{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:32:00Z","timestamp":1792643520739,"version":"4.5.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>Guided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of \u226510) and\/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of \u226510). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Participants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n\u2009=\u2009445), self-guided (n\u2009=\u2009439), or treatment as usual (n\u2009=\u2009435).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Remission of anxiety (GAD-7 scores of \u22644) and depression (PHQ-9 scores of \u22644) 3 months after baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.003) or treatment as usual (40.0% [2.7%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.007; self-guided i-CBT: 25.4% [8.8%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.004; treatment as usual: 31.0% [9.4%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.14; treatment as usual: 53.0% [6.0%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.001; treatment as usual: 41.8% [3.2%]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.07).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Guided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04780542\">NCT04780542<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2023.1675","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T15:07:17Z","timestamp":1686150437000},"page":"768","source":"Crossref","is-referenced-by-count":50,"title":["A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students"],"prefix":"10.1001","volume":"80","author":[{"given":"Corina","family":"Benjet","sequence":"first","affiliation":[{"name":"Center for Global Mental Health, National 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