A Randomized Controlled Feasibility Trial of Internet-Delivered Guided Self-Help for Generalized Anxiety Disorder (GAD) Among University Students in India

Clinical Impact Statement Question: Can Internet-delivered, guided self-help be used to treat generalized anxiety disorder symptoms among university students in India? Findings: Participants who received guided self-help recorded high levels of program usage and had significantly greater symptom reductions than participants in the waitlist control group. Meaning: Internet-delivered, guided self-help appears to be an efficacious and feasible method for treating generalized anxiety disorder symptoms in India's university student population. Next Steps: Research should evaluate the feasibility and efficacy of Internet-delivered guided self-help for university students in India delivered at a larger scale and in comparison with existing treatment options. Online guided self-help may be an effective and scalable intervention for symptoms of generalized anxiety disorder (GAD) among university students in India. Based on an online screen for GAD administered at 4 Indian universities, 222 students classified as having clinical (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria) or subthreshold (Generalized Anxiety Disorder Questionnaire, Fourth Edition, score >= 5.7) GAD were randomly assigned to receive either 3 months of guided self-help cognitive-behavioral therapy (n = 117) or a waitlist control condition (n = 105). Guided self-help participants recorded high program usage on average across all participants enrolled (M = 9.99 hr on the platform; SD = 20.87). Intent-to-treat analyses indicated that participants in the guided self-help condition experienced significantly greater reductions than participants in the waitlist condition on GAD symptom severity (d = -.40), worry (d = -.43), and depressive symptoms (d = -.53). No usage variables predicted symptom change in the guided self-help condition. Participants on average reported that the program was moderately helpful, and a majority (82.1%) said they would recommend the program to a friend. Guided self-help appears to be a feasible and efficacious intervention for university students in India who meet clinical or subthreshold GAD criteria. The trial is registered with ClinicalTrials.gov (NCT02410265).