Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT?

Kiropoulos, Litza A.; Klein, Britt; Austin, David W.; Gilson, Kathryn; Pier, Ciaran; Mitchell, Joanna; Ciechomski, Lisa

doi:10.1016/j.janxdis.2008.01.008

Cited by 290Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT?

Kiropoulos, Litza A., Klein, Britt, Austin, David W., Gilson, Kathryn, Pier, Ciaran, Mitchell, Joanna, Ciechomski, Lisa·2008·Journal of Anxiety Disorders

DOI 10.1016/j.janxdis.2008.01.008

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Abstract

This study compared Panic Online (PO), an internet-based CBT intervention, to best-practice face-to-face CBT for people with panic disorder with or without agoraphobia. Eighty-six people with a primary diagnosis of panic disorder were recruited from Victoria, Australia. Participants were randomly assigned to either PO (n=46) or best practice face-to-face CBT (n=40). Effects of the internet-based CBT program were found to be comparable to those of face-to-face CBT. Both interventions produced significant reductions in panic disorder and agoraphobia clinician severity ratings, self reported panic disorder severity and panic attack frequency, measures of depression, anxiety, stress and panic related cognitions, and displayed improvements in quality of life. Participants rated both treatment conditions as equally credible and satisfying. Participants in the face-to-face CBT treatment group cited higher enjoyment with communicating with their therapist. Consistent with this, therapists' ratings for compliance to treatment and understanding of the CBT material was higher in the face-to-face CBT treatment group. PO required significantly less therapist time than the face-to-face CBT condition.

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Internet-delivered psychological treatments for anxiety and phobias are feasible, acceptable, and effective.
“Thus, Internet-delivered psychological treatments for anxiety and phobias are feasible, acceptable, and effective.”
From Short-term effectiveness of web-based guided self-help for phobic outpatients: randomized controlled trial. (2014) · cites this paper as [22]
This dropout seems to reflect the reality of trials conducted in routine mental health care, as comparable rates were found in earlier clinical trials comparing iCBT with ftfCBT; it could not be prevented by our e-mail and telephone reminders.
“This dropout seems to reflect the reality of trials conducted in routine mental health care, as comparable rates were found in earlier clinical trials comparing iCBT with ftfCBT [65, 74–77]; it could not be prevented by our e-mail and telephone reminders.”
From Acceptability, effectiveness and cost-effectiveness of blended cognitive-behavioural therapy (bCBT) versus face-to-face CBT (ftfCBT) for anxiety disorders in specialised mental health care: A 15-week randomised controlled trial with 1-year follow-up (2021) · cites this paper as [76]

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Titov, N., Andrews, G., Choi, I., Schwencke, G., & Mahoney, A. (2008) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670802512107 · Cited by 221 · see citing works
Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress: Lessons Learned From Prolonged Exposure Therapy for PTSD
Foa, E., Gillihan, S. J., & Bryant, R. (2013) · Psychological Science in the Public Interest · doi:10.1177/1529100612468841 · Cited by 211 · see citing works
“Crucially, computer-based CBT programs can be as effective as face-to-face therapy in managing anxiety and depression conditions (Kiropoulos et al., 2008; Selmi, Klein, Greist, Sorrell, & Erdman, 1990).”
Background
Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of depression: a randomized controlled trial
Titov, N., Dear, B. F., Ali, S., Zou, J. B., Lorian, C. N., Johnston, L., Terides, M. D., Kayrouz, R., Klein, B., Gandy, M., et al. (2015) · Behavior Therapy · doi:10.1016/j.beth.2014.09.008 · Cited by 210 · see citing works
Self-citation
Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder
Andersson, G., Paxling, B., Wiwe, M., Vernmark, K., Felix, C. B., Lundborg, L., Furmark, T., Cuijpers, P., & Carlbring, P. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.05.003 · Cited by 202 · see citing works
“Equal outcomes have been found in studies on panic disorder (Bergström et al., 2010; Carlbring et al., 2005; Kiropoulos et al., 2008), social anxiety disorder (Andrews, Davies, & Titov, 2011; Hedman et al., 2011), and subclinical depression (Spek, Nyklicek et al., 2007), but also in studies on…”
Result
Collateral outcomes in e-mental health: a systematic review of the evidence for added benefits of computerized cognitive behavior therapy interventions for mental health.
