An internet-based guided self-help intervention for panic symptoms: randomized controlled trial
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BACKGROUND: Internet-based guided self-help is efficacious for panic disorder, but it is not known whether such treatment is effective for milder panic symptoms as well. OBJECTIVE: To evaluate the effectiveness of Don't Panic Online, an Internet-based self-help course for mild panic symptoms, which is based on cognitive behavioral principles and includes guidance by email. METHODS: A pragmatic randomized controlled trial was conducted. Participants (N=126) were recruited from the general population and randomized to either the intervention group or to a waiting-list control group. Inclusion criteria were a Panic Disorder Severity Scale-Self Report (PDSS-SR) score between 5-15 and no suicide risk. Panic symptom severity was the primary outcome measure; secondary outcome measures were anxiety and depressive symptom severity. Measurements were conducted online and took place at baseline and 12 weeks after baseline (T1). At baseline, diagnoses were obtained by telephone interviews. RESULTS: Analyses of covariance (intention-to-treat) showed no significant differences in panic symptom reduction between groups. Completers-only analyses revealed a moderate effect size in favor of the intervention group (Cohen's d=0.73, P=.01). Only 27% of the intervention group finished lesson 4 or more (out of 6). Nonresponse at T1 was high for the total sample (42.1%). Diagnostic interviews showed that many participants suffered from comorbid depression and anxiety disorders. CONCLUSIONS: The Internet-based guided self-help course appears to be ineffective for individuals with panic symptoms. However, intervention completers did derive clinical benefits from the intervention. TRIAL REGISTRATION: Nederlands Trial Register: NTR1639; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1639 (Archived by WebCite at http://www.webcitation.org/6ITZPozs9).
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Studies evaluating online trainings with self-exposure elements consistently report particularly high dropout rates.
“Studies that evaluate online trainings with self-exposure elements consistently report particularly high dropout rates [17, 18].”
From Efficacy of a hybrid online training for panic symptoms and agoraphobia: study protocol for a randomized controlled trial. (2014) · cites this paper as [18]
The Results (Intervention Adherence; Study Dropout, pages unavailable) document substantial noncompletion in this online trial: only 5 of 63 intervention participants finished all six modules, and 53 of 126 participants were lost to posttreatment follow-up. But the Methods (Intervention, page unavailable) do not establish that the course included self-exposure, and the Discussion (Comparison With the Literature, page unavailable) says low adherence was not found in previous comparable studies, which reported 79%–95% adherence. This paper therefore does not support the claim that studies of trainings with self-exposure elements consistently report particularly high dropout. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe 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 Ballegooijen et al., 2013
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- Authors
- van Ballegooijen, W., Riper, H., Klein, B., Ebert, D. D., Kramer, J., Meulenbeek, P., & Cuijpers, P.
- Affiliations
- Leuphana University of Lüneburg (DE)
- Australian National University (AU)
- Trimbos Institute (NL)
- GGNet (NL)
- Amsterdam Public Health (NL)
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2013-07-29
- Volume
- 15
- Issue
- 7
- Pages
- e154
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC3742403
- OpenAlex
- W2132666627
- Cited by
- 56
- References
- 48
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 11 · 2022: 1 · 2021: 6 · 2020: 3 · 2019: 5 · 2018: 5 · 2017: 4 · 2016: 6 · 2015: 3 · 2014: 5 · 2013: 1
- FWCI
- 7.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- VU Research Portal (publishedVersion, other-oa)
- University of Twente Research Information (publishedVersion, cc-by)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
- FedUni ResearchOnline (Federation University Australia) (submittedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- ANU Open Research (Australian National University) (submittedVersion)
- Multilingual Matters (Channel View Publications) (submittedVersion, cc-by)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion, other-oa)
- University of Twente Research Information (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Vrije Universiteit Amsterdam
- 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 › Social Psychology › Mental Health Treatment and Access
- Keywords
- panic symptoms, cognitive behavioral therapy, treatment effectiveness, treatment completion, comorbid depression, anxiety disorders, general population
- MeSH terms
- Humans, Self Care, Severity of Illness Index, Waiting Lists, Panic Disorder, Internet
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