Supplement: Intervention Components of Anxiety IMIs

Supporting information: Internet- and mobile-based interventions

for anxiety disorders: A meta-analytic review of intervention
components
 Differences between PROSPERO registration and final conduction of the review
 eMethods (search strings, detailed inclusion criteria)
 eTable 1. Main characteristics of included studies
 eFigures 1.1-1.19. Forest plots of meta-analyses
 PRISMA checklist

Differences between PROSPERO registration (CRD42017068268) and final conduction of the

review
(1) We included studies examining several mental disorders, if subgroup information for anxiety disorders was
sufficiently reported; this was the case for one study (Johansson et al., 2013).
(2) We preferred the instrument with better psychometric properties or selected the instrument by chance,
when information on different anxiety symptom severity scales on the same hierarchical level was
provided. We further preferred the instrument for which more data existed. This extension was applied in
three studies (Dear et al., 2015; Dear et al., 2016; Fogliati et al., 2016).
(3) We added a third review question (“Are IMIs for anxiety disorders more efficacious than common factor
controls?”), in order to establish a basic prerequisite for the original two research questions specified in
the study protocol (“Which characteristics related to the treatment program underlie the efficacy of
internet- and mobile-based interventions (IMIs) for anxiety disorders? Which characteristics related to the
treatment program are associated with adherence to the IMIs for anxiety disorders?”).

