as binge and hazardous drinking, which were sustained to the six-month follow-up compared to those receiving information about alcohol and safe drinking guidelines. The completion of more modules was associated with greater improvements in all outcomes [1194].
An Australian program called Mental Health Online (formerly Anxiety Online) provides psychoeducation about AOD use [1195]. Mental Health Online comprises five e-therapy programs for GAD, SAD, panic disorder, PTSD, and OCD. Definitive evidence regarding the efficacy of this program is lacking; however, preliminary findings from two naturalistic studies show promise, reporting that participation in Mental Health Online was associated with reductions in severity of all five disorders, and increased confidence in managing one’s own mental health care [1195, 1196]. Significant improvements in quality of life were also consistently observed for GAD, SAD, and PTSD e-therapy programs, but not the OCD or panic disorder program [1195, 1196]. Overall, treatment satisfaction was good across all five e-therapy programs [1195].