Hostname: page-component-7d684dbfc8-w65q4 Total loading time: 0 Render date: 2023-09-26T17:56:23.271Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "coreDisableSocialShare": false, "coreDisableEcommerceForArticlePurchase": false, "coreDisableEcommerceForBookPurchase": false, "coreDisableEcommerceForElementPurchase": false, "coreUseNewShare": true, "useRatesEcommerce": true } hasContentIssue false
  • English
  • Français

Internet cognitive–behavioural treatment for panic disorder: randomised controlled trial and evidence of effectiveness in primary care

Published online by Cambridge University Press:  02 January 2018

Adrian R. Allen ,
Jill M. Newby ,
Anna Mackenzie ,
Jessica Smith ,
Matthew Boulton ,
Siobhan A. Loughnan  and
Gavin Andrews
Adrian R. Allen*
Affiliation:
Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
Jill M. Newby
Affiliation:
Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
Anna Mackenzie
Affiliation:
Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
Jessica Smith
Affiliation:
Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
Matthew Boulton
Affiliation:
Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
Siobhan A. Loughnan
Affiliation:
Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
Gavin Andrews
Affiliation:
Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
*
Adrian R. Allen, Clinical Research Unit for Anxiety and Depression, Level 4, O'Brien Centre, St Vincent's Hospital, 394–404 Victoria Street, Darlinghurst 2010, NSW, Australia. Email: adrian.allen@unsw.edu.au
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not possible as this article does not have html content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background

Internet cognitive–behavioural therapy (iCBT) for panic disorder of up to 10 lessons is well established. The utility of briefer programmes is unknown.

Aims

To determine the efficacy and effectiveness of a five-lesson iCBT programme for panic disorder.

Method

Study 1 (efficacy): Randomised controlled trial comparing active iCBT (n=27) and waiting list control participants (n=36) on measures of panic severity and comorbid symptoms. Study 2 (effectiveness): 330 primary care patients completed the iCBT programme under the supervision of primary care practitioners.

Results

iCBT was significantly more effective than waiting list control in reducing panic (g=0.97, 95% CI 0.34 to 1.61), distress (g=0.92, 95% CI 0.28 to 1.55), disability (g=0.81, 95% CI 0.19 to 1.44) and depression (g=0.79, 95% CI 0.17 to 1.41), and gains were maintained at 3 months post-treatment (iCBT group). iCBT remained effective in primary care, but lower completion rates were found (56.1% in study 2 v. 63% in study 1). Adherence appeared to be related to therapist contact.

Conclusions

The five-lesson Panic Program has utility for treating panic disorder, which translates to primary care. Adherence may be enhanced with therapist contact.

Type
Research Article
Information
BJPsych Open , Volume 2 , Issue 2 , March 2016 , pp. 154 - 162
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Copyright
Copyright © The Royal College of Psychiatrists 2016

Footnotes

Declaration of interest

None.