eMethods

Search strings for PsycINFO, PSYNDEX, Embase, MEDLINE and CENTRAL in Ovid
No PsycINFO / PSYNDEXa
c
1 anxiety disorders/
2 exp generalized anxiety
disorder/
3 exp phobias/
4 exp panic disorder/
5 exp panic attack/
6 (anxiety adj
disorder*).ab,ti,id.
7 (social* adj
anxi*).ab,ti,id.
8 (generali?ed adj
anxi*).ab,ti,id.
9 phobia*.ab,ti,id.
10 phobic.ab,ti,id.
11 agoraphobi*.ab,ti,id.
Embase
anxiety disorder/
exp generalized anxiety
disorder/
exp phobia/
exp panic/
- -
(anxiety adj
disorder*).ab,ti,kw.
(social* adj
anxi*).ab,ti,kw.
(generali?ed adj
anxi*).ab,ti,kw.
phobia*.ab,ti,kw.
phobic.ab,ti,kw.
agoraphobi*.ab,ti,kw.
MEDLINEb CENTRAL
anxiety disorders/ anxiety disorders/
exp agoraphobia/ exp agoraphobia/
exp phobic disorders/ exp phobic disorders/
exp panic disorder/ exp panic disorder/
-
(anxiety adj (anxiety adj
disorder*).ab,ti,kw. disorder*).ab,ti,kw.
(social* adj (social* adj
anxi*).ab,ti,kw. anxi*).ab,ti,kw.
(generali?ed adj (generali?ed adj
anxi*).ab,ti,kw. anxi*).ab,ti,kw.
phobia*.ab,ti,kw. phobia*.ab,ti,kw.
phobic.ab,ti,kw. phobic.ab,ti,kw.
agoraphobi*.ab,ti,kw. agoraphobi*.ab,ti,kw.
1
Supplement: Intervention Components of Anxiety IMIs
12 panic*.ab,ti,id.
13 anxiety.ti,id.
14 fear.ti,id.
15 1 or 2 or 3 or 4 or 5 or 6 1 or 2 or 3 or 4 or 6 or 7
or 7 or 8 or 9 or 10 or 11 or 8 or 9 or 10 or 11 or
or 12 or 13 or 14
16 internet*.ti,id.
17 online*.ti,id.
18 web*.ti,id.
19 digital*.ti,id.
20 virtual*.ti,id.
21 cyber*.ti,id.
22 electronic*.ti,id.
23 videoconferenc*.ti,id.
24 computer*.ti,id.
25 mobile*.ti,id.
26 smartphone*.ti,id.
27 app.ti,id.
28 e-mail*.ti,id.
29 email*.ti,id.
30 chat*.ti,id.
31 e-health*.ti,id.
32 ehealth*.ti,id.
33 16 or 17 or 18 or 19 or
20 or 21 or 22 or 23 or
24 or 25 or 26 or 27 or
28 or 29 or 30 or 31 or
32
34 exp psychotherapy/
35 psychotherap*.ab,ti,id.
36 therap*.ab,ti,id.
37 treatment*.ab,ti,id.
38 intervention*.ab,ti,id.
39 counse?ling.ab,ti,id.
40 exposure*.ab,ti,id.
41 training*.ab,ti,id.
42 self-help*.ab,ti,id.
43 CBT.ab,ti,id.
44 34 or 35 or 36 or 37 or
38 or 39 or 40 or 41 or
42 or 43
45 exp telemedicine/
46 exp computer assisted
therapy/
47 exp online therapy/
panic*.ab,ti,kw. panic*.ab,ti,kw. panic*.ab,ti,kw.
anxiety.ti,kw. anxiety.ti,kw. anxiety.ti,kw.
fear.ti,kw. fear.ti,kw. fear.ti,kw.
1 or 2 or 3 or 4 or 6 or 7 1 or 2 or 3 or 4 or 6 or 7
or 8 or 9 or 10 or 11 or or 8 or 9 or 10 or 11 or
12 or 13 or 14 12 or 13 or 14 12 or 13 or 14
internet*.ti,kw. internet*.ti,kw. internet*.ti,kw.
online*.ti,kw. online*.ti,kw. online*.ti,kw.
web*.ti,kw. web*.ti,kw. web*.ti,kw.
digital*.ti,kw. digital*.ti,kw. digital*.ti,kw.
virtual*.ti,kw. virtual*.ti,kw. virtual*.ti,kw.
cyber*.ti,kw. cyber*.ti,kw. cyber*.ti,kw.
electronic*.ti,kw. electronic*.ti,kw. electronic*.ti,kw.
videoconferenc*.ti,kw. videoconferenc*.ti,kw. videoconferenc*.ti,kw.
computer*.ti,kw. computer*.ti,kw. computer*.ti,kw.
mobile*.ti,kw. mobile*.ti,kw. mobile*.ti,kw.
smartphone*.ti,kw. smartphone*.ti,kw. smartphone*.ti,kw.
app.ti,kw. app.ti,kw. app.ti,kw.
e-mail*.ti,kw. e-mail*.ti,kw. e-mail*.ti,kw.
email*.ti,kw. email*.ti,kw. email*.ti,kw.
chat*.ti,kw. chat*.ti,kw. chat*.ti,kw.
e-health*.ti,kw. e-health*.ti,kw. e-health*.ti,kw.
ehealth*.ti,kw. ehealth*.ti,kw. ehealth*.ti,kw.
16 or 17 or 18 or 19 or 16 or 17 or 18 or 19 or 16 or 17 or 18 or 19 or
20 or 21 or 22 or 23 or 20 or 21 or 22 or 23 or 20 or 21 or 22 or 23 or
24 or 25 or 26 or 27 or 24 or 25 or 26 or 27 or 24 or 25 or 26 or 27 or
28 or 29 or 30 or 31 or 28 or 29 or 30 or 31 or 28 or 29 or 30 or 31 or
32 32 32
exp psychotherapy/ exp psychotherapy/ exp psychotherapy/
psychotherap*.ab,ti,kw. psychotherap*.ab,ti,kw. psychotherap*.ab,ti,kw.
therap*.ab,ti,kw. therap*.ab,ti,kw. therap*.ab,ti,kw.
treatment*.ab,ti,kw. treatment*.ab,ti,kw. treatment*.ab,ti,kw.
intervention*.ab,ti,kw. intervention*.ab,ti,kw. intervention*.ab,ti,kw.
counse?ling.ab,ti,kw. counse?ling.ab,ti,kw. counse?ling.ab,ti,kw.
exposure*.ab,ti,kw. exposure*.ab,ti,kw. exposure*.ab,ti,kw.
training*.ab,ti,kw. training*.ab,ti,kw. training*.ab,ti,kw.
self-help*.ab,ti,kw. self-help*.ab,ti,kw. self-help*.ab,ti,kw.
CBT.ab,ti,id. CBT.ab,ti,id. CBT.ab,ti,id.
34 or 35 or 36 or 37 or 34 or 35 or 36 or 37 or 34 or 35 or 36 or 37 or
38 or 39 or 40 or 41 or 38 or 39 or 40 or 41 or 38 or 39 or 40 or 41 or
42 or 43 42 or 43 42 or 43
exp telemedicine/ exp telemedicine/ exp telemedicine/
exp computer assisted exp therapy, computer- exp therapy, computer-
therapy/ assisted/ assisted/
- - -
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Supplement: Intervention Components of Anxiety IMIs

