Skip to main content
×
×
Home

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

  • Adrian R. Allen (a1), Jill M. Newby (a1), Anna Mackenzie (a1), Jessica Smith (a1), Matthew Boulton (a1), Siobhan A. Loughnan (a1) and Gavin Andrews (a1)...
Abstract
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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Internet cognitive–behavioural treatment for panic disorder: randomised controlled trial and evidence of effectiveness in primary care
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Internet cognitive–behavioural treatment for panic disorder: randomised controlled trial and evidence of effectiveness in primary care
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Internet cognitive–behavioural treatment for panic disorder: randomised controlled trial and evidence of effectiveness in primary care
      Available formats
      ×
Copyright
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/).
Corresponding author
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
Footnotes
Hide All

Declaration of interest

None.

Copyright and usage

© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Footnotes
References
Hide All
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: 594605.
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.
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.
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: 2939.
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.
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.
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.
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.
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.
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: 599607.
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): 2233.
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: 93121.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
23 Costa, PTJ, McCrae, RR. The NEO Personality Inventory Manual. Psychological Assessment Resources, 1985.
24 Cuijpers, P, van Straten, A, Donker, M. Personality traits of patients with mood and anxiety disorders. Psychiatry Res 2005; 133: 229–37.
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.
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.
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.
28 Klein, B, Richards, JC, Austin, DW. Efficacy of internet therapy for panic disorder. J Behav Ther Exp Psychiatry 2006; 37: 213–38.
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.
30 West, B, Welch, KB, Galecki, AT. Linear Mixed Models: A Practical Guide Using Statistical Software. Chapman & Hall/CRC, 2006.
31 Jacobson, NS, Truax, P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991; 59: 1219.
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: 4450.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Open
  • ISSN: -
  • EISSN: 2056-4724
  • URL: /core/journals/bjpsych-open
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 1
Total number of PDF views: 47 *
Loading metrics...

Abstract views

Total abstract views: 145 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 17th July 2018. This data will be updated every 24 hours.

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

  • Adrian R. Allen (a1), Jill M. Newby (a1), Anna Mackenzie (a1), Jessica Smith (a1), Matthew Boulton (a1), Siobhan A. Loughnan (a1) and Gavin Andrews (a1)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *