Usage and Longitudinal Effectiveness of a Web-Based Self-Help Cognitive Behavioral Therapy Program for Panic Disorder

Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada.
Journal of Medical Internet Research (Impact Factor: 3.43). 03/2005; 7(1):e7. DOI: 10.2196/jmir.7.1.e7
Source: PubMed


Anxiety disorders are common problems that result in enormous suffering and economic costs. The efficacy of Web-based self-help approaches for anxiety disorders has been demonstrated in a number of controlled trials. However, there is little data regarding the patterns of use and effectiveness of freely available Web-based interventions outside the context of controlled trials.
To examine the use and longitudinal effectiveness of a freely available, 12-session, Web-based, cognitive behavioral therapy (CBT) program for panic disorder and agoraphobia.
Cumulative anonymous data were analyzed from 99695 users of the Panic Center. Usage statistics for the website were examined and a longitudinal survey of self-reported symptoms for people who registered for the CBT program was conducted. The primary outcome measures were self-reported panic-attack frequency and severity at the beginning of each session (sessions 2-12).
Between September 1, 2002 and February 1, 2004, there were 484695 visits and 1148097 page views from 99695 users to the Panic Center. In that same time period, 1161 users registered for the CBT program. There was an extremely high attrition rate with only 12 (1.03%) out of 1161 of registered users completing the 12-week program. However, even for those who remained in the program less than 12 weeks we found statistically significant reductions (P<.002) in self-reported panic attack frequency and severity, comparing 2 weeks of data against data after 3, 6, or 8 weeks. For example, the 152 users completing only 3 sessions of the program reduced their average number of attacks per day from 1.03 (week 2) to 0.63 (week 3) (P<.001).
Freely available Web-based self-help will likely be associated with high attrition. However, for the highly self-selected group who stayed in the program, significant improvements were observed.

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Available from: R. Michael Bagby, Aug 26, 2014
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    • "Consistent with other online treatment trials that have low barriers to participation, offer minimal or no support and report between 1% and 37% adherence (Christensen et al. 2004a; Etter, 2005; Farvolden et al. 2005), attrition rates in this trial were high. "
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    ABSTRACT: BACKGROUND: Despite the high prevalence of postnatal depression (PND), few women seek help. The internet may increase timely access to treatment. We report a randomized controlled trial of a minimal intervention internet Behavioral Activation (iBA) treatment modified to address postnatal specific concerns (Postnatal-iBA). METHODS: Women (n=910) recruited via a popular UK parenting site,, scoring above 12 on the Edinburgh Postnatal Depression Scale (EPDS) were randomly assigned to receive either Postnatal-iBA delivered or treatment-as-usual (TAU). We investigated the feasibility (recruitment, trial and treatment adherence) and effectiveness (depression status EPDS >12) of the intervention. RESULTS: Recruitment was excellent; 1261 women, 961 of whom met inclusion criteria, signed up to the trial within two 2-week recruitment periods. Thirty-eight percent (343/910) of women completed the 15-week outcome assessment. Of those who completed 15-week assessment, fewer exceeded the depression cutoff in the Postnatal-iBA group (n=66/181) compared to TAU (n=91/162). Assuming all non-respondents remained depressed, the Postnatal-iBA effect was reduced. LIMITATIONS: The study suffered from high attrition and future trials need to consider strategies for improving outcome completion. Some women reported struggles "keeping up" with the treatment. CONCLUSIONS: A minimal support, widely accessible internet Behavioral Activation program for PND is feasible to deliver to community populations when embedded within popular parenting sites. For women who provide outcome data, postnatal-iBA offers promise as an effective treatment for PND. The addition of support may reduce women's struggles to keep pace with the treatment.
    Journal of Affective Disorders 04/2013; DOI:10.1016/j.jad.2013.03.005 · 3.38 Impact Factor
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    • "Refining the target group and role of the tool may go some way to improving rates of use. However, previous research found similar problems with continued motivation to use open-access online tools, with rates of completion as low as 1 % for a 12-week online program for panic (Farvolden et al. 2005), and for all modules of an open access site for depression (Christensen et al. 2004). Eysenbach (2005) highlights the importance of differentiating between attrition from a trial and non-usage of a site, stating that, with internet-based studies, usability and technological factors can affect website adherence. "
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    ABSTRACT: Background Moodscope is an entirely service-user-developed online mood-tracking and feedback tool with built-in social support, designed to stabilize and improve mood. Many free internet tools are available with no assessment of acceptability, validity or usefulness. This study provides an exemplar for future assessments. Method A mixed-methods approach was used. Participants with mild to moderate low mood used the tool for 3 months. Correlations between weekly assessments using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Assessment (GAD-7) with daily Moodscope scores were examined to provide validity data. After 3 months, focus groups and questionnaires assessed use and usability of the tool. Results Moodscope scores were correlated significantly with scores on the PHQ-9 and the GAD-7 for all weeks, suggesting a valid measure of mood. Low rates of use, particularly toward the end of the trial, demonstrate potential problems relating to ongoing motivation. Questionnaire data indicated that the tool was easy to learn and use, but there were concerns about the mood adjectives, site layout and the buddy system. Participants in the focus groups found the tool acceptable overall, but felt clarification of the role and target group was required. Conclusions With appropriate adjustments, Moodscope could be a useful tool for clinicians as a way of initially identifying patterns and influences on mood in individuals experiencing low mood. For those who benefit from ongoing mood tracking and the social support provided by the buddy system, Moodscope could be an ongoing adjunct to therapy.
    Psychological Medicine 11/2012; 43(7):1-10. DOI:10.1017/S0033291712002280 · 5.94 Impact Factor
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    • "Recent years have seen a rise in randomized controlled trials that investigated structured treatment programs for a variety of psychosomatic and health-related psychological issues [24], [25], [26], [27], [28], [29], [30], [31], [32], but empirical data for one-on-one online therapy is limited to case studies and exploratory pilot studies [33], [34], [35]. Generally, there is a lack of both exploratory empirical observations and controlled studies of online therapy’s feasibility and effectiveness for oncological patients. "
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    ABSTRACT: Objectives: The internet offers new possibilities in psychosocial patient care. However, empirical data are lacking for oncological patients. A field-experimental study was conducted to obtain initial data to enable evaluation of the effectiveness of online counseling via e-mail for breast cancer patients. A secondary objective was to explore how patients reached by the service can be characterized on psychosocial status and illness. Methods: On a dedicated German-language website, 235 breast cancer patients registered for psychosocial counseling via e-mail. 133 registrants were randomly assigned to a treatment group to receive immediate counseling or to a waiting list control group. The two-month counseling session took the form of a psychoeducation, individually tailored to each patient. Psychosocial outcome measures including psychological distress (BSI) and quality of life (EORTC QLQ-C30) were assessed at registration and at a two-month follow-up. Descriptive data were recorded at registration. At the conclusion of the program, participants were asked to complete a patient satisfaction questionnaire (ZUF-8). Results: BSI responses showed that 85% of all patients were initially diagnosable with comorbid psychopathology. Despite high severity of distress and attendant large reductions in quality of life, 72% of all patients were not obtaining conventional assistance. Among counseling participants (n=31), no significant improvements in distress or quality of life were found in comparison to the control group (n=34), but patient satisfaction was nonetheless high. Conclusion: The study demonstrates that online counseling via e-mail reaches patients with unmet therapeutic needs, but also indicated its limitations, suggesting that the online setting may be most useful for prompting and supporting a transition to conventional counseling services.
    GMS Psycho-Social-Medicine 09/2011; 8:Doc05. DOI:10.3205/psm000074
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