***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED There is preliminary support for internet-delivered cognitive behaviour therapy ( iCBT ) as a way of improving access to treatment among older adults with anxiety . The aim of this r and omized controlled trial ( RCT ) was to examine the efficacy , long-term outcomes , and cost-effectiveness of an iCBT program for adults over 60 years of age with anxiety . Successful applicants were r and omly allocated to either the treatment group ( n=35 ) or the waitlist control group ( n=37 ) . The online treatment course was delivered over 8 weeks and provided with brief weekly contact with a clinical psychologist via telephone or secure email . Eighty-four percent of participants completed the iCBT course within the 8 weeks and 90 % provided data at posttreatment . Significantly lower scores on measures of anxiety ( Cohen 's d=1.43 ; 95 % CI : 0.89 - 1.93 ) and depression ( Cohen 's d=1.79 ; 95 % CI : 1.21 - 2.32 ) were found among the treatment group compared to the control group at posttreatment . These lower scores were maintained at 3-month and 12-month follow-up and the treatment group rated the iCBT treatment as acceptable . The treatment group had slightly higher costs ( $ 92.2 ; 95 % CI : $ 38.7 to $ 149.2 ) and Quality -Adjusted Life-Years ( QALYs=0.010 ; 95 % CI : 0.003 to 0.018 ) than the control group at posttreatment and the intervention was found to have a greater than 95 % probability of being cost-effective . The results support iCBT as an efficacious and cost-effective treatment option for older adults with symptoms of anxiety  . TRIAL REGISTRATION TRIAL REGISTRATION Australian and New Zeal and Clinical Trials Registry : ACTRN12611000929909 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?ACTRN=12611000929909 Patients with anxiety disorders exhibit excessive neural reactivity in the amygdala , which can be normalized by effective treatment like cognitive behavior therapy ( CBT ) . Mechanisms underlying the brain ’s adaptation to anxiolytic treatments are likely related both to structural plasticity and functional response alterations , but multimodal neuroimaging studies addressing structure – function interactions are currently missing . Here , we examined treatment-related changes in brain structure ( gray matter ( GM ) volume ) and function ( blood – oxygen level dependent , BOLD response to self-referential criticism ) in 26 participants with social anxiety disorder r and omly assigned either to CBT or an attention bias modification control treatment . Also , 26 matched healthy controls were included . Significant time × treatment interactions were found in the amygdala with decreases both in GM volume ( family-wise error ( FWE ) corrected PFWE=0.02 ) and BOLD responsivity ( PFWE=0.01 ) after successful CBT . Before treatment , amygdala GM volume correlated positively with anticipatory speech anxiety ( PFWE=0.04 ) , and CBT-induced reduction of amygdala GM volume ( pre – post ) correlated positively with reduced anticipatory anxiety after treatment ( PFWE⩽0.05 ) . In addition , we observed greater amygdala neural responsivity to self-referential criticism in socially anxious participants , as compared with controls ( PFWE=0.029 ) , before but not after CBT . Further analysis indicated that diminished amygdala GM volume mediated the relationship between decreased neural responsivity and reduced social anxiety after treatment ( P=0.007 ) . Thus , our results suggest that improvement-related structural plasticity impacts neural responsiveness within the amygdala , which could be essential for achieving anxiety reduction with CBT Background Major depression and depressive symptoms are common in patients with a recent myocardial infa rct ion ( MI ) , and depression is associated with adverse cardiovascular outcomes . Anxiety post-MI is less studied , but occurs commonly in patients with heart disease , and is also considered a risk factor for recurrence of cardiac events . Cognitive behavior therapy ( CBT ) is an established therapy for depression and anxiety disorders . To the best of our knowledge , there have not been any studies to determine if internet-based CBT ( iCBT ) can reduce the symptoms of depression and anxiety in patients with a recent MI . The main aim of the U-CARE Heart trial is to evaluate an iCBT intervention for patients with a recent MI . Methods / design This is a r and omized , controlled , prospect i ve study with a multicenter design . A total