48 ICBT.ab,ti,id. ICBT.ab,ti,kw. ICBT.ab,ti,kw. ICBT.ab,ti,kw.

49 CCBT.ab,ti,id. CCBT.ab,ti,kw. CCBT.ab,ti,kw. CCBT.ab,ti,kw.
50 e-therap*.ab,ti,id. e-therap*.ab,ti,kw. e-therap*.ab,ti,kw. e-therap*.ab,ti,kw.
51 etherap*ab,ti,id. etherap*ab,ti,kw. etherap*ab,ti,kw. etherap*ab,ti,kw.
52 (ecological adj (ecological adj (ecological adj (ecological adj
momentary).ab,ti,id. momentary).ab,ti,kw momentary).ab,ti,kw. momentary).ab,ti,kw
53 (experience adj (experience adj (experience adj (experience adj
sampl*).ab,ti,id. sampl*).ab,ti,kw. sampl*).ab,ti,kw. sampl*).ab,ti,kw.
54 45 or 46 or 47 or 48 or 45 or 46 or 48 or 49 or 45 or 46 or 48 or 49 or 45 or 46 or 48 or 49 or
49 or 50 or 51 or 52 or 50 or 51 or 52 or 53 50 or 51 or 52 or 53 50 or 51 or 52 or 53
53
55 (33 and 44) or 54 (33 and 44) or 54 (33 and 44) or 54 (33 and 44) or 54
56 exp clinical trials/ exp controlled clinical exp controlled clinical -
trial/ trial/
57 random*.ab,ti,id,pt,md. random*.ab,ti,kw,pt. random*.ab,ti,kw,pt. -
58 trial*.ab,ti,id,pt,md. trial*.ab,ti,kw,pt. trial*.ab,ti,kw,pt. -
59 RCT.ab,ti,id,pt,md. RCT.ab,ti,kw,pt. RCT.ab,ti,kw,pt. -
60 56 or 57 or 58 or 59 56 or 57 or 58 or 59 56 or 57 or 58 or 59 -
61 15 and 55 and 60 15 and 55 and 60 15 and 55 and 60 15 and 55

ab = abstract. adj = positional operator which finds two terms next to each other in the specified order. adj3 = positional operator which finds
terms in any order with two words (or fewer) between them. exp = explode (retrieve results using the selected thesaurus term and all of its
more specific terms). id = key concepts. kw = keyword. md = methodology. pt = publication type. ti = title.
a
PSYNDEXplus Literature and Audiovisual Media. b MEDLINE databases included were: Epub Ahead of Print, In-Process & Other Non-
Indexed Citations, Ovid MEDLINE® Daily and Ovid MEDLINE®. c Thesaurus terms are presented in italics.

Search string for ICTRP

No Advanced search
1 Title = (internet OR online OR web OR virtual OR electronic OR computer OR mobile OR smartphone)
2 Condition = (anxiety disorder OR social phobia OR generalized anxiety disorder OR phobia OR panic
disorder OR fear)
3 Intervention = (psychotherapy OR treatment)
4 1 and 2 and 3
ICTRP = WHO International Clinical Trials Registry Platform

Detailed inclusion criteria

Studies were eligible for inclusion if they fulfilled the following eight criteria:
Population
(1) Studies focused on adults (≥ 18years), (2) who met diagnostic criteria according to DSM-
IV, DSM-5 or ICD-10 for at least one of the following anxiety disorders at baseline: specific
phobia (SP), social anxiety disorder (SAD), panic disorder (PD), agoraphobia (A) or
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Supplement: Intervention Components of Anxiety IMIs

generalized anxiety disorder (GAD). The diagnosis was based on clinical interviews, validated
self-reports with a threshold for clinical relevant anxiety or ratings by health care professionals.
Studies examining various mental disorders were included as well, if they reported subgroup
information for anxiety disorders, or if at least 80% of the participants had one (or more) of the
aforementioned anxiety disorders.
Intervention
(3) Studies investigated internet- or mobile-based interventions (i.e. provided in an online
setting through web pages, e-mail, chat, videoconference, mobile app or instant messaging).
These IMIs could have been complemented with an initial face-to-face contact or regular phone
calls, if more than half of the time invested per participant was carried out online. (4)
Furthermore, the interventions had a psychotherapeutic orientation and were based on
established psychotherapeutic approaches as defined by Kampling and colleagues31 (i.e. CBT,
psychodynamic psychotherapy, behaviour therapy or behaviour modification, systemic therapy,
third wave cognitive behavioural therapies, humanistic therapies, integrative therapies and
other psychological treatments), or one of their components alone (e.g. relaxation techniques).
Control and comparison group
(5) Studies had to compare an IMI with an internet- or mobile-based active control group (e.g.
online discussion forum), or trials compared at least two IMIs varying in one (or more)
intervention component(s), i.e. additive or dismantling design studies.
Outcomes
(6) Studies had to report (a) anxiety symptom severity and/or (b) adherence to the intervention
as outcome. Anxiety symptom severity was operationalized by the sum-score of a validated
observer-rated or self-report instrument. In case that more than one scale was ascertained,
preference was given in the following order: (i) validated observer-rated instruments, (ii)
validated self-report instruments of anxiety symptoms in general, (iii) validated self-report
instruments of anxiety disorder-specific symptoms. If scales were on the same hierarchical
level, the instrument with better psychometric properties was preferred. In case of insufficient
information, one outcome measure was randomly chosen. In addition to anxiety symptom
severity at post-intervention assessment, we also included 6 to 12 months follow-ups.
Adherence was defined following Donkin and colleagues as (i) the mean number of modules
completed, and (ii) the proportion of participants that completed the whole intervention.
Study design
(7) Studies identified as a randomized controlled trial (RCT), (8) written in English or German,
published in a peer-reviewed journal were eligible for inclusion.
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Supplement: Intervention Components of Anxiety IMIs

eTable 2. Main characteristics of included studies

Anxiety Comparison of n (% Age Drop- Modules Guidance Anxiety Follow- Method of

Disorder/ intervention female) M (SD) outa / severity upb data
Recruitment components in % Duration measuresb analysis
setting in weeks