Musiat, P., & Tarrier, N. (2014) · Psychological Medicine · doi:10.1017/s0033291714000245 · Cited by 188 · see citing works
Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression
Andersson, G., Hesser, H., Veilord, A., Svedling, L., Andersson, F., Sleman, O., Mauritzson, L., Sarkohi, A., Claesson, E., Zetterqvist, V., et al. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.08.022 · Cited by 195 · see citing works
“In the field of anxiety disorders there are direct comparative trials, for example on panic disorder (Bergström et al., 2010; Kiropoulos et al., 2008), and social anxiety disorder (Hedman et al.”
Background
Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial
Bergström, J., Andersson, G., Ljótsson, B., Rück, C., Andréewitch, S., Karlsson, A., Carlbring, P., Andersson, E., & Lindefors, N. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-54 · Cited by 202 · see citing works
“We hypothesized that the two treatment formats would both be effective, based on the established efficacy of both group [8] and Internet delivered CBT [20], and two previous efficacy studies comparing live individual and Internet treatment [21,22] which showed no major differences between the two treatment formats.”
Background
Internet-based treatment for social phobia: A randomized controlled trial
Berger, T., Hohl, E., & Caspar, F. (2009) · Journal of Clinical Psychology · doi:10.1002/jclp.20603 · Cited by 198 · see citing works
Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial
Titov, N., Andrews, G., Johnston, L., Robinson, E., & Spence, J. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.05.014 · Cited by 196 · see citing works
A systematic review of internet-based therapy for the treatment of addictions
Gainsbury, S., & Blaszczynski, A. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.11.007 · Cited by 192 · see citing works
Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review
Lewis, C., Pearce, J., & Bisson, J. I. (2012) · British Journal of Psychiatry · doi:10.1192/bjp.bp.110.084756 · Cited by 189 · see citing works
Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: A meta-analysis.
Hofmann, S. G., Wu, J. Q., & Boettcher, H. (2014) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0035491 · Cited by 191 · see citing works
Best Practices in Online Therapy
Abbott, J.-A. M., Klein, B., & Ciechomski, L. (2008) · Journal of Technology in Human Services · doi:10.1080/15228830802097257 · Cited by 185 · see citing works
Self-citation
Therapist Experience and Knowledge Acquisition in Internet-Delivered CBT for Social Anxiety Disorder: A Randomized Controlled Trial
Andersson, G., Carlbring, P., Furmark, T., & on behalf of the S. O. F. I. E. Research Group (2012) · PLoS ONE · doi:10.1371/journal.pone.0037411 · Cited by 166 · see citing works
The working alliance in a randomized controlled trial comparing online with face-to-face cognitive-behavioral therapy for depression
Preschl, B., Maercker, A., & Wagner, B. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-189 · Cited by 158 · see citing works
“Our study contributes to a better understanding of the working alliance in internet-supported therapeutic interventions, replicating previous findings [18,20,22-25] showing that a strong working alliance can be established in an online setting, comparable to that established in faceto-face settings.”
BackgroundMethodResult
Effectiveness of cognitive-behavioural therapy on glycaemic control and psychological outcomes in adults with diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials
Uchendu, C., & Blake, H. (2017) · Diabetic Medicine · doi:10.1111/dme.13195 · Cited by 157 · see citing works
Internet-based guided self-help for several anxiety disorders: A randomized controlled trial comparing a tailored with a standardized disorder-specific approach.
