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Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT?
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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“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]
In the citing paper
“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.”
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“Online MH interventions are also as effective as traditional in-person therapy for disorders such as depression and anxiety [94-97].”
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Zandieh, S., Abdollahzadeh, S. M., Sadeghirad, B., Wang, L., McCabe, R. E., Yao, L., Inness, B. E., Pathak, A., Couban, R., Crandon, H. N., et al. (2024) · Canadian Medical Association Journal · doi:10.1503/cmaj.230274 · Cited by 52
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McCombie, A., Gearry, R., Andrews, J., Mikocka-Walus, A., & Mulder, R. (2015) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-015-9420-0 · Cited by 42
“, 2011) and panic disorder with or without agoraphobia (Kiropoulos et al., 2008).”
BackgroundInternet-assisted cognitive behavioral therapy
Andersson, G., & Carlbring, P. (2017) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2017.08.004 · Cited by 45
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“Several studies (Carlbring et al, 2005 ; Kiropoulos et al, 2008 ) also show that therapist-assisted ICBT is comparable to face-to-face CBT.”
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“sizes for both face-to-face and internet-based interventions in general have been frequently reported (Andersson et al., 2008; Barak et al., 2008; Cuijpers et al., 2010; Kiropoulos et al., 2008; Paxton et al., 2007).”
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“Building on studies demonstrating the superiority of an Internet-based treatment for panic disorder and agoraphobia to control conditions, Kiropoulos et al. (2008) compared the intervention (Panic Online) with the best evidence-based treatment, which at present is 12–15 sessions of face-to-face manualized CBT treatmen…”
MethodTRANSDIAGNOSTIC INTERNET TREATMENT FOR ANXIETY AND DEPRESSION
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“…creates a strong therapeutic alliance equivalent to face-to-face psychotherapy (Berman et al., 2014), consistent with previous CB therapy literature (Andersson et al., 2012; Kiropoulos et al., 2008; Knaevelsrud & Maercker, 2006, 2007; Pugh, Hadjistavropoulos, & Dirkse, 2016; Sucala et al., 2012).”
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“In patients with panic disorder, clinically significant improvements have been reported following treatment with an internet-based CCBT program [13,14], with equivalent results obtained by people with panic disorder treated either via the internet or face to face [13] and equivalent results for those treated by a clin…”
ResultOnline mental health resources for adolescents: Overview of research and theory
Edwards-Hart, T., & Chester, A. (2010) · Australian Psychologist · doi:10.1080/00050060903584954 · Cited by 29
Understanding adherence to web-based interventions
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“Thirteen studies did not administer the CEQ and three research groups were not able to send data, citing limited resources (Carlbring et al., 2005; Zerwas et al., 2017) or unavailability of data (Kiropoulos et al., 2008).”
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“Satisfaction at the end of treatment is assessed with a 35-item Treatment Satisfaction Questionnaire (Cox, Fergus, & Swinson, 1994) and the 17-item Therapist Alliance Questionnaire (Kiropoulos et al., 2008), both modified to be specific to TAICBT.”
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“Similarly, Kiropoulos et al. (Kiropoulos et al., 2008), found support for iCBT to be equally effective as face-to-face CBT for panic disorder in a randomised study (post-treatment assessment for Panic Disorder Severity Scale: iCBT (N = 45): M = 9.92 SD = 5.88; CBT (N = 35): M = 9.24 SD = 5.65;…”
BackgroundInfluentialCavanagh, K., Belnap, B. H., Rothenberger, S. D., Abebe, K. Z., & Rollman, B. L. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.10.005 · Cited by 27
Die therapeutische Beziehung in internetbasierten Therapieverfahren
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Are formal self-care interventions for healthy people effective? A systematic review of the evidence
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Treating people you never see: Internet-based treatment of the internalising mental disorders
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“2003), with some studies reporting equivalence of self- to therapist-directed CBT (Lidren et al. 1994 ; Park et al. 2001 ; Carlbring et al. 2005 ; Kiropoulos et al. 2008).”
