Introduction: Worries about the immediate and long-term consequences of the COVID-19 pandemic may for some individuals develop into pervasive worry that is disproportionate in its intensity or duration and significantly interferes with everyday life. Objective: The aim of this study was to investigate if a brief self-guided, online psychological intervention can reduce the degree of dysfunctional worry related to the COVID-19 pandemic and associated symptoms. Methods: 670 adults from the Swedish general population reporting daily uncontrollable worry about CO-VID-19 and its possible consequences (e.g., illness, death, the economy, one’s family) were randomised (1:1 ratio) to a 3-week self-guided, online cognitive behavioural intervention targeting dysfunctional COVID-19 worry and associated symptoms, or a waiting list of equal duration. The primary outcome measure was a COVID-19 adapted version of the Generalised Anxiety Disorder 7-item scale administered at baseline and weeks 1–3 (primary endpoint). Follow-up assessments were conducted 1 month after treatment completion. The trial was registered on ClinicalTrials.gov (NCT04341922) before inclusion of the first participant. Results: The main pre-specified intention-to-treat analysis indicated significant reductions in COVID-19-related worry for the intervention group compared to the waiting list (β = 1.14, Z = 9.27, p < 0.001), corresponding to a medium effect size (bootstrapped d = 0.74 [95% CI: 0.58–0.90]). Improvements were also seen on all secondary measures, including mood, daily functioning, insomnia, and intolerance of uncertainty. Participant satisfaction was high. No serious adverse events were recorded. Conclusions: A brief digital and easily scalable self-guided psychological intervention can significantly reduce dysfunctional worry and associated behavioural symptoms related to the COVID-19 pandemic.

1.
González-Sanguino
C
,
Ausín
B
,
Castellanos
MA
,
Saiz
J
,
López-Gómez
A
,
Ugidos
C
, et al.
Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain
.
Brain Behav Immun
.
2020
Jul
;
87
:
172
6
.
[PubMed]
0889-1591
2.
Voitsidis
P
,
Gliatas
I
,
Bairachtari
V
,
Papadopoulou
K
,
Papageorgiou
G
,
Parlapani
E
, et al.
Insomnia during the COVID-19 pandemic in a Greek population
.
Psychiatry Res
.
2020
Jul
;
289
:
113076
.
[PubMed]
0165-1781
3.
Wang
C
,
Pan
R
,
Wan
X
,
Tan
Y
,
Xu
L
,
Ho
CS
, et al.
Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China
.
Int J Environ Res Public Health
.
2020
Mar
;
17
(
5
):
E1729
.
[PubMed]
1661-7827
4.
Asmundson
GJ
,
Taylor
S
.
Coronaphobia: fear and the 2019-nCoV outbreak
.
J Anxiety Disord
.
2020
Mar
;
70
:
102196
.
[PubMed]
0887-6185
5.
Garfin
DR
,
Silver
RC
,
Holman
EA
.
The novel coronavirus (COVID-2019) outbreak: amplification of public health consequences by media exposure
.
Health Psychol
.
2020
May
;
39
(
5
):
355
7
.
[PubMed]
0278-6133
6.
Andersson
E
,
Hedman
E
,
Wadström
O
,
Boberg
J
,
Andersson
EY
,
Axelsson
E
, et al.
Internet-based extinction therapy for worry: a randomized controlled trial
.
Behav Ther
.
2017
May
;
48
(
3
):
391
402
.
[PubMed]
0005-7894
7.
Andersson
E
,
Ljótsson
B
,
Hedman-Lagerlöf
M
,
Nygren
L
,
Persson
M
,
Rosengren
K
, et al.
Targeting excessive worry with internet-based extinction therapy: a randomised controlled trial with mediation analysis and economical evaluation
.
Psychol Med
.
2020
Apr
;
•••
:
1
11
.
[PubMed]
0033-2917
8.
Wahlund
T
,
Mataix-Col
D
,
Olofsdotter Lauri
K
,
Dias
E
,
Ljótsson
B
,
Aspvall
K
, et al.
Brief online cognitive behavioural intervention for dysfunctionalworry related to the covid-19 pandemic: Pre-specified interim results from a randomised trial.
PsyArXiv
.
2020
.
9.
Svanborg
P
,
Åsberg
M
.
A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS)
.
J Affect Disord
.
2001
May
;
64
(
2-3
):
203
16
.
[PubMed]
0165-0327
10.
Merikangas
KR
,
Milham
M
,
Stringaris
A
. The CoRonavIruS Health Impact Survey (CRISIS).
2020
.
11.
Spitzer
RL
,
Kroenke
K
,
Williams
JB
,
Löwe
B
.
A brief measure for assessing generalized anxiety disorder: the GAD-7
.
Arch Intern Med
.
2006
May
;
166
(
10
):
1092
7
.