Berger, T., Boettcher, J., & Caspar, F. (2014) · Psychotherapy · doi:10.1037/a0032527 · Cited by 158 · see citing works
Effectiveness Randomized Controlled Trial of Face to Face Versus Internet Cognitive Behaviour Therapy for Social Phobia
Andrews, G., Davies, M., & Titov, N. (2011) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048674.2010.538840 · Cited by 152 · see citing works
Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults
Olthuis, J. V., Watt, M. C., Bailey, K., Hayden, J. A., & Stewart, S. H. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011565 · Cited by 150 · see citing works
Guided Internet-Delivered Cognitive Behavior Therapy for Generalized Anxiety Disorder: A Randomized Controlled Trial
Paxling, B., Almlöv, J., Dahlin, M., Carlbring, P., Breitholtz, E., Eriksson, T., & Andersson, G. (2011) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.576699 · Cited by 147 · see citing works
“However, previous randomized controlled trials on panic disorder suggest that the two treatment formats can both be effective (Carlbring et al, 2005 ; Kiropoulos et al, 2008 ), and the effect sizes in our study and in Titov et al.”
BackgroundResult
Clinician-Assisted Internet-Based Treatment is Effective for Generalized Anxiety Disorder: Randomized Controlled Trial
Titov, N., Andrews, G., Robinson, E., Schwencke, G., Johnston, L., Solley, K., & Choi, I. (2009) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670903179269 · Cited by 147 · see citing works
Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled trial
Nordgren, L. B., Hedman, E., Etienne, J., Bodin, J., Kadowaki, Å., Eriksson, S., Lindkvist, E., Andersson, G., & Carlbring, P. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.05.007 · Cited by 145 · see citing works
Therapeutic alliance in guided internet therapy programs for depression and anxiety disorders – A systematic review
Pihlaja, S., Stenberg, J.-H., Joutsenniemi, K., Mehik, H., Ritola, V., & Joffe, G. (2018) · Internet Interventions · doi:10.1016/j.invent.2017.11.005 · Cited by 134 · see citing works
“…program rather than with the internet therapist (Berger et al., 2014; Clarke et al., 2016, 32,33), and four others (Hadjistavropoulos et al., 2016; Kiropoulos et al., 2008; Lindner et al., 2014; Reynolds et al., 2006) made no exploration of the association of therapeutic alliance with outcome.”
Background
Effectiveness of Internet‐based cognitive behaviour therapy for panic disorder in routine psychiatric care
Hedman, E., Ljótsson, B., Rück, C., Bergström, J., Andersson, G., Kaldo, V., Jansson, L., Andersson, E., Andersson, E., Blom, K., et al. (2013) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12079 · Cited by 144 · see citing works
Brief cognitive-behavioral internet therapy for irritable bowel syndrome
Hunt, M. G., Moshier, S., & Milonova, M. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.05.002 · Cited by 139 · see citing works
Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews
Barnett, P., Goulding, L., Casetta, C., Jordan, H., Sheridan-Rains, L., Steare, T., Williams, J., Wood, L., Gaughran, F., & Johnson, S. (2021) · Journal of Medical Internet Research · doi:10.2196/26492 · Cited by 136 · see citing works
Computer-Aided Psychological Treatments: Evolving Issues
Marks, I., & Cavanagh, K. (2009) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.032408.153538 · Cited by 133 · see citing works
Internet‐Based Treatment for Panic Disorder: Does Frequency of Therapist Contact Make a Difference?
Klein, B., Austin, D., Pier, C., Kiropoulos, L., Shandley, K., Mitchell, J., Gilson, K., & Ciechomski, L. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070802561132 · Cited by 123 · see citing works
“In addition, the Treatment Satisfaction Questionnaire (TSQ; Cox, Fergus, & Swinson, 1994) was used as in our previous three studies (Kiropoulos et al., 2008; Klein et al., 2006; Richards et al., 2006).”
MethodSelf-citation
Guided internet-based CBT for common mental disorders
Andersson, G., Carlbring, P., Ljótsson, B., & Hedman, E. (2013) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-013-9237-9 · Cited by 119 · see citing works
“for panic disorder (Kiropoulos et al. 2008), and one additional Swedish effectiveness trial showing similar findings (Bergström et al.”
