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Cited by 262Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTelemedicine and Telehealth Implementation

Remote treatment of panic disorder: a randomized trial of Internet-based cognitive behavior therapy supplemented with telephone calls

Open access
Carlbring, Per, Bohman, Susanna, Brunt, Sara, Buhrman, Monica, Westling, Bengt E., Ekselius, Lisa, Andersson, Gerhard·2006·American Journal of Psychiatry
DOI 10.1176/ajp.2006.163.12.2119
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Abstract

Objective: This study evaluated a 10-week Internet-based bibliotherapy self-help program with short weekly telephone calls for people suffering from panic disorder with or without agoraphobia. Method: After the authors confirmed the diagnosis by administering the Structured Clinical Interview for DSM-IV by telephone, 60 participants were randomly assigned to either a wait-listed control group or a multimodal treatment package based on cognitive behavior therapy plus minimal therapist contact via e-mail. A 10-minute telephone call was made each week to support each participant. Total mean time spent on each participant during the 10 weeks was 3.9 hours. The participants were required to send in homework assignments before receiving the next treatment module. Results: Analyses were conducted on an intention-to-treat basis, which included all randomly assigned participants. From pretreatment to posttreatment, all treated participants improved significantly on all measured dimensions (bodily interpretations, maladaptive cognitions, avoidance, general anxiety and depression levels, and quality of life). Treatment gains on self-report measures were maintained at the 9-month follow-up. A blind telephone interview after the end of treatment revealed that 77% of the treated patients no longer fulfilled the criteria for panic disorder, whereas all of the wait-listed subjects still suffered from it. Conclusions: This study provides evidence to support the use of treatment distributed via the Internet with the addition of short weekly telephone calls to treat panic disorder. Replication should be made to compare self-help and telephone treatment based on cognitive behavior methods with nonspecific interventions.

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  • Stand-alone computerized CBT is generally acceptable and effective for depression and anxiety, including specific anxiety disorders.

    “Stand-alone (i.e., without clinician involvement) computerized versions of CBT are well researched, and have been shown to be generally acceptable to patients and effective in treating depression and anxiety (34,35), as well as specific anxiety disorders, including PD (36,37,38), SAD (39,40), PTSD (41), and obsessive compulsive disorder (42,43).”

    From Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings. (2009) · cites this paper as [36]

    The Discussion (page not provided) reports that Internet-based CBT with therapist e-mail contact and weekly telephone calls was effective for panic disorder. It does not establish effectiveness without clinician involvement; the study also does not establish general acceptability or effectiveness across depression and anxiety disorders. (LLM, conf=0.90)

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  • The recent meta-analysis of Andrews et al. (2018) found a large mean effect size of hedge g = 1.31 for browser-based trainings for PD, indicating that the benefit of the app in terms of clinical efficacy needs further investigation.

    “Moreover, in the recent meta-analysis of Andrews et al. (2018), including only browser-based trainings for PD (e.g. Carlbring et al., 2006; Ballegooijen et al., 2013; Wims et al., 2010), a large mean effect size of hedge g = 1.31 was found, which also indicates that the benefit of the app in terms of clinical efficacy needs further investigation.”

    From A mobile application for panic disorder and agoraphobia: Insights from a multi-methods feasibility study (2020) · cites this paper as Carlbring et al., 2006

  • Another potential limitation of previous iCBT trials is that participants with comorbid anxiety and depression disorders often are excluded.

    “Another potential limitation of previous iCBT trials is that participants with comorbid anxiety and depression disorders often are excluded [16].”

    From Individually Tailored Internet-Based Treatment for Young Adults and Adults With Panic Attacks: Randomized Controlled Trial (2012) · cites this paper as [16]

  • The results of this trial are consistent with previous trials of iCBT for panic disorder and transdiagnostic iCBT treatment for anxiety.

    “The results of this trial, with moderate to large effect sizes, are consistent with previous trials of iCBT for panic disorder [16] and transdiagnostic iCBT treatment for anxiety [37], which shares some features with our treatment approach.”

    From Individually Tailored Internet-Based Treatment for Young Adults and Adults With Panic Attacks: Randomized Controlled Trial (2012) · cites this paper as [16]

  • Internet-delivered treatments for anxiety disorders have included interventions for panic disorder, SAD, SP, and posttraumatic stress and have established findings that support their potential effectiveness and efficacy.

    “Internet-delivered treatments for anxiety disorders have included interventions for panic disorder, SAD, SP, and posttraumatic stress and they have established findings that support their potential effectiveness and efficacy [43-47].”

    From Low-intensity internet-delivered treatment for generalized anxiety symptoms in routine care: protocol for a randomized controlled trial (2014) · cites this paper as [44]

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Research works printed but not linked: 2

  1. National Institutes of Health: Treatment of panic disorder, in NIH Consensus Development Conference Consensus Statement (Volume 9). Bethesda, Md, NIH, 1991, pp 1-24
  2. First MB, Gibbon M, Spitzer RL, Williams JBW: Structured Clini- cal Interview for DSM-IV Axis I Disorders (SCID-I). Washington, DC, American Psychiatric Press, 1997

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Authors
Carlbring, P., Bohman, S., Brunt, S., Buhrman, M., Westling, B. E., Ekselius, L., & Andersson, G.
Affiliations
Linköping University (SE)
Corresponding author
Carlbring, Per
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2006-12
Volume
163
Issue
12
Pages
2119-2125
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/ajp.2006.163.12.2119
OpenAlex
W2033333868
Cited by
262
References
34
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 10 · 2020: 3 · 2019: 5 · 2018: 9 · 2017: 8 · 2016: 18 · 2015: 14 · 2014: 24 · 2013: 23 · 2012: 24
FWCI
27.40
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Vårdalstiftelsen
  • Vetenskapsrådet
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords
panic disorder, agoraphobia, internet-based cognitive behavioral therapy, bibliotherapy, telephone support, self-help, remote therapy, medication adherence, homework, maintenance therapy, quality of life
MeSH terms
Adult, Combined Modality Therapy, Female, Follow-Up Studies, Health Status, Humans, Male, Personality Inventory, Physician-Patient Relations, Psychiatric Status Rating Scales, Quality of Life, Self Care, Social Support, Telephone, Waiting Lists, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome, Remote Consultation, Internet, Control Groups

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