[PubMed]
0003-9926
12.
Mundt
JC
,
Marks
IM
,
Shear
MK
,
Greist
JH
.
The Work and Social Adjustment Scale: a simple measure of impairment in functioning
.
Br J Psychiatry
.
2002
May
;
180
(
5
):
461
4
.
[PubMed]
0007-1250
13.
Carleton
RN
,
Norton
MA
,
Asmundson
GJ
.
Fearing the unknown: a short version of the Intolerance of Uncertainty Scale
.
J Anxiety Disord
.
2007
;
21
(
1
):
105
17
.
[PubMed]
0887-6185
14.
Bastien
CH
,
Vallières
A
,
Morin
CM
.
Validation of the Insomnia Severity Index as an outcome measure for insomnia research
.
Sleep Med
.
2001
Jul
;
2
(
4
):
297
307
.
[PubMed]
1389-9457
15.
Larsen
DL
,
Attkisson
CC
,
Hargreaves
WA
,
Nguyen
TD
.
Assessment of client/patient satisfaction: development of a general scale
.
Eval Program Plann
.
1979
;
2
(
3
):
197
207
.
[PubMed]
0149-7189
16.
Behar
E
,
DiMarco
ID
,
Hekler
EB
,
Mohlman
J
,
Staples
AM
.
Current theoretical models of generalized anxiety disorder (GAD): conceptual review and treatment implications
.
J Anxiety Disord
.
2009
Dec
;
23
(
8
):
1011
23
.
[PubMed]
0887-6185
17.
Deacon
B
,
Maack
DJ
. The effects of safety behaviors on the fear of contamination: An experimental investigation. Behaviour Research and Therapy. 2008
2008
/
04
/
01
/;46(4):537-47.
18.
Olatunji
BO
,
Etzel
EN
,
Tomarken
AJ
,
Ciesielski
BG
,
Deacon
B
. The effects of safety behaviors on health anxiety: An experimental investigation. Behaviour Research and Therapy. 2011
2011
/
11
/
01
/;49(11):719-28.
19.
Rachman
S
.
The treatment of obsessions
.
Oxford
:
Oxford University Press
;
2003
.
20.
Cuijpers
P
,
Sijbrandij
M
,
Koole
S
,
Huibers
M
,
Berking
M
,
Andersson
G
.
Psychological treatment of generalized anxiety disorder: a meta-analysis
.
Clin Psychol Rev
.
2014
Mar
;
34
(
2
):
130
40
.
[PubMed]
0272-7358
21.
Pocock
SJ
.
Group sequential methods in the design and analysis of clinical trials
.
Biometrika
.
1977
;
64
(
2
):
191
9
. 0006-3444
22.
Farvolden
P
,
Denisoff
E
,
Selby
P
,
Bagby
RM
,
Rudy
L
.
Usage and longitudinal effectiveness of a Web-based self-help cognitive behavioral therapy program for panic disorder
.
J Med Internet Res
.
2005
Mar
;
7
(
1
):
e7
.
[PubMed]
1438-8871
23.
Melville
KM
,
Casey
LM
,
Kavanagh
DJ
.
Dropout from Internet-based treatment for psychological disorders
.
Br J Clin Psychol
.
2010
Nov
;
49
(
Pt 4
):
455
71
.
[PubMed]
0144-6657
24.
Twomey
C
,
O’Reilly
G
,
Byrne
M
,
Bury
M
,
White
A
,
Kissane
S
, et al.
A randomized controlled trial of the computerized CBT programme, MoodGYM, for public mental health service users waiting for interventions
.
Br J Clin Psychol
.
2014
Nov
;
53
(
4
):
433
50
.
[PubMed]
0144-6657
25.
Richards
D
,
Richardson
T
,
Timulak
L
,
McElvaney
J
.
The efficacy of internet-delivered treatment for generalized anxiety disorder: A systematic review and meta-analysis
.
Internet Interv
.
2015
;
2
(
3
):
272
82
. 2214-7829
26.
Gold
SM
,
Enck
P
,
Hasselmann
H
,
Friede
T
,
Hegerl
U
,
Mohr
DC
, et al.
Control conditions for randomised trials of behavioural interventions in psychiatry: a decision framework
.
Lancet Psychiatry
.
2017
Sep
;
4
(
9
):
725
32
.
[PubMed]
2215-0366
27.
Adhanom Ghebreyesus
T
.
WHO Director-General’s opening remarks at the media briefing on COVID-19
.
World Health Organization
;
2020
.
28.
Hollis
C
,
Morriss
R
,
Martin
J
,
Amani
S
,
Cotton
R
,
Denis
M
, et al.
Technological innovations in mental healthcare: harnessing the digital revolution
.
Br J Psychiatry
.
2015
Apr
;
206
(
4
):
263
5
.
[PubMed]
0007-1250
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.