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“In contrast to previous studies that found no significant differences in effects between face-to-face interventions and internet-based interventions in reducing anxiety (Kiropoulos et al., 2008) and fatigue (Carlbring, Andersson, Cuijpers, Riper, & Hedman-Lagerlof, 2018), we found larger effects of face-to-face interv…”
ResultO’Kearney, R., Kim, S., Dawson, R. L., & Calear, A. L. (2019) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867419864433 · Cited by 18
Delivery of cognitive behavioural therapy to workers: a systematic review
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“, mental disorders associated with greater burden in the present study), studies conducted in other countries suggest that internet-based prevention and treatment efforts for these disorders are effective (Carlbring et al., 2011; Farrer et al., 2011; Kiropoulos et al., 2008; Klein et al., 2006; Titov et al., 2011).”
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Training Postgraduate Psychology Students to Deliver Psychological Services Online
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“Research has shown that the effective use of technology can deliver outcomes equivalent to face-to-face therapy and can reach individuals who were previously unable, or unwilling, to access more traditional forms of therapy (Kiropoulos et al., 2008).”
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“As an alternative to services offered in person (face-to-face) by mental health professionals, online cognitive-behavioral interventions (including online self-help CBT) have emerged as a cheaper, anonymous, and locationindependent solution (Barnett, 2005; Kiropoulos et al., 2008).”
Understanding the Therapist Contribution to Psychotherapy Outcome: A Meta-Analytic Approach
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“…patient and disease characteristics (Enck et al., 2006; Roberto et al., 2010), online delivered information and education (Simpson et al., 2009; Wisner et al., 2008), screening (Donker et al., 2009) and online psychotherapy (Kessler et al., 2009; Kiropoulos et al., 2008; Mitchell et al., 2008).”
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“The Internet has the potential to overcome a number of the structural and attitudinal barriers that often avert efforts to seek help, especially within rural and regional areas, including stigma, a shortage of trained health professionals and geographic and social isolation [32-35].”
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Guided Internet Treatment for Anxiety Disorders. As Effective As Face-To-Face Therapies?
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Strengths and Limitations of Internet-Based Cognitive-Behavioral Treatments for Anxiety Disorders
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“Similar results were found by Kiropoulos et al. (2008) in which ratings of treatment compliance and understanding of CBT material were higher in face-to-face therapy compared with those receiving an ICBT intervention.”
ResultStrengths-based CBT: Internet-Based Versus Face-to-Face Therapy in A Randomized Controlled Trial
Victor, P. P., Krug, I., Vehoff, C., Lyons, N., & Willutzki, U. (2018) · Journal of Depression & Anxiety · doi:10.4172/2167-1044.1000301 · Cited by 10
“Overall, the alliance results are in contrast to current research stating equal therapeutic alliances in face-to-face and electronic treatments [51-54].”
ResultWalderhaug, E. P., Gjestad, R., Egeland, J., Havik, O. E., & Nordgreen, T. (2019) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2019.1646803 · Cited by 8
“Guided ICBT for PAD is also documented effective in regular clinical settings in Sweden [9,10] and Norway [11,12] as well as other countries [13].”
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Látalová, K., Praško, J. P., Kamarádová, D., Jelenova, D., Ocisková, M., & Sedláčková, J. (2013) · Psychiatric Quarterly · doi:10.1007/s11126-013-9286-y · Cited by 9
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Clinical Trials on Computer Based Telemedicine: A Systematic Review
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“Psychiatry The three retrospective studies (14-16) presenting computer based treatment for psychiatric disorders have shown that the outcome was found to be comparable to that of face-to-face methods.”