Andersson et SAD / Higher qualified 42 (-) - - 9/9 Weekly via e-mail by clinician BAI 12 months ITT (mixed
al. (2012a) / Community vs. (LSAS-SR, effect
Sweden lower qualified e-coach 60 (-) - - 9/9 Weekly via e-mail by student SIAS, SPS, models)
SPSQ)
IMIc 102 38.1 (11.3) 7.8 9/9 Weekly via e-mail by clinician/
vs. (60.8) student
peer support 38.4 (10.9) 2.0 -/9
102 None, unless necessary (questions
(59.8) or inappropriate discussions)
Andersson et GAD / CBT 27 (74.1) 44.4 (12.8) 14.8 8/8 Weekly via e-mail by clinician BAI (GAD- (3 months, ITT (mixed
al. (2012b) / Community vs. Q-IV, 18 months) effect
Sweden psychodynamic therapy 27 (77.8) 36.4 (9.7) 3.7 8/8 Weekly via e-mail by clinician PSWQ, models)
STAI)
Berger et al. SAD / Guided 27 (48.1) 36.9 (11.6) 11.1 5 / 10 Weekly via e-mail by clinician/d LSAS-SR 6 months ITT (LOCF,
(2011) / Community vs. student (SIAS, SPS) mixed
Switzerland unguided 27 (55.6) 37.3 (11.1) 3.7 5 / 10 effect
None models)
Scheduled guidancee 27 (48.1) 36.9 (11.6) 11.1 5 / 10
vs. Weekly via e-mail by clinician
step-up guidance on 27 (55.6) 37.4 (11.4) 7.4 5 / 10
demand On demand weekly via e-mail or
stepped up to weekly via e-mail +
telephone by clinician
Berger et al. GAD, PD/A, Tailored 44 (59.1) 35.0 (10.9) 9.1 8/8 Weekly via e-mail by clinician/ BAI (ACQ, 6 months ITT (LOCF,
(2014) / SAD / vs. student BSQ, MI, mixed
Switzerland Community disorder-specific 44 (54.5) 34.4 (11.6) 11.4 8/8

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Supplement: Intervention Components of Anxiety IMIs

Weekly via e-mail by clinician/ PSWQ, effect

student SIAS, SPS) models)
Boettcher et SAD / Diagnostic interview + 57 (52.8) 35.5 (11.3) 40.4 5 / 10 None SPS (LSAS- (4 months) ITT (mixed
al. (2012) / Community IMI vs. SR, SIAS) effect
Germany IMI 56 (57.1) 35.9 (12.7) 39.3 5 / 10 None models)
Boettcher et ADNOS, GAD, IMI 45 (75.6) 37 (8.9) 11.1 8/8 None BAI (6 months)f ITT (mixed
al. (2014a) / PD/A, SAD / vs. effect
Sweden Community peer support 46 (67.4) 40 (11.5) 4.3 -/8 None models)
Boettcher et SAD / ABM + IMI 66 (68.2) - 6.1 1+9 / 11 Weekly via e-mail by clinician LSAS-SR - ITT (mixed
al. (2014b) / Community vs. (SIAS, SPS) effect
Sweden control training + IMI 67 (59.7) - 4.5 1+9 / 11 Weekly via e-mail by clinician models)
Butler et al. SAD / Positive CBM + IMI 20 (70.0) 23.9 (6.6) - 3+3 / 1 None SPIN (2 weeks) -
(2015) / Community vs.
Australia (students) neutral CBM + IMI 20 (70.0) 24.4 (7.2) - 3+3 / 1 None
Carlbring et PD/A / CBT 11 (72.7) 38.5 (11) 27.3 6/- After each module via e-mail BAI (ACQ, - ITT
al. (2003) / Community vs. BSQ, MI) (LOCF)
Sweden applied relaxation 11 (63.6) 37.4 (6.1) 18.2 9/- After each module via e-mail
Carlbring et Any specific IMI 27 (66.7) 39.3 (11.2) 7.4 6-10 / 10 After each module via e-mail by BAI - ITT
al. (2011) / AD, ADNOS / vs. clinician (LOCF)
Sweden Community peer support 27 (85.2) 38.3 (10.3) 0.0 - / 10
Via forum by clinician
Christensen GAD / IMI 8 (75.0) 25.0 (4.2) 25.0 10 / 10 Four times face-to-face by clinician GAD-7 (6 months, ITT (mixed
et al. (2014) / Community (≤ vs. 12 effect
Australia 30 years) active control 7 (85.7) 26.0 (3.8) 14.3 10 / 10 Four times face-to-face by clinician months)g models)
Dagöo et al. SAD / CBT 27 (48.1) 34.7 (11.2) 11.1 9/9 Weekly via e-mail by student BAI (3 months) ITT
(2014) / Community vs. (LSAS-SR, (multiple
Sweden interpersonal therapy 25 (56.0) 39.1 (11.3) 24.0 9/9 Weekly via e-mail by student SIAS, SPS) imputation)
Dear et al. SAD / Guidedh 112i 41.2 (9.6) - 5/8 Weekly via e-mail or telephone by MINI-SPIN 12 months ITT
(2016) / Community vs. (62.5) clinician (GAD-7, (3 months, (general-
Australia mostly unguidedh 41.9 (12.2) - 5/8 On demand technical guidance by PDSS-SR) 24 months) ized
108i research assistant estimation
Transdiagnostich (53.7) 41.5 (11.0) - 5/8 Mixed (guided or unguided) model)
vs.
disorder-specifich 41.7 (10.8) - 5/8 Mixed (guided or unguided)

