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Open Access Study protocol

Effectiveness and cost-effectiveness of web-based treatment for phobic outpatients on a waiting list for psychotherapy: protocol of a randomised controlled trial

Robin N Kok1*, Annemieke van Straten1, Aartjan Beekman2, Judith Bosmans3, Manja de Neef4 and Pim Cuijpers1

Author Affiliations

1 Department of Clinical Psychology and the EMGO institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands

2 Department of Psychiatry and the EMGO institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands

3 Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands

4 Dutch Association of Cognitive Behaviour Therapy, Utrecht, The Netherlands

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BMC Psychiatry 2012, 12:131  doi:10.1186/1471-244X-12-131

Published: 31 August 2012



Phobic disorders are highly prevalent and constitute a considerable burden for patients and society. As patients wait for face-to-face psychotherapy for phobic disorders in outpatient clinics, this time can be used for guided self-help interventions. The aim of this study is to investigate a five week internet-based guided self-help programme of exposure therapy in terms of clinical effectiveness and impact on speed of recovery in psychiatric outpatients, as well as the cost-effectiveness of this pre-treatment waiting list intervention.


A randomised controlled trial will be conducted among 244 Dutch adult patients recruited from waiting lists of outpatient clinics for face-to-face psychotherapy for phobic disorders. Patients suffering from at least one DSM-IV classified phobic disorder (social phobia, agoraphobia or specific phobia) are randomly allocated (at a 1:1 ratio) to either a five-week internet-based guided self-help program followed by face-to-face psychotherapy, or a control group followed by face-to-face psychotherapy. Waiting list status and duration are unchanged and actual need for further treatment is evaluated prior to face-to-face psychotherapy. Clinical and economic self-assessment measurements take place at baseline, post-test (five weeks after baseline) and at 3, 6, 9 and 12 months after baseline.


Offering pre-treatment internet-based guided self-help efficiently uses time otherwise lost on a waiting list and may increase patient satisfaction. Patients are expected to need fewer face-to-face sessions, reducing total treatment cost and increasing speed of recovery. Internet-delivered treatment for phobias may be a valuable addition to psychotherapy as demand for outpatient treatment increases while budgets decrease.

Trial registration

Netherlands Trial Register NTR2233

Phobias; Phobic disorders; Web-based intervention; Internet therapy; Randomised controlled trial; Cost-effectiveness; Outpatients