Result
A therapist-assisted cognitive behavior therapy internet intervention for posttraumatic stress disorder: Pre-, post- and 3-month follow-up results from an open trial
Klein, B., Mitchell, J., Abbott, J.-A., Shandley, K. A., Austin, D., Gilson, K., Kiropoulos, L. A., Cannard, G., & Redman, T. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.04.005 · Cited by 124 · see citing works
“Simlarly high levels of therapeutic alliance have also been found in ur other trials of our internet-based program for Panic Disorder, Panic Online’ (Kiropoulos et al., 2008; Klein, Austin, et al., 2009; lein et al., 2006).”
BackgroundSelf-citation
Insomnia before and after treatment for anxiety and depression
Mason, E. C., & Harvey, A. G. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.07.020 · Cited by 124 · see citing works
Anxiety Online—A Virtual Clinic: Preliminary Outcomes Following Completion of Five Fully Automated Treatment Programs for Anxiety Disorders and Symptoms
Klein, B., Meyer, D., Austin, D. W., & Kyrios, M. (2011) · Journal of Medical Internet Research · doi:10.2196/jmir.1918 · Cited by 118 · see citing works
“Additionally, therapist-assisted e-therapy treatment programs have been found to be as effective as best-practice face-to-face therapy [13,27].”
BackgroundSelf-citation
Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults
Mayo-Wilson, E., & Montgomery, P. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005330.pub4 · Cited by 112 · see citing works
Attitudes Toward Psychological Telehealth: Current and Future Clinical Psychologists’ Opinions of Internet‐Based Interventions
Perle, J. G., Langsam, L. C., Randel, A. B., Lutchman, S., Levine, A. B., Odland, A. P., Nierenberg, B. P., & Marker, C. D. (2012) · Journal of Clinical Psychology · doi:10.1002/jclp.21912 · Cited by 118 · see citing works
The Working Alliance Inventory for guided Internet interventions (WAI‐I)
Gómez Penedo, J. M., Berger, T., grosse Holtforth, M., Krieger, T., Schröder, J., Hohagen, F., Meyer, B., Moritz, S., & Klein, J. P. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.22823 · Cited by 100 · see citing works
The relationship between persuasive technology principles, adherence and effect of web-Based interventions for mental health: A meta-analysis
Wildeboer, G., Kelders, S. M., & van Gemert-Pijnen, J. E. W. C. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.04.005 · Cited by 98 · see citing works
An RCT Comparing Effect of Two Types of Support on Severity of Symptoms for People Completing Internet-Based Cognitive Behaviour Therapy for Social Phobia
Titov, N., Andrews, G., Schwencke, G., Solley, K., Johnston, L., & Robinson, E. (2009) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670903179228 · Cited by 112 · see citing works
Internet-delivered cognitive behavioural therapy in the treatment of psychiatric illness
Gratzer, D., & Khalid-Khan, F. (2015) · Canadian Medical Association Journal · doi:10.1503/cmaj.150007 · Cited by 111 · see citing works
The association between therapeutic alliance and outcome in internet-based psychological interventions: A meta-analysis
Kaiser, J., Hanschmidt, F., & Kersting, A. (2020) · Computers in Human Behavior · doi:10.1016/j.chb.2020.106512 · Cited by 105 · see citing works
Establishing and Governing e-Mental Health Care in Australia: A Systematic Review of Challenges and A Call For Policy-Focussed Research.
