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

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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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“…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…”
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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
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
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 106
“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
“…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
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
“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
“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
“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
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
“…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
“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
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 94
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
“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
“…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
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
“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 87
“…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
“, 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
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
“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
“…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
“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
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
The Psychiatrist-Patient Relationship of the Future: Anytime, Anywhere?
Yellowlees, P., & Nafiz, N. (2010) · Harvard Review of Psychiatry · doi:10.3109/10673221003683952 · Cited by 63
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
“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 66
“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
“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
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 55
Comparative efficacy and acceptability of psychotherapies for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials
Papola, D., Ostuzzi, G., Tedeschi, F., Gastaldon, C., Purgato, M., Giovane, C. D., Pompoli, A., Pauley, D., Karyotaki, E., Sijbrandij, M., et al. (2021) · The British Journal of Psychiatry · doi:10.1192/bjp.2021.148 · Cited by 63
Stepped Care and e-Health
Draper, C., & O’Donohue, W. (2010) · Springer eBooks · doi:10.1007/978-1-4419-6510-3 · Cited by 58

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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