BACKGROUND The effect of internet mediated cognitive behavioral therapy (iCBT) on anxiety in adults is considered to be well-known, although the dropout rates are usually high in these studies. Additional interventions might be needed to help patients cope with continued symptoms and stay in treatment even while they receive current evidence-based treatments. A key aspect for staying in treatment might be the feeling of support, belonging and being empowered by the treatment. Peer support means

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... that people with a previous personal experience of mental health problems are trained to work as professional support persons in mental health care. OBJECTIVE To assess the feasibility, safety, experiences, acceptability and preliminary effectiveness on psychosocial variables, empowerment and adherence to treatment of an 8-week iCBT-program with peer support for patients with anxiety disorders treated in primary care. METHODS This was a single-arm mixed-methods pilot study. Participants were recruited from patients who were referred to a central unit for iCBT in primary care. Quantitative data was collected on psychosocial variables, empowerment and functioning at pre-post and three months post intervention. Qualitative data was collected through semi-structured interviews. RESULTS Nine participants completed the quantitative outcome assessment. Statistically significant improvements were observed on empowerment at a three month follow up and significant decreases were observed on anxiety, depression and psychological distress at the end of the treatment and were maintained at a three month follow up. Eight of the nine patients were considered "improved" regarding the severity of the symptoms of anxiety. Adherence to treatment was good among the participants. No serious adverse events were reported. Eight participants were enrolled in the qualitative analysis. The qualitative results showed three main themes; 1) Real contact in an online world 2) Empowering experiences and 3) Being behind the wheel. Qualitative results in large emphasized the personal relationship and supported the acceptability of adding peer support in iCBT-treatment. CONCLUSIONS Peer support in digital treatment seem to be a safe and acceptable intervention that shows promising effect on a range of psychosocial variables. The results suggest preliminary support for the effectiveness of peer support on patient empowerment, reduction in psychological symptoms and on adherence to treatment. Results support the value of future studies evaluating the effect of peer support in iCBT in randomized controlled trials. CLINICALTRIAL ClinicalTrials.gov NCT04244617