Meurk, C., Leung, J., Hall, W., Head, B. W., & Whiteford, H. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.4827 · Cited by 105 · see citing works
“…with panic disorder Compare the effectiveness of iCBT versus face-to-face CBT for panic disorder and agoraphobia (B, II-EU) Kiropoulos et al, 2008 [37] Low; T 225 people self-selected for e-therapy programs Evaluate the Anxiety Online programs (B, II-EU) Klein et al, 2011 [38] Low; T 22 adults…”
Psychotherapy for inflammatory bowel disease: a review and update
McCombie, A. M., Mulder, R. T., & Gearry, R. B. (2013) · Journal of Crohn s and Colitis · doi:10.1016/j.crohns.2013.02.004 · Cited by 105 · see citing works
Cognitive behavioral therapy, mindfulness-based cognitive therapy and acceptance commitment therapy for anxiety disorders: Integrating traditional with digital treatment approaches
Apolinário-Hagen, J., Drüge, M., & Fritsche, L. (2020) · Advances in Experimental Medicine and Biology · doi:10.1007/978-981-32-9705-0_17 · Cited by 100 · see citing works
Clinicians' Attitudes Towards the Use of Computerized Cognitive Behaviour Therapy (cCBT) with Children and Adolescents
Stallard, P. N., Richardson, T. H., & Velleman, S. C. (2010) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465810000421 · Cited by 102 · see citing works
“For example, previous research has demonstrated that participants may ﬁnd cCBT too demanding (Andersson et al., 2005), and/or have problems with computer or internet access (Carlbring, Westling, Ljungstrand, Ekselius and Andersson, 2001; Kiropoulos et al., 2008).”
BackgroundMethod
Internet-based self-help versus one-session exposure in the treatment of spider phobia: a randomized controlled trial
Andersson, G., Waara, J., Jonsson, U., Malmaeus, F., Carlbring, P., & Öst, L. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070902931326 · Cited by 101 · see citing works
“…social anxiety (e.g. Andersson et al., 2006, Titov, Andrews, Schwencke, Drobny, & Einstein, 2008) and panic (e.g. Carlbring, Westling, Ljungstrand, Ekselius, & Andersson, 2001; Kiropoulos et al., 2008) disorders, we wanted to test whether the approach would be beneficial for spider phobia as well.”
Background
Characteristics of Adults with Anxiety or Depression Treated at an Internet Clinic: Comparison with a National Survey and an Outpatient Clinic
Titov, N., Andrews, G., Kemp, A., & Robinson, E. (2010) · PLoS ONE · doi:10.1371/journal.pone.0010885 · Cited by 97 · see citing works
A mobile app–based intervention for depression: end-user and expert usability testing study
Fuller-Tyszkiewicz, M., Richardson, B., Klein, B., Skouteris, H., Christensen, H., Austin, D., Castle, D., Mihalopoulos, C., O'Donnell, R., Arulkadacham, L., et al. (2018) · JMIR Mental Health · doi:10.2196/mental.9445 · Cited by 98 · see citing works
“The past decade has seen increasing use of technology to enhance access to, and engagement with, treatments previously established as efficacious when delivered face-to-face [10,11].”
BackgroundSelf-citation
Web-based treatment for infertility-related psychological distress
Sexton, M. B., Byrd, M. R., O’Donohue, W., & Jacobs, N. (2010) · Archives of Women s Mental Health · doi:10.1007/s00737-009-0142-x · Cited by 97 · see citing works
“Specific psychological and physiological concerns such as depression (Spek et al. 2007), anxiety (Kiropoulos et al. 2008; Tillfors et al. 2008), weight control and eating disorders (Hunter et al. 2008), substance abuse and smoking cessation interventions (Brendryen and Kraft 2008; FinfgeldConnett…”
Background
Phishing Happens Beyond Technology: The Effects of Human Behaviors and Demographics on Each Step of a Phishing Process
Abroshan, H., Devos, J., Poels, G., & Laermans, E. (2021) · IEEE Access · doi:10.1109/access.2021.3066383 · Cited by 107 · see citing works
“This could be deliverable through Internet-based psychotherapies such Internet-based Cognitive Behavioural Therapy (iCBT) [36], [132], [133].”
Background
The dissemination of computer-based psychological treatment: A preliminary analysis of patient and clinician perceptions
Carper, M. M., McHugh, R. K., & Barlow, D. H. (2013) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-011-0377-5 · Cited by 92 · see citing works
Challenges and opportunities in internet-mediated telemental health.