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Supplement: Intervention Components of Anxiety IMIs

105i
(55.2)

115i
(60.9)
Dear et al. GAD / Guidedh 168i 44.5 (11.7) - 5/8 Weekly via e-mail or telephone by GAD-7 12 months ITT
(2015) / Community vs. (76.2) clinician (MINI- (3 months, (general-
Australia mostly unguidedh 43.0 (10.8) - 5/8 On demand technical guidance by SPIN, 24 months) ized
170i research assistant PDSS-SR) estimation
Transdiagnostich (75.3) 44.3 (10.7) - 5/8 Mixed (guided or unguided) model)
vs.
disorder-specifich 105i 43.2 (11.9) - 5/8 Mixed (guided or unguided)
(55.2)

115i
(60.9)
Fogliati et al. PD/A / Guidedh 72i (73.6) 39.4 (11.1) - 5/8 Weekly via e-mail or telephone by PDSS-SR 12 months ITT
(2016) / Community vs. clinician (GAD-7, (3 months, (general-
Australia mostly unguidedh 73i (84.9) 43.4 (11.2) - 5/8 On demand technical guidance by MINI- 24 months) ized
research assistant SPIN) estimation
Transdiagnostigh 72i (73.6) 43.4 (11.2) - 5/8 Mixed (guided or unguided) model)
vs.
disorder-specifich 73i (84.9) 39.4 (11.1) - 5/8 Mixed (guided or unguided)
Furmark et SAD / CBT 29 (65.5) 34.9 (8.5) 0.0 9/9 Weekly via e-mail by clinician BAI 12 months ITT
al. (2009) / Community vs. (LSAS-SR, (LOCF)
Sweden applied relaxation 29 (75.9) 36.4 (9.8) 0.0 9/9 Weekly via e-mail by clinician SIAS, SPS)

IMIe 29 (65.5) 34.9 (8.5) 0.0 9/9 Weekly via e-mail by clinician
vs.
bibliotherapy + peer 28 (64.3) 35 (10.4) 0.0 9/9 None
support
Gershkovich SAD / Guided 20 (85.0) 33.8 (11.2) 20.0 8/8 Weekly videoconferencing + daily LSAS-SR - ITT
(2016) / USA Community vs. text-messages by clinician; (SCQ,
feedback on homework SIAS,
mostly unguided 22 (45.5) 29.3 (8.4) 50.0 8/8 Feedback on homework SPAI)

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Supplement: Intervention Components of Anxiety IMIs