References

1 Slade, T, Johnston, A, Oakley Browne, MA, Andrews, G, Whiteford, H. 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Aust NZ J Psychiatry 2009; 43: 594–605.CrossRefGoogle ScholarPubMed
2 Carlbring, P, Westling, BE, Ljungstrand, P, Ekselius, L, Andersson, G. Treatment of panic disorder via the Internet: a randomized trial of a self-help program. Behav Ther 2001; 32: 751–64.CrossRefGoogle Scholar
3 Olthuis, JV, Watt, MC, Bailey, K, Hayden, JA, Stewart, SH. Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev 2015; 3: CD011565.Google Scholar
4 Pier, C, Austin, DW, Klein, B, Mitchell, J, Schattner, P, Ciechomski, L, et al. A controlled trial of Internet-based cognitive-behavioural therapy for panic disorder with face-to-face support from a general practitioner or email support from a psychologist. Ment Health Fam Med 2008; 5: 29–39.Google ScholarPubMed
5 Hedman, E, Ljotsson, B, Ruck, C, Bergstrom, J, Andersson, G, Kaldo, V, et al. Effectiveness of Internet-based cognitive behaviour therapy for panic disorder in routine psychiatric care. Acta Psychiatr Scand 2013; 128: 457–67.CrossRefGoogle ScholarPubMed
6 Bergstrom, J, Andersson, G, Ljotsson, B, Ruck, C, Andreewitch, S, Karlsson, A, et al. Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial. BMC Psychiatry 2010; 10: 54.CrossRefGoogle Scholar
7 Kiropoulos, LA, Klein, B, Austin, DW, Gilson, K, Pier, C, Mitchell, J, et al. Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? J Anxiety Disord 2008; 22: 1273–84.CrossRefGoogle ScholarPubMed
8 Hedman, E, Ljotsson, B, Lindefors, N. Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Rev Pharmacoecon Outcomes Res 2012; 12: 745–64.CrossRefGoogle ScholarPubMed
9 van Ballegooijen, W, Riper, H, Klein, B, Ebert, DD, Kramer, J, Meulenbeek, P, et al. An Internet-based guided self-help intervention for panic symptoms: randomized controlled trial. J Med Internet Res 2013; 15: e154.CrossRefGoogle ScholarPubMed
10 Wims, E, Titov, N, Andrews, G, Choi, I. Clinician-assisted Internet-based treatment is effective for panic: a randomized controlled trial. Aust NZ J Psychiatry 2010; 44: 599–607.CrossRefGoogle ScholarPubMed
11 Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, et al. The Mini-international neuropsychiatric Interview (M.I.N.I): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59 (suppl 20): 22–33.Google ScholarPubMed
12 Kessler, RC, Ustun, TB. The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004; 13: 93–121.CrossRefGoogle Scholar
13 Shear, MK, Rucci, P, Williams, J, Frank, E, Grochocinski, V, Vander Bilt, J, et al. Reliability and validity of the Panic Disorder Severity Scale: replication and extension. J Psychiatr Res 2001; 35: 293–6.CrossRefGoogle Scholar
14 Houck, PR, Spiegel, DA, Shear, MK, Rucci, P. Reliability of the self-report version of the panic disorder severity scale. Depress Anxiety 2002; 15: 183–5.CrossRefGoogle ScholarPubMed
15 Kessler, R, Andrews, G, Colpe, L, Hiripi, E, Mroczek, D, Normand, S, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002; 32: 959–76.CrossRefGoogle ScholarPubMed
16 Furukawa, T, Kessler, R, Slade, T, Andrews, G. The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychol Med 2003; 33: 357–62.10.1017/S0033291702006700CrossRefGoogle ScholarPubMed
17 Kroenke, K, Spitzer, R, Williams, J. The PHQ-9: valdity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606–13.CrossRefGoogle Scholar
18 Zuithoff, N, Vergouwe, Y, King, M, Nazareth, I, van Wezep, M, Moons, K, et al. The Patient Health Questionnaire-9 for detection of major depressive disorder in primary care: consequences of current thresholds in a crosssectional study. BMC Fam Pract 2010; 11: 98.10.1186/1471-2296-11-98CrossRefGoogle Scholar
19 Wittkampf, KA, Naeije, L, Schene, AH, Huyser, J, van Weert, HC. Diagnostic accuracy of the mood module of the Patient Health Questionnaire: a systematic review. Gen Hosp Psychiatry 2007; 29: 388–95.CrossRefGoogle ScholarPubMed
20 Ustun, TB, Chatterji, S, Kostanjsek, N, Rehm, J, Kennedy, C, Epping-Jordan, J, et al. Developing the World Health Organization disability assessment schedule 2.0. Bull World Health Organ 2010; 88: 815–23.10.2471/BLT.09.067231CrossRefGoogle ScholarPubMed
21 Chopra, PK, Couper, JW, Herrman, H. The assessment of patients with long-term psychotic disorders: application of the WHO disability assessment schedule II. Aust NZ J Psychiatry 2004; 38: 753–9.CrossRefGoogle ScholarPubMed
22 Andrews, G, Kemp, A, Sunderland, M, von Korff, M, Ustun, TB. Normative data for the 12 item WHO disability assessment schedule 2.0. PLoS One 2009; 4: e8343.CrossRefGoogle ScholarPubMed
23 Costa, PTJ, McCrae, RR. The NEO Personality Inventory Manual. Psychological Assessment Resources, 1985.Google Scholar
24 Cuijpers, P, van Straten, A, Donker, M. Personality traits of patients with mood and anxiety disorders. Psychiatry Res 2005; 133: 229–37.CrossRefGoogle ScholarPubMed
25 Salim, A, Mackinnon, A, Christensen, H, Griffiths, K. Comparison of data analysis strategies for intent-to-treat analysis in pre-test–post-test designs with substantial dropout rates. Psychiatry Res 2008; 160: 335–45.CrossRefGoogle ScholarPubMed
26 Gueorguieva, R, Krystal, J. Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Arch Gen Psychiatry 2004; 61: 310–17.CrossRefGoogle ScholarPubMed
27 Furukawa, TA, Katherine Shear, M, Barlow, DH, Gorman, JM, Woods, SW, Money, R, et al. Evidence-based guidelines for interpretation of the Panic Disorder Severity Scale. Depress Anxiety 2009; 26: 922–9.CrossRefGoogle ScholarPubMed
28 Klein, B, Richards, JC, Austin, DW. Efficacy of internet therapy for panic disorder. J Behav Ther Exp Psychiatry 2006; 37: 213–38.CrossRefGoogle ScholarPubMed
29 Braunholtz, DA, Edwards, SJ, Lilford, RJ. Are randomized clinical trials good for us (in the short term)? Evidence for a “trial effect.” J Clin Epidemiol 2001; 54: 217–24.CrossRefGoogle ScholarPubMed
30 West, B, Welch, KB, Galecki, AT. Linear Mixed Models: A Practical Guide Using Statistical Software. Chapman & Hall/CRC, 2006.CrossRefGoogle Scholar
31 Jacobson, NS, Truax, P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991; 59: 12–19.CrossRefGoogle ScholarPubMed
32 Bergstrom, J, Andersson, G, Karlsson, A, Andreewitch, S, Ruck, C, Carlbring, P, et al. An open study of the effectiveness of Internet treatment for panic disorder delivered in a psychiatric setting. Nord J Psychiatry 2009; 63: 44–50.CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.