of 500 participants will be r and omized at a 1:1 ratio , around two months after an acute MI , to either iCBT or to a  control group . Both groups will receive an optimal st and ard of care according to guidelines . The intervention consists of a self-help program delivered via the internet with individual online support from a psychologist . Treatment duration is 14 weeks . The primary outcome is change in patients ’ self-rated anxiety and depression symptoms from baseline to end of treatment . An internal pilot study was conducted indicating sufficient levels of study acceptability and engagement in treatment . Discussion The present study is design ed to evaluate an iCBT intervention targeting symptoms of depression and anxiety in a post-MI population . If effective , iCBT has several advantages , and will potentially be implemented as an easily accessible treatment option added to modern st and ard of care . Trial registration This trial was registered with Clinical trials.gov ( identifier : NCT01504191 ) on 19 December 2011 Background Symptoms of anxiety and depression are prevalent in older adults . Aims To compare clinician-guided and self-guided versions of a transdiagnostic internet-delivered cognitive – behavioural therapy ( iCBT ) intervention for adults aged 60 years and above . Method Adults ( n=433 ) with symptoms of anxiety and depression were r and omly allocated to : ( 1 ) clinician-guided treatment ( n=153 ) ; ( 2 ) initial clinician interview followed by self-guided treatment ( n=140 ) ; or ( 3 ) self-guided treatment without interview ( n=140 ) . Results Large reductions ( d ≥1.00 ) in symptoms of depression and anxiety were observed across groups , and sustained at follow-up . No differences were observed in clinical outcomes or satisfaction ratings . Age did not affect outcomes . Conclusions Carefully developed iCBT interventions may significantly reduce symptoms of anxiety and depression  in older adults when delivered in either clinician-guided or self-guided formats . Declaration of interest N.T. and B.F.D. developed the Wellbeing Plus Course but derive no financial benefit from it . Copyright and usage © 2016 The Royal College of Psychiatrists . This is an open access article distributed under the terms of the Creative Commons Non-Commercial , No Derivatives ( CC BY-NC-ND ) licence Background Previous studies on Internet-based treatment with minimal therapist guidance have shown promising results for several specific diagnoses . Objective To ( 1 ) investigate the effects of a tailored , therapist-guided , Internet-based treatment for individuals with reoccurring panic attacks , and ( 2 ) to examine whether people in different age groups ( 18–30 years and 31–45 years ) would respond differently to the treatment . Methods We recruited 149 participants from an online list of individuals having expressed an interest in Internet treatment . Screening consisted of online question naires followed by a telephone interview . A total of 57 participants were included after a semistructured diagnostic interview , and they were r and omly assigned to an 8-week treatment program ( n = 29 ) or to a control condition ( n = 28 ) . Treatment consisted of individually prescribed cognitive behavior therapy text modules in conjunction with online therapist guidance . The control group consisted of people on a waitlist who later received treatment . Results All dependent measures improved significantly immediately following treatment and at the 12-month follow-up . The between-group effect size on the primary outcome measure , the Panic Disorder Severity Scale , was d = 1.41 ( 95 % confidence interval 0.81–1.95 ) at posttreatment . The within-group effect size from pretreatment to 12-month follow-up was d = 1.66 ( 95 % confidence interval 1.14–2.35 ) . Age group had no effect , suggesting that age did not influence the outcome . Conclusions Tailoring an Internet-based treatment can be a feasible approach in the treatment of panic symptoms and comorbid anxiety and depressive symptoms . Younger adults benefit as much as adults over 30 years and up to 45 years of age . Trial Registration Clinical trials.gov NCT01296321 ; http://www . clinical trials.gov/ct2/show/NCT01296321 ( Archived by WebCite at http://www.webcitation.org/65wddsqlL BACKGROUND To study the clinical relevance of type of comorbidity and number of comorbid disorders in anxiety disorders . Four groups were compared according to sociodemographic- , vulnerability- and clinical