Ivanova et al. PD/A, SAD / Guided 50 (60.0) 36.2 (11.4) 16.0 8 / 10 Twice per week via online GAD-7 12 months ITT (mixed
(2016) / Community vs. environment by clinician (LSAS-SR, effect
Sweden unguided 51 (62.7) 36 (12.1) 23.5 8 /10 None PDSS-SR) models)
Johansson et ADNOS, GAD, IMI 22 (-) - 0.0 8 / 10 Weekly via online environment by GAD-7 (7 months)f ITT (mixed
al. (2013) / PD/A, MDDk, vs. clinician effect
Sweden SAD / active control 21 (-) - 0.0 - / 10 Weekly via online environment by models)
Community clinician
Johnston et GAD, PD/A, Higher qualified 47 (50.0) 43.7 (13.4) 10.6 8 / 10 Weekly via e-mail or telephone by SIAS- (3 months) ITT
al. (2011) / SAD / vs. clinician 6/SPS-6 (LOCF)
Australia Community lower qualified e-coach 46 (65.1) 38.6 (11.6) 15.2 8 / 10 Weekly via e-mail or telephone by (GAD-7,
research assistant PSWQ,
PDSS-SR)
Klein et al. PD/A / IMI 19 (-) - 5.3 6/6 On demand via e-mail by clinician PDSS (3 months) ITT
(2006) / Community vs. (ACQ, ASP, (LOCF)
Australia active control 18 (-) - 27.8 -/6 Weekly via telephone by clinician BVS, PAQ)
Klein et al. PD/A / Frequent guidance 19 (-) - 5.3 5+6 / 8 Minimum 3 times a week via email PDSS-SR - ITT
(2009) / Community vs. by clinician (ACQ, ASP, (LOCF)
Australia infrequent guidance 18 (-) - 27.8 5+6 / 8 Weekly via e-mail by clinician BVS)
i
LaFreniere & GAD / EMI 29 (-) - - - / 1.5 Once face-to-face + once via PSWQ (1 month) ITT
Newman Community vs. telephone (GAD-Q- (multiple
(2016) / USA (students) active control 22i (-) - - - / 1.5 IV) imputation)
Once face-to-face + once via
telephone
Nordgren et Any specific IMI 50 (66.0) 35 (13) 8.0 10 / 7-10 Weekly via messenger system by BAI (12 ITT (mixed
al. (2014) / AD / Primary vs. clinician months)f effect
Sweden care active control 50 (60.0) 36 (12) 10.0 - / 10 None unless necessary models)
Nordmo et al. SAD / Primary IMI + face-to-face 17 (41.2) 23.7 (3.4) 41.2 1+9 / 9 Once face-to-face + weekly via SPS (SIAS) 6 months ITT (mixed
(2015) / care (students) psychoeducation session telephone by clinician effect
Norway vs. models)
IMI 20 (45.0) 27.3 (8.1) 35.0 9/9 Weekly via telephone by clinician
Oromendia et PD/A / Scheduled guidance 25 (76.0) 38.2 (7.8) 4.0 8/8 Weekly via telephone by clinician BAI (ASI-3, 6 months ITT
al. (2016) / Community vs. PDSS-SR) (LOCF)
Spain guidance on demand 27 (70.4) 39.4 (8.5) 11.1 8/8 On demand via telephone by
clinician

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Supplement: Intervention Components of Anxiety IMIs

Richards et PD/A / IMI + stress 11 (90.9) 31.9 (9.3) 9.1 6+6 / 8 Weekly via e-mail by clinician PDSS (3 months) ITT
al. (2006) / Community management (ACQ, ASP, (LOCF)
Australia vs. 12 (50.0) 37.4 (8.6) 16.7 6/8 Weekly via e-mail by clinician BVS)
IMI
23 (69.6) 34.8 (9.2) 13.0 6/8 Weekly via e-mail by clinician
IMIc
vs. 9 (66.7) 41.2 (10.7) 22.2 -/8 Weekly via e-mail by clinician
active control
Robinson et GAD / Higher qualified 51 (72.3) 45.5 (13.1) 9.8 6 / 10 Weekly via e-mail or telephone + PSWQ (3 months) ITT
al. (2010) / Community vs. forum by clinician (GAD-7) (LOCF)
Australia lower qualified e-coach 50 (62.0) 44.2 (12.4) 10.0 6 / 10 Weekly via e-mail or telephone by
technician
IMI 50 (62.0) 44.2 (12.4) 10.0 6 / 10 Weekly via e-mail or telephone by
vs. technician
IMI + peer supportl 51 (72.3) 45.5 (13.1) 9.8 6 / 10 Weekly via e-mail or telephone +
forum by clinician
Schulz et al. SAD / IMI 60 (55.0) 36.1 (11.1) 25.0 8 / 12 Weekly via e-mail by clinician SIAS (SPS) 6 months ITT (mixed
(2016) / Community vs. effect
Switzerland IMI + peer support 60 (50.0) 35.8 (11.4) 23.3 8 / 12 Weekly via forum by clinician models)
Tillfors et al. SAD / IMI + face-to-face 19 (83.3) 30.4 (6.3) 5.3 9+5 / 9 After each module via e-mail by BAI 12 months ITT
(2008) / Community exposure clinician; 5 times face-to-face (LSAS-SR, (LOCF)
Sweden vs. 19 (78.9) 32.3 (9.7) 5.3 9/9 After each module via e-mail by SIAS, SPS,
IMI clinician SPSQ)
Titov et al. SAD / Guided 32 (54.8) 39.7 (9.5) 6.3 6 / 10 After each module via e-mail + SPS (SIAS) - ITT
(2008) / Community vs. forum by clinician (LOCF)
Australia unguided 31 (76.7) 36.9 (10.8) 12.9 6 / 10 None
Titov et al. SAD / Guided 84 (-) - 14.3 6/8 Weekly via telephone by assistant SIAS (SPS) - ITT
(2009a) / Community vs. (LOCF)
Australia unguided 84 (-) - 10.7 6/8 None
Titov et al. SAD / IMI 43 (-) - 7.0 6/8 Weekly via telephone by technician SIAS (SPS) - ITT
(2009b) / Community vs. (LOCF)
Australia IMI + peer support 42 (-) - 14.3 6/8 Once via telephone + 3 times a
week via forum by clinician
Higher qualified 42 (-) - 14.3 6/8 Once via telephone + 3 times a
vs. week via forum by clinician