Yuen, E. K., Goetter, E. M., Herbert, J. D., & Forman, E. M. (2012) · Professional Psychology: Research and Practice · doi:10.1037/a0025524 · Cited by 89 · see citing works
“…et al., 2010), social anxiety disorder (Berger et al., 2009; Carlbring, Furmark, Steczko, Ekselius, & Andersson, 2006; Carlbring et al., 2007; Kiropoulos et al., 2008; Titov, Andrews, & Schwencke, 2008; Titov, Andrews, Schwencke, Drobny, & Einstein, 2008), posttraumatic stress disorder…”
Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder: Pilot Single-Arm Trial
Matsumoto, K., Sutoh, C., Asano, K., Seki, Y., Urao, Y., Yokoo, M., Takanashi, R., Yoshida, T., Tanaka, M., Noguchi, R., et al. (2018) · Journal of Medical Internet Research · doi:10.2196/12091 · Cited by 83 · see citing works
“ICBT has been shown to be effective for OCD, PD, and SAD from several randomized controlled trials [19-35].”
Shyness programme: Longer term benefits, cost-effectiveness, and acceptability
Titov, N., Andrews, G., Johnston, L., Schwencke, G., & Choi, I. (2009) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670802534424 · Cited by 88 · see citing works
Telepsychiatry
Hilty, D. M., Yellowlees, P., Parrish, M. B., & Chan, S. R. (2015) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2015.05.006 · Cited by 88 · see citing works
The COMTval158met polymorphism is associated with symptom relief during exposure-based cognitive-behavioral treatment in panic disorder
Lonsdorf, T. B., Rück, C., Bergström, J., Andersson, G., Öhman, A., Lindefors, N., & Schalling, M. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-99 · Cited by 88 · see citing works
“Additionally and importantly, it has been demonstrated convincingly that iCBT and gCBT do not differ in their efficacy in the treatment of PD [27-29,13].”
Background
Disorder-specific versus transdiagnostic and clinician-guided versus self-guided internet-delivered treatment for panic disorder and comorbid disorders: a randomized controlled trial
Fogliati, V. J., Dear, B. F., Staples, L. G., Terides, M. D., Sheehan, J., Johnston, L., Kayrouz, R., Dear, R., McEvoy, P. M., & Titov, N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.03.005 · Cited by 86 · see citing works
“…for improving access to treatment. nfortunately, although some studies have shown good outcomes an be obtained with very little clinician contact (Klein et al., 2009), Disorders 39 (2016) 88–102 89 no studies have directly compared the acceptability or efficacy of self-guided and…”
Background
“Like Drawing Into Sand”: Acceptability, Feasibility, and Appropriateness of a New e‐Mental Health Resource for Service Providers Working With Aboriginal and Torres Strait Islander People
Dingwall, K. M., Puszka, S., Sweet, M., & Nagel, T. (2015) · Australian Psychologist · doi:10.1111/ap.12100 · Cited by 71 · see citing works
Advances in mobile mental health: opportunities and implications for the spectrum of e-mental health services
Hilty, D. M., Chan, S. R., Hwang, T., Wong, A., & Bauer, A. M. (2017) · mHealth · doi:10.21037/mhealth.2017.06.02 · Cited by 86 · see citing works
“Online MH interventions are also as effective as traditional in-person therapy for disorders such as depression and anxiety (67-69).”
Background
A Therapist‐Assisted Internet‐Based CBT Intervention for Posttraumatic Stress Disorder: Preliminary Results
Klein, B., Mitchell, J., Gilson, K., Shandley, K. A., Austin, D., Kiropoulos, L. A., Abbott, J.-A., & Cannard, G. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070902803483 · Cited by 82 · see citing works
“…the latter being a modified version of the validated Helping Alliance Questionnaire (Bassler, Potratz, & Krauthauser, 1995; Luborsky, 1985) and used previously in other Internet-based intervention trial studies (see Kiropoulos et al., 2008; Klein et al., 2006; Richards, Klein, & Austin, 2006).”