factors : single anxiety disorder , anxiety-anxiety comorbidity , anxiety-depressive comorbidity and " double " comorbidity ( i.e. anxiety and depressive comorbidity ) . METHODS Data were obtained from the Netherl and s Study of Anxiety and Depression ( NESDA ) . A sample of 1004 participants with a current anxiety disorder was evaluated . RESULTS As compared with single anxiety , anxiety-anxiety comorbidity was associated with higher severity , greater chronicity and more treatment . Anxiety-anxiety comorbidity was associated with an earlier age of onset and a more chronic course compared with anxiety-depressive comorbidity , while anxiety-depressive comorbidity was associated with more severe symptoms and more impaired functioning than anxiety-anxiety comorbidity . " Double " comorbidity was associated with higher severity , greater chronicity , more treatment and increased disability . Sociodemographic and vulnerability factors were comparable among the four groups . Limitations A prospect i ve design would be more appropriate to study the outcome . In this study no distinction was made between whether depression or anxiety disorder preceded the current anxiety disorder . CONCLUSIONS It is clinical relevant to diagnose and treat comorbidity among anxiety disorders as it is associated with higher severity and more chronicity . Whereas anxiety-anxiety comorbidity has an earlier age of onset and a more chronic course , anxiety-depressive comorbidity leads to more treatment and impaired functioning . " Double " comorbidity leads to even more severity , chronicity and impairment functioning compared with both anxiety-anxiety and anxiety-depressive comorbidity Transdiagnostic cognitive behaviour therapy ( TD-CBT ) aims to target the symptoms of multiple disorders whereas disorder-specific CBT ( DS-CBT ) targets the symptoms of principal disorders . This study compared the relative benefits of internet-delivered TD-CBT and DS-CBT when provided in clinician-guided ( CG-CBT ) and self-guided ( SG-CBT ) formats for people with a principal diagnosis of Panic Disorder ( PD ) . Participants ( n=145 ) were r and omly allocated to receive TD-CBT or DS-CBT and CG-CBT or SG-CBT .  Large reductions in symptoms of PD ( Cohen 's d ≥ 0.71 ; avg . reduction ≥ 36 % ) and moderate-to-large reductions in symptoms of comorbid depression ( Cohen 's d ≥ 0.71 ; avg . reduction ≥ 33 % ) , generalised anxiety disorder ( Cohen 's d ≥ 0.91 ; avg . reduction ≥ 34 % ) and social anxiety disorder ( Cohen 's d ≥ 0.50 ; avg . reduction ≥ 15 % ) were found over the 24-month follow-up period . Highlighting their efficacy and acceptability , no marked and consistent differences were observed between TD-CBT and DS-CBT or CG-CBT and DS-CBT Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Clinician-guided Internet-based cognitive behavioural therapy ( iCBT ) programs are clinical ly effective at treating specific anxiety disorders . The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment ( iCBT ) program to treat more than one anxiety disorder within the same program ( the Anxiety Program ) . Eighty six individuals meeting diagnostic criteria for generalized anxiety disorder ( GAD ) , panic disorder , and /or social phobia were r and omly assigned to a  treatment group  , or to a waitlist control group . Treatment consisted of CBT based online educational lessons and homework assignments , weekly email or telephone contact from a clinical psychologist , access to a moderated online discussion forum , and automated emails . An intention-to-treat model using the baseline-observation-carried-forward principle was employed for data analyses . Seventy-five percent of treatment group participants completed all 6 lessons within the 8 week program . Post-treatment data was collected from 38/40 treatment group and 38/38 control group participants , and 3-month follow-up data was collected from 32/40 treatment group participants . Relative to controls , treatment group participants reported significantly reduced symptoms of anxiety as measured by the Generalized Anxiety Disorder - 7 Item , Social Phob 
    Output:
    
There was a large effect on generic outcome measures and a moderate effect on comorbidities .
When compared to disorder-specific treatments there were no differences on anxiety and quality of life outcomes , however there were differences in depression outcomes .
Transdiagnostic and tailored iCBT are effective interventions for anxiety disorders and depression .