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Supplement: Intervention Components of Anxiety IMIs

lower qualified e-coach 43 (-) - 7.0 6/8 Weekly via telephone by technician

Titov et al. SAD / IMI + motivational 57 (-) - 10.5 2+6 / 11 None SPS (SIAS) (3 months) ITT
(2010) / Community enhancement strategies (LOCF)
Australia vs.
IMI 56 (-) - 14.3 2+6 / 11 None

ABM = attention bias modification training. ACQ = Agoraphobic Cognitions Questionnaire. AD = anxiety disorder. ADNOS = anxiety disorder not otherwise specified. ASI-3 = Anxiety Sensitivity Index-3. ASP = Anxiety
Sensitivity Profile. BAI = Beck Anxiety Inventory. BSQ = Bodily Sensations Questionnaire. BVS = Body Vigilance Scale. CBM = cognitive bias modification training. CBT = cognitive-behavioural therapy. EMI = ecological
momentary intervention. GAD = generalized anxiety disorder. GAD-7 = Generalized Anxiety Disorder Questionnaire-7. GAD-Q-IV = Generalized Anxiety Disorder Questionnaire IV. IMI = Internet- and mobile-based
intervention. ITT = intention-to-treat analysis. LOCF = last observation carried forward. LSAS-SR = Liebowitz Social Anxiety Scale Self-report Version. MDD = major depressive disorder. MI = Mobility Inventory for
Agoraphobia. MINI-SPIN = Mini Social Phobia Inventory. PAQ = Panic Attack Questionnaire. PD/A = panic disorder with/without agoraphobia. PDSS = Panic Disorder Severity Scale. PDSS-SR = Panic Disorder Severity
Scale Self-Rated Version. PSWQ = Penn State Worry Questionnaire. SAD = social anxiety disorder. SCQ = Social Phobia Cognitions Questionnaire. SIAS = Social Interaction Anxiety Scale. SIAS-6/SPS-6 = Short Form
Social Interaction Anxiety and Social Phobia Scale. SPAI = Social Phobia and Anxiety Inventory. SPIN = Social Phobia Inventory. SPS = Social Phobia Scale. SPSQ = Social Phobia Screening Questionnaire. STAI = State
Trait Anxiety Inventory.
a
Percentage of participants who did not provide data at post-intervention assessment. b Anxiety severity measures and follow-up measurement points not included in statistical analysis are reported in brackets. c The two
intervention groups from the first comparison were combined to create another single pair-wise comparison. d Clinical psychologist or clinical psychology graduate student in training (in a program which is required to practice
psychotherapy in the respective country). e This intervention group was also included in the first comparison (but with another name: guided = scheduled guidance; CBT = IMI). f The follow-up measurement point was not
included, because results were not reported for all groups or not for the anxiety subgroup. g The follow-up measurement times were not included because participants in the active control group were provided with the iCBT
treatment after post assessment. h Two different trial groups were statistically combined to create this group. i Because the number of participants randomized was not specified in the record, the number of pre-intervention
assessment completers is given. k Results for participants with MDD as primary disorder were reported in a separate subgroup not included in this systematic review and meta-analysis. l The same two intervention groups were
also included in the first comparison.