BackgroundMethodSelf-citation
The working alliance in a randomized controlled trial comparing Internet-based self-help and face-to-face cognitive behavior therapy for chronic tinnitus
Jasper, K., Weise, C., Conrad, I., Andersson, G., Hiller, W., & Kleinstäuber, M. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.04.002 · Cited by 68 · see citing works
“, 2011), and the other panic disorders (Kiropoulos et al., 2008).”
BackgroundResultInfluential
Are Internet- and mobile-based interventions effective in adults with diagnosed panic disorder and/or agoraphobia? A systematic review and meta-analysis
Domhardt, M., Letsch, J., Kybelka, J., Koenigbauer, J., Doebler, P., & Baumeister, H. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.06.059 · Cited by 75 · see citing works
Computer-assisted cognitive-behavioral therapy.
Spurgeon, J. A., & Wright, J. H. (2010) · Current Psychiatry Reports · doi:10.1007/s11920-010-0152-4 · Cited by 67 · see citing works
“Klein et al. [33] built on the work of Kiropoulos and coworkers [ 32 ] by investigating the amount of therapist time needed for Panic Online to be a successful intervention.”
Background
Ethical and legal considerations for internet-based psychotherapy
Dever Fitzgerald, T., Hunter, P. V., Hadjistavropoulos, T., & Koocher, G. P. (2010) · Cognitive Behaviour Therapy · doi:10.1080/16506071003636046 · Cited by 69 · see citing works
“…that seek to directly regulate IBP have begun circulating (e.g., the Telemedicine Development Act, 1996), and clinicians have begun to develop Internet-based services, including Internet-based treatment protocols for specific conditions (e.g. Kiropoulos et al., 2008; B. Klein et al., 2009).”
BackgroundResultInfluential
Therapeutic Alliance in Internet‐Delivered Cognitive Behaviour Therapy for Depression or Generalized Anxiety
Hadjistavropoulos, H. D., Pugh, N. E., Hesser, H., & Andersson, G. (2017) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2014 · Cited by 61 · see citing works
“Across trials, a strong therapeutic relationship has consistently been found using standardized measures, such as the Working Alliance Inventory-12 item (Tracey & Kokotovic, 1989) and the Therapeutic Alliance Questionnaire (Kiropoulos et al., 2008).”
BackgroundMethodInfluential
The role of self-help in the treatment of mild anxiety disorders in young people: an evidence-based review
Rickwood, D., & Bradford (2012) · Psychology Research and Behavior Management · doi:10.2147/prbm.s23357 · Cited by 62 · see citing works
Current perspectives on Internet delivered cognitive behavioral therapy for adults with anxiety and related disorders
Mewton, L., Smith, J., Rossouw, P., & Andrews, G. (2014) · Psychology Research and Behavior Management · doi:10.2147/prbm.s40879 · Cited by 57 · see citing works
The Psychiatrist-Patient Relationship of the Future: Anytime, Anywhere?
Yellowlees, P., & Nafiz, N. (2010) · Harvard Review of Psychiatry · doi:10.3109/10673221003683952 · Cited by 62 · see citing works
Selection of intervention components in an internet stop smoking participant preference trial: Beyond randomized controlled trials
Schueller, S. M., Leykin, Y., Pérez‐Stable, E. J., & Muñoz, R. F. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.08.030 · Cited by 61 · see citing works
“Guided, therapist-assisted, internet interventions can be as effective as face-to-face interventions at a lower cost (Kiropoulos et al., 2008).”
EMDR in Telemental Health Counseling for Healthcare Workers Caring for COVID-19 Patients: A Pilot Study
Tarquinio, C., Brennstuhl, M., Rydberg, J. A., Bassan, F., Peter, L., Tarquinio, C., Auxéméry, Y., Rotonda, C., & Tarquinio, P. (2020) · Issues in Mental Health Nursing · doi:10.1080/01612840.2020.1818014 · Cited by 63 · see citing works
“Outcomes are similar to those achieved in face-to-face therapy (Spek et al., 2007; Kiropoulos et al., 2008) and it appears that the quality of the therapeutic alliance is not affected (Ghosh et al.”
