Clinician-assisted Internet-based treatment is effective for panic: A randomized controlled trial
To determine the efficacy of an Internet-based clinician-assisted cognitive behavioural treatment program (the Panic program) for panic disorder (with or without agoraphobia).
Fifty-nine individuals meeting diagnostic criteria for panic disorder with agoraphobia were randomly assigned to a treatment group or to a waitlist control group. Treatment group participants completed the Panic program, comprising six on-line lessons, weekly homework assignments, received weekly email contact from a psychiatry registrar, and contributed to a moderated online discussion forum with other participants. An intention-to-treat model was used for data analyses.
Twenty-three (79%) of treatment group participants completed all lessons within the 8-week program, and post-treatment data were collected from 22/29 treatment group and 22/25 waitlist group participants. Compared to the control group, treatment group participants reported significantly reduced symptoms of panic as measured by the Panic Disorder Severity Scale, Body Sensation Questionnaire, and Agoraphobic Cognitions Questionnaires. Significant reductions were also reported on measures of disability and depression. The mean within- and between-group effect size (Cohen's d) on the Panic Disorder Severity Scale was 0.93 and 0.59, respectively, and effects were sustained at 1-month follow-up. Mean therapist time per participant was 75 minutes for the program.
These results replicate those from the open trial of the Panic Program indicating the efficacy of the Internet-based clinician-assisted cognitive behavioural treatment program for panic disorder with agoraphobia.
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- "Internet-based cognitive behavioral therapy (iCBT) has been shown to be efficacious in the treatment of anxiety and depression. Specifically, the efficacy of iCBT has been demonstrated in the treatment of Generalized Anxiety Disorder (Robinson et al., 2010*, Cuijpers et al., 2009), 1 Social Anxiety Disorder (Titov et al., 2008b*, Titov et al., 2009a*, Titov et al., 2009b*, Carlbring et al., 2009), Panic Disorder with and without Agoraphobia (Wims et al., 2010*, Carlbring et al., 2006), Depression (Andersson and Cuijpers, 2009; Perini et al., 2009*), and mixed anxiety and depression (Titov et al., 2011*, Newby et al., 2013*). A recent metaanalysis of 22 studies demonstrated that iCBT had a mean effect size of 0.88 (Number needed to treat = 2.13; Andrews et al., 2010). "
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ABSTRACT: There is evidence from randomized control trials that internet-based cognitive behavioral therapy (iCBT) is efficacious in the treatment of anxiety and depression, and recent research demonstrates the effectiveness of iCBT in routine clinical care. The aims of this study were to implement and evaluate a new pathway by which patients could access online treatment by completing an automated assessment, rather than seeing a specialist health professional. We compared iCBT treatment outcomes in patients who received an automated pre-treatment questionnaire assessment with patients who were assessed by a specialist psychiatrist prior to treatment. Participants were treated as part of routine clinical care and were therefore not randomized. The results showed that symptoms of anxiety and depression decreased significantly with iCBT, and that the mode of assessment did not affect outcome. That is, a pre-treatment assessment by a psychiatrist conferred no additional treatment benefits over an automated assessment. These findings suggest that iCBT is effective in routine care and may be implemented with an automated assessment. By providing wider access to evidence-based interventions and reducing waiting times, the use of iCBT within a stepped-care model is a cost-effective way to reduce the burden of disease caused by these common mental disorders.
Internet Interventions 11/2014; 1(4). DOI:10.1016/j.invent.2014.10.003
Available from: Erik Hedman
- "Control conditions from published RCTs Carlbring et al. 2001 Carlbring et al. 2006 Wims et al. 2010 Within-group effect sizes "
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Guided Internet-based cognitive behaviour therapy (ICBT) for panic disorder has been shown to be efficacious in several randomized controlled trials. However, the effectiveness of the treatment when delivered within routine psychiatric care has not been studied. The aim of this study was to investigate the effectiveness of ICBT for panic disorder within the context of routine psychiatric care. Method
We conducted a cohort study investigating all patients (n=570) who had received guided ICBT for panic disorder between 2007 and 2012 in a routine care setting at an out-patient psychiatric clinic providing Internet-based treatment. The primary outcome measure was the Panic Disorder Severity Scale-Self-report (PDSS-SR). ResultsParticipants made large improvements from screening and pretreatment assessments to posttreatment (Cohen's d range on the PDSS-SR=1.07-1.55). Improvements were sustained at 6-month follow-up. Conclusion
This study suggests that ICBT for panic disorder is as effective when delivered in a routine care context as in the previously published randomized controlled trials.
Acta Psychiatrica Scandinavica 02/2013; 128(6). DOI:10.1111/acps.12079 · 5.61 Impact Factor
- "The Wellbeing program is based on evidence-based principles of CBT (Andrews et al., 2003) and comprises materials derived from existing disorder-specic iCBT programs for depression (Perini, Titov, & Andrews, 2009; Titov, Andrews, Davies, et al., 2010), GAD (Robinson et al., 2010), social phobia (Titov, Andrews, Schwencke, Drobny, & Einstein, 2008), and panic disorder (Wims et al., 2010). Because additional information about managing the symptoms of depression was required and this information could not easily be integrated into the previously reported internet-based unied protocol for anxiety disorders (Titov, Andrews, Davies, et al., 2010), a new program was created. "
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ABSTRACT: Disorder-specific cognitive behavioural therapy programs delivered over the internet (iCBT) with clinician guidance are effective at treating specific anxiety disorders and depression. The present study examined the efficacy of a transdiagnostic iCBT protocol to treat three anxiety disorders and/or depression within the same program (the Wellbeing Program). Seventy-seven individuals with a principal diagnosis of major depression, generalised anxiety disorder, panic disorder, and/or social phobia were randomly assigned to a Treatment or 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. Eighty one percent of Treatment group participants completed all 8 lessons within the 10 week program. Post-treatment data were collected from 34/37 Treatment group and 35/37 Control group participants, and 3-month follow-up data were collected from 32/37 Treatment group participants. Relative to Controls, Treatment group participants reported significantly reduced symptoms of anxiety and depression as measured by the Depression Anxiety and Stress Scales-21 item, Patient Health Questionnaire-9 item, and Generalised Anxiety Disorder-7 item scales, with corresponding between-groups effect sizes (Cohen's d) at post treatment of.56,.58, and.52, respectively. The clinician spent a mean time of 84.76 min (SD=50.37) per person over the program. Participants rated the procedure as highly acceptable, and gains were sustained at follow-up. These results provide preliminary support for the efficacy of transdiagnostic iCBT in the treatment of anxiety and depressive disorders.
Behaviour Research and Therapy 08/2011; 49(8):441-52. DOI:10.1016/j.brat.2011.03.007 · 3.85 Impact Factor
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