Adults with subthreshold anxiety (GAD-7 ≥ 5) and/or depressive symptoms (CES-D ≥ 16) without clinical diagnosis in past six months
Care Setting
Internet-delivered intervention with either individual or automated guidance
Key Highlights
Both individually guided and automatically guided internet-based interventions significantly reduced the 12-month onset of anxiety and depressive disorders compared to waitlist control.
Cumulative incidence of disorder onset was 23.1% (individually guided), 20.7% (automated guided), and 36.0% (waitlist control).
Number needed to treat (NNT) was 7.76 for individually guided and 5.79 for automated guided interventions, indicating effective prevention.
Guideline-Based Recommendations
Diagnosis
Use standardized diagnostic interviews (e.g., MINI 6.0) to confirm absence of clinical anxiety or depressive disorders at baseline.
Assess subthreshold symptoms using validated scales such as GAD-7 for anxiety and CES-D for depression.
Management
Implement transdiagnostic, self-tailored CBT-based internet interventions comprising 8 sessions for indicated prevention in adults with subthreshold symptoms.
Offer interventions with either individualized human guidance or automated guidance to enhance adherence and efficacy.
Monitoring & Follow-up
Conduct follow-up diagnostic interviews at 6 and 12 months to assess onset of anxiety or depressive disorders.
Monitor session completion rates to evaluate adherence and engagement with the digital intervention.
Risks
No specific risks reported; however, adherence may influence outcomes and should be supported.
Ensure participants do not have recent clinical diagnoses to target indicated prevention appropriately.
Patient & Prescribing Data
Adults with subthreshold anxiety and/or depressive symptoms without recent clinical diagnosis
Both individually guided and automated internet-based CBT interventions effectively reduce incidence of anxiety and depressive disorders over 12 months, with automated guidance showing slightly lower cumulative incidence and NNT.
Clinical Best Practices
Screen patients for subthreshold anxiety and depression using validated symptom scales before intervention.
Use transdiagnostic and self-tailored CBT modules to address comorbid anxiety and depressive symptoms simultaneously.
Provide guidance (individual or automated) to improve adherence and intervention effectiveness.
Follow patients longitudinally with diagnostic interviews to confirm prevention of disorder onset.
by Anna-Carlotta Zarski, Kiona K. Weisel, Thomas Berger, Tobias Krieger, Michael P. Schaub, Matthias Berking, Dennis Görlich, Corinna Jacobi, Rosa Baños, Cristina Botella, Rocio Herrero, David D. Ebert