Background
Internet-Delivered Cognitive Behavioral Therapy for Anxiety Disorders in Open Community Versus Clinical Service Recruitment: Meta-Analysis
Romijn, G., Batelaan, N., Kok, R., Koning, J., van Balkom, A., Titov, N., & Riper, H. (2019) · Journal of Medical Internet Research · doi:10.2196/11706 · Cited by 52 · see citing works
“When a general measure of anxiety was not available, we used a measure for specific anxiety symptoms (see Multimedia Appendix 2 [39-49] for the order of rating scales and Multimedia Appendix 3 [7,27-31,50-85] for the outcome measures we used for all studies).”
Method
Internet-delivered cognitive behavior therapy for anxiety and insomnia in a higher education context
Morris, J., Firkins, A., Millings, A., Möhr, C., Redford, P., & Rowe, A. (2015) · Anxiety Stress & Coping · doi:10.1080/10615806.2015.1058924 · Cited by 60 · see citing works
Not just “big” data: Importance of sample size, measurement error, and uninformative predictors for developing prognostic models for digital interventions
McNamara, M. E., Zisser, M., Beevers, C. G., & Shumake, J. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104086 · Cited by 56 · see citing works
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Self-citation
Intensive one-week internet-delivered cognitive behavioral therapy for panic disorder and agoraphobia: A pilot study
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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.
Pier, C., Austin, D., Klein, B., Mitchell, J., Schattner, P. L., Ciechomski, L., Gilson, K., Pierce, D., Shandley, K. A., & Wade, V. (2008) · PubMed Central · Cited by 33 · see citing works
Self-citation
Clinician-Assisted Internet-Based Treatment is Effective for Panic: A Randomized Controlled Trial
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Internet-delivered cognitive behavioral therapy for panic disorder with or without agoraphobia: a systematic review and meta-analysis
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Authors: Kiropoulos, L. A., Klein, B., Austin, D. W., Gilson, K., Pier, C., Mitchell, J., & Ciechomski, L.
Affiliations: Monash University (AU)
Corresponding author: Kiropoulos, Litza A.
ORCID: Kiropoulos, Litza A.
Klein, Britt
Austin, David W.
Gilson, Kathryn
Mitchell, Joanna
Venue: Journal of Anxiety Disorders
Publisher: Elsevier BV
Published: 2008-12
Volume: 22
Issue: 8
Pages: 1273-1284
ISSN: 0887-6185 (ISSN-L)
DOI: 10.1016/j.janxdis.2008.01.008
OpenAlex: W2013146721
Cited by: 290
References: 53
Citations by year: 2026: 4 · 2025: 7 · 2024: 13 · 2023: 6 · 2022: 11 · 2021: 14 · 2020: 11 · 2019: 12 · 2018: 14 · 2017: 12 · 2016: 20 · 2015: 20 · 2014: 25 · 2013: 21 · 2012: 24
FWCI: 32.78
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of Anxiety Disorders (publishedVersion)
PubMed (publishedVersion)
FedUni ResearchOnline (Federation University Australia) (submittedVersion)
Swinburne figshare (Swinburne University of Technology) (submittedVersion)
Topics: Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords: internet-based CBT, panic disorder, agoraphobia, treatment effectiveness, treatment credibility, treatment satisfaction, quality of life, depression, anxiety, stress, medication adherence
MeSH terms: Adult, Agoraphobia, Australia, Female, Humans, Male, Manuals as Topic, Middle Aged, Patient Compliance, Quality of Life, Surveys and Questionnaires, Self-Help Groups, Severity of Illness Index, Therapy, Computer-Assisted, Comorbidity, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome, Patient Satisfaction, Remote Consultation, Internet

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Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT?

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