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Intervention Components of Anxiety IMIs

eFigure 1. Forest plots of meta-analyses

eFigure 1.1. Comparison IMI vs. active online control groups – symptom severity at post-
intervention assessment

eFigure 1.2. Comparison IMI vs. online peer support only – symptom severity at post-
intervention assessment

eFigure 1.3. Comparison guided vs. completely unguided interventions – symptom severity
at post-intervention assessment

eFigure 1.4. Comparison guided vs. completely unguided interventions – mean number of
completed modules

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Intervention Components of Anxiety IMIs

eFigure 1.5. Comparison guided vs. completely unguided interventions – completer rate

eFigure 1.6. Comparison guided vs. mostly unguided interventions – symptom severity at
post-intervention assessment

eFigure 1.7. Comparison guided vs. mostly unguided interventions – symptom severity at 6
to 12 months follow-up

eFigure 1.8. Comparison guided vs. mostly unguided interventions – mean number of
completed modules

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Intervention Components of Anxiety IMIs

eFigure 1.9. Comparison guided vs. mostly unguided interventions – completer rate

eFigure 1.10. Comparison higher vs. lower qualified e-coaches – symptom severity at post-
intervention assessment

eFigure 1.11. Comparison higher vs. lower qualified e-coaches – completer rate

eFigure 1.12. Comparison CBT vs. other psychotherapeutic approaches – symptom severity
at post-intervention assessment

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Intervention Components of Anxiety IMIs

eFigure 1.13. Comparison disorder-specific vs. transdiagnostic approaches – symptom

severity at post-intervention assessment

eFigure 1.14. Comparison disorder-specific vs. transdiagnostic approaches – symptom

severity at 6 to 12 months follow-up

eFigure 1.15. Comparison disorder-specific vs. transdiagnostic approaches – mean number

of completed modules

eFigure 1.16. Comparison disorder-specific vs. transdiagnostic approaches – completer rate

14
Intervention Components of Anxiety IMIs

eFigure 1.17. Comparison IMIs vs. IMIs plus specific non-online intervention components–
symptom severity at post-intervention assessment

eFigure 1.18. Comparison IMIs vs. IMIs/bibliotherapy with additional peer support –
symptom severity at post-intervention assessment

eFigure 1.19. Comparison IMIs vs. IMIs/bibliotherapy with additional peer support

15
Intervention Components of Anxiety IMIs

PRISMA checklist.

Reported
Section/topic # Checklist item
on page #
TITLE
Title 1 Identify the report as a systematic review, meta-analysis, or both. 1
ABSTRACT
Structured summary 2 Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility 2-3
criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and
implications of key findings; systematic review registration number.

INTRODUCTION
Rationale 3 Describe the rationale for the review in the context of what is already known. 4-6
Objectives 4 Provide an explicit statement of questions being addressed with reference to participants, interventions, 4-6
comparisons, outcomes, and study design (PICOS).
METHODS
Protocol and registration 5 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide 7
registration information including registration number.
Eligibility criteria 6 Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, 7 (3-4
language, publication status) used as criteria for eligibility, giving rationale. Supplement)
Information sources 7 Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify 7
additional studies) in the search and date last searched.
Search 8 Present full electronic search strategy for at least one database, including any limits used, such that it could be 1-3
repeated. Supplement
Study selection 9 State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, 7-8
included in the meta-analysis).
Data collection process 10 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes 7-8
for obtaining and confirming data from investigators.
Data items 11 List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and 7-9 (study
simplifications made. protocol and

16
Intervention Components of Anxiety IMIs

3-4
Supplement)

Risk of bias in individual 12 Describe methods used for assessing risk of bias of individual studies (including specification of whether this was 8 and Figure
studies done at the study or outcome level), and how this information is to be used in any data synthesis. 3.2
Summary measures 13 State the principal summary measures (e.g., risk ratio, difference in means). 8-9 (and
study
protocol)
Synthesis of results 14 Describe the methods of handling data and combining results of studies, if done, including measures of consistency 8-9 (and
(e.g., I2) for each meta-analysis. study
protocol)

Reported
Section/topic # Checklist item
on page #
Risk of bias across studies 15 Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective 8 and Figure
reporting within studies). 3.1
Additional analyses 16 Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, 8-9, 14
indicating which were pre-specified.
RESULTS
Study selection 17 Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions 9 and Figure
at each stage, ideally with a flow diagram. 2
Study characteristics 18 For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) 9-10 and
and provide the citations. eTable 1
(Supplement)
Risk of bias within studies 19 Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12). 10 and
Figure 3.2
Results of individual studies 20 For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each eTable 1
intervention group (b) effect estimates and confidence intervals, ideally with a forest plot. (Supplement)
Synthesis of results 21 Present results of each meta-analysis done, including confidence intervals and measures of consistency. 10-14 and
Table 1
Risk of bias across studies 22 Present results of any assessment of risk of bias across studies (see Item 15). 10 and
Figure 3.1

17
Intervention Components of Anxiety IMIs

Additional analysis 23 Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16]). 14

DISCUSSION
Summary of evidence 24 Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to 14-15
key groups (e.g., healthcare providers, users, and policy makers).
Limitations 25 Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of 17-18
identified research, reporting bias).
Conclusions 26 Provide a general interpretation of the results in the context of other evidence, and implications for future research. 18

FUNDING
Funding 27 Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for 19
the systematic review.

18