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Feasibility and Efficiency of a Telehealth-Based Stepped-Care Model for Treatment of Anxiety in Rural Populations

Peter C Meidlinger, University of Nebraska - Lincoln


Disorders for which anxiety is the core affective component are among the most common and result in substantial impairment and distress for individuals suffering with them. Cognitive behavioral treatments have been widely shown to be effective in treating this class of problems. These disorders are highly comorbid with one another and have substantial overlap in terms of their underlying etiology, maintaining factors, and treatment approaches. Recent research into transdiagnostic treatment has capitalized on this overlap to provide uniform and effective treatments for these disorders, that may offer some benefits, particularly for individuals with more than one anxiety disorder. Despite the presence of effective treatments, many individuals in rural areas lack access to them due to lack of both providers generally and an overall lack of providers trained in evidence-based treatment of anxiety. While treatment delivered via videoconferencing software offers a means of reaching these individuals, many rural states, such as Nebraska, lack the providers in urban areas to meet the needs of rural populations as well. The present study examined the efficacy and efficiency of a 12-week stepped care intervention designed to effectively treat individuals with heightened efficiency in terms of therapist time using single-subject methodology across 9 participants. This intervention included an initial step of 6 weeks of therapist-guided self-help that included three brief phone calls with a therapist. Non-responders then moved on to a 6 week transdiagnostic cognitive behavioral therapy administered over 6 1-hour weekly sessions with a therapist delivered over videoconferencing software to the participants home. Results indicated that participants improved significantly and were classified as responders at a similar rate to that seen in other studies. Participants reported the treatment was highly credible and they were highly satisfied with it, similar to what is seen in standard face-to-face CBT. Additionally, the treatment was effective at reducing therapist time investment per participant by 2/3rds over standard treatment. The limitations and implications of this study are discussed as are future directions.

Subject Area

Clinical psychology

Recommended Citation

Meidlinger, Peter C, "Feasibility and Efficiency of a Telehealth-Based Stepped-Care Model for Treatment of Anxiety in Rural Populations" (2017). ETD collection for University of Nebraska-Lincoln. AAI10615621.