Psychiatry · Medical Literature
Extent of therapeutic support in Positive Psychotherapy: A randomized comparative efficacy study for the treatment of anxiety disorders in an online group setting.
Abstract
Positive Psychotherapy (PPT) is increasingly being studied as a potential treatment option for psychological diseases. In recent years the internet has been incorporated into traditional face-to-face therapy which, if successful in its treatment outcome, could lead to a more economic and affordable therapy since a certain proportion of therapy could be done without real-time therapist contact. The aim of this study is to investigate whether significant differences in outcome are found when comparing the effectiveness of PPT with complete therapeutic support (cPPT) in treating anxiety disorders compared to PPT with minimal therapeutic supervision (mPPT) in an online group setting. Participants in the cPPT group took part in ten weekly 120-minute online sessions with a therapist, while the mPPT group only had three 60-minute online sessions. For the remaining seven sessions, participants received videos. This paper presents the outcomes of both groups. This randomized controlled trial involved 106 participants allocated into either a group with complete therapeutic support (cPPT; n = 53) or a group with minimal supervision (mPPT; n = 53) for ten weeks. Data collection occurred through online questionnaires, evaluating anxiety levels, subjective happiness, quality of life, and psychological distress. These assessments were conducted at three time points: baseline (T0), post-intervention (T1), and three-month follow-up (T2). Significant improvements over time were observed in both the cPPT and mPPT groups across several outcomes. Anxiety symptoms decreased substantially from pre-treatment to post-treatment and remained stable at the three-month follow-up. Significant time effects were found for fear and anxiety-related outcomes, including FQ ([Formula: see text]), BAI ([Formula: see text]), PAS ([Formula: see text]), GAD-7 ([Formula: see text]), with gains maintained at the three-month follow-up. Positive psychological outcomes also improved significantly over time. Significant effects were observed for subjective well-being and flourishing, including PPTI ([Formula: see text]), FS ([Formula: see text]), and SWLS ([Formula: see text]). Psychological distress likewise decreased significantly across treatment. Significant time effects were found for ISR ([Formula: see text]), PHQ-9 ([Formula: see text]), with improvements remaining stable at follow-up. In all cases, there were no significant group × time interactions, indicating that the mPPT and cPPT groups showed comparable changes over time. Our study did not find significant differences between Positive Psychotherapy with minimal therapeutic supervision and PPT with complete therapeutic supervision. These findings challenge the traditional notion regarding the significance of face-to-face contact and therapist-patient interaction and suggest an economic and efficient alternative to the regular individual face-to-face therapy. As the participants were predominately female, further research should focus on a more gender-equal sample to generalize these findings.
Clinical relevance
This RCT addresses a critical question in the digital mental health space: whether therapist contact intensity in online Positive Psychotherapy (PPT) meaningfully affects clinical outcomes for anxiety disorder patients. With rising demand for mental health services and limited therapist availability, determining whether a low-contact, video-augmented model is non-inferior to fully therapist-guided treatment has direct implications for scalable, cost-effective care delivery. Clinicians and health systems considering stepped-care or telehealth models for anxiety disorders should evaluate these findings carefully.
Key findings
1. Both the complete PPT (cPPT; 10 weekly 120-min therapist-led sessions) and minimal PPT (mPPT; 3 therapist-led 60-min sessions + 7 video sessions) groups demonstrated significant within-group reductions in anxiety symptoms from baseline (T0) to post-intervention (T1), sustained at 3-month follow-up (T2), across multiple validated instruments. 2. Fear and anxiety-related outcomes showed significant time effects in both groups: Fear Questionnaire (FQ; p<0.05), Beck Anxiety Inventory (BAI; p<0.05), Panic and Agoraphobia Scale (PAS; p<0.05), and GAD-7 (p<0.05), with no specific effect sizes or CIs reported in the abstract. 3. Positive psychological outcomes improved significantly over time in both groups: PPT Inventory (PPTI; p<0.05), Flourishing Scale (FS; p<0.05), and Satisfaction with Life Scale (SWLS; p<0.05). 4. Psychological distress decreased significantly in both conditions: ICD-10 Symptom Rating (ISR; p<0.05) and PHQ-9 (p<0.05), with improvements stable at 3-month follow-up. 5. Critically, no significant group × time interactions were detected for any outcome measure, indicating statistical equivalence between cPPT and mPPT in rate and magnitude of change across all timepoints. 6. The RCT enrolled 106 participants (n=53 per arm); however, the sample was predominantly female, limiting generalizability, and no NNT, effect sizes (Cohen's d), or confidence intervals were provided in the abstract.
Practice implications
Clinicians delivering online group-based interventions for anxiety disorders may consider a minimal-contact PPT format — comprising as few as three live therapist sessions supplemented by structured video content — as a potentially equivalent alternative to fully therapist-guided care, supporting its use in stepped-care pathways or resource-limited settings. Patient selection should account for the study's predominantly female sample, and caution is warranted before extrapolating to male patients or to severe/complex anxiety presentations not well-represented in this trial. Until replication studies with larger, gender-balanced, and diagnostically diverse cohorts confirm these findings and report effect sizes and confidence intervals, full therapeutic support should remain the standard for patients with significant comorbidity or those failing low-intensity interventions.