BackgroundResultCiuca, A., Berger, T., Crişan, L. G., & Miclea, M. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0709-9 · Cited by 9
Anksiyete Bozukluklarının Tedavisinde İnternet Tabanlı Bilişsel Davranışçı Terapi Uygulamaları
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“…for poor engagement in online therapy have included participants finding the intervention too demanding and being unable to find time to complete tasks [28], preferring face-to-face therapy with a human therapist [29], and experiencing problems with their computer or poor Internet access [30].”
BackgroundJung, H. W., Jang, K.-W., Nam, S., Kim, A. Y., Lee, J., Ahn, M. E., Lee, S., Kim, Y. J., Shin, J.-K., & Roh, D. D. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14051771 · Cited by 9
Online Counseling: Advantages, Disadvantages and Ethical Issues
Kiriakaki, S., Tzovanou, M., Sotiriou, A., Lampou, M., & Varsamidou, E. (2022) · Homo Virtualis · doi:10.12681/homvir.30316 · Cited by 7
Effectiveness of cognitive-behavioral group therapy for panic disorder in a specialized unit.
Prats, E., Domínguez‐Clavé, E., Rosado, S., Pailhez, G., Bulbena, A., & Fullana, M. A. (2014) · PubMed · Cited by 7
Participatory medicine: model based tools for engaging and empowering the individual
Sagar, M. A., & Broadbent, E. (2016) · Interface Focus · doi:10.1098/rsfs.2015.0092 · Cited by 7
Internetbasierte Psychotherapien
Berger, T., & Caspar, F. (2010) · Psychiatrie und Psychotherapie up2date · doi:10.1055/s-0030-1265934 · Cited by 7
Kingdon, D., & Mander, H. (2015) · Elsevier eBooks · doi:10.1016/b978-0-08-097086-8.27011-6 · Cited by 10
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EMDR in the Treatment of Panic Disorder With Agoraphobia: A Case Description
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“Other therapies such as bibliotherapy, computer-administered vicarious exposure, Internet-based cognitive behavioral therapy (ICBT) have also shown effective results for PD (Hedman et al., 2013; Kiropoulos et al., 2008).”
BackgroundCiuca, A., Berger, T., & Miclea, M. (2017) · Pragmatic Case Studies in Psychotherapy · doi:10.14713/pcsp.v13i3.2011 · Cited by 7
Strauss, A. Y., Halaj, A., Zalaznik, D., Fradkin, I., Katz, B. A., Zlotnick, E., Barzilay, S., Andersson, G., Ebert, D. D., & Huppert, J. D. (2022) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2021.12.005 · Cited by 7
Chan, C. H. Y., Lau, B. H. P., Wong, Q. S., Tam, M. Y. J., So, G. Y. K., Leung, H. T., Fung, Y. L., Chan, C., Li, R., & Ng, E. H. Y. (2019) · Asia Pacific Journal of Social Work and Development · doi:10.1080/02185385.2019.1578684 · Cited by 5
“, 2009), panic disorder (Kiropoulos et al., 2008), and postpartum depression (Leis, Mendelson, Tandon, & Perry, 2009).”
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“Our findings are consistent with multiple other studies examining the effect of mode of delivery of various psychological therapies in therapeutic alliance and outcome (Kiropoulos et al. 2008; Andersson et al. 2012; Stiles-Shields et al. 2014; Pihlaja et al. 2018).”
ResultInternet-Delivered Psychotherapy for Anxiety Disorders and Depression
Titov, N., Dear, B. F., & Andersson, G. (2014) · Focus · doi:10.1176/appi.focus.12.3.299 · Cited by 5
Muuraiskangas, S. T., Honka, A. M., Junno, U.-M., Nieminen, H., & Kaartinen, J. K. (2022) · Journal of Medical Internet Research · doi:10.2196/26569 · Cited by 7
Metadata
- 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.
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2008-12
- Volume
- 22
- Issue
- 8
- Pages
- 1273-1284
- ISSN
- 0887-6185 (ISSN-L)
- 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
- 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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