Clinician-Assisted Internet-Based Treatment is Effective for Panic: A Randomized Controlled Trial
Abstract
OBJECTIVE: To determine the efficacy of an Internet-based clinician-assisted cognitive behavioural treatment program (the Panic program) for panic disorder (with or without agoraphobia). METHOD: Fifty-nine individuals meeting diagnostic criteria for panic disorder with agoraphobia were randomly assigned to a treatment group or to a waitlist control group. Treatment group participants completed the Panic program, comprising six on-line lessons, weekly homework assignments, received weekly email contact from a psychiatry registrar, and contributed to a moderated online discussion forum with other participants. An intention-to-treat model was used for data analyses. RESULTS: Twenty-three (79%) of treatment group participants completed all lessons within the 8-week program, and post-treatment data were collected from 22/29 treatment group and 22/25 waitlist group participants. Compared to the control group, treatment group participants reported significantly reduced symptoms of panic as measured by the Panic Disorder Severity Scale, Body Sensation Questionnaire, and Agoraphobic Cognitions Questionnaires. Significant reductions were also reported on measures of disability and depression. The mean within- and between-group effect size (Cohen's d) on the Panic Disorder Severity Scale was 0.93 and 0.59, respectively, and effects were sustained at 1-month follow-up. Mean therapist time per participant was 75 minutes for the program. CONCLUSIONS: These results replicate those from the open trial of the Panic Program indicating the efficacy of the Internet-based clinician-assisted cognitive behavioural treatment program for panic disorder with agoraphobia.
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Internet-delivered cognitive behavioral therapy (CBT) is as effective as face-to-face therapy for depression, anxiety, and social phobia.
“Some studies have shown Internet-delivered cognitive behavioral therapy (CBT) to be as effective as face-to-face therapy for depression, anxiety, and social phobia [10,12,13].”
From Acceptability of Mental Health Apps for Aboriginal and Torres Strait Islander Australians: A Qualitative Study (2016) · cites this paper as [13]
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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
“, 2008), and panic disorder (Wims et al., 2010).”
Self-citationCombining Imagination and Reason in the Treatment of Depression
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“Australian population (Perini et al., 2009; Titov et al., 2010a) for use by a Chinese population.”
BackgroundMethodResultInfluentialSelf-citationNewby, J. M., Mackenzie, A., Williams, A. D., McIntyre, K., Watts, S., Wong, N., & Andrews, G. (2013) · Psychological Medicine · doi:10.1017/s0033291713000111 · Cited by 181 · see citing works
“2011), and for the primary disorders (Perini et al. 2009).”
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Internet-delivered psychotherapy for depression in adults
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Self-citationProviding Human Support for the Use of Digital Mental Health Interventions: Systematic Meta-review
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“The adherence rate in the present study is comparable to that observed in other online guided interventions, in which adherence varied between 55% and 75% [13,14,23,30,99].”
BackgroundResultMohr, D., Duffecy, J., Ho, J., Kwasny, M., Cai, X., Burns, M., & Begale, M. (2013) · PLoS ONE · doi:10.1371/journal.pone.0070086 · Cited by 156 · see citing works
“three of these trials did not include clinical counseling, while many trials examining coached web-based interactions do include clinical coaching [10,30].”
BackgroundBaikie, K. A., Geerligs, L., & Wilhelm, K. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.11.032 · Cited by 150 · see citing works
“Computer-based therapy and educational programs have been shown to be clinically-effective and acceptable to patients within other intervention programs (Perini et al., 2009; Titov et al., 2009).”
BackgroundJohnston, L., Titov, N., Andrews, G., Spence, J., & Dear, B. F. (2011) · PLoS ONE · doi:10.1371/journal.pone.0028079 · Cited by 150 · see citing works
“Analyses by principal disorder yielded results consistent with those reported in recent studies of disorder-specific iCBT programs for GAD [53], SP [54] and Pan/Ag [46].”
BackgroundResultInfluentialSelf-citationOnline interventions for depression and anxiety – a systematic review
Saddichha, S., Al-Desouki, M., Lamia, A., Linden, I. A., & Krausz, M. (2014) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2014.945934 · Cited by 133 · see citing works
Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults
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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
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“In addition, we compared the effects of the present cohort with control conditions in previously published superiority RCTs on ICBT for panic disorder (6, 7, 10).”
BackgroundResultWilliams, A. D., & Andrews, G. (2013) · PLoS ONE · doi:10.1371/journal.pone.0057447 · Cited by 149 · see citing works
“au/clinic) has been evaluated in a number of trials [11,12,13].”
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“Effects were also larger than any previous reported effect sizes across 11 RCTs comparing Internet interventions to waitlist, treatment as usual or placebo control conditions for depression [6,15,17,38,39, 40,41,42,43,44,45].”
ResultPovey, J., Mills, P. P. J. R., Dingwall, K. M., Lowell, A., Singer, J., Rotumah, D., Bennett-Levy, J., & Nagel, T. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5314 · Cited by 121 · see citing works
“Some studies have shown Internet-delivered cognitive behavioral therapy (CBT) to be as effective as face-to-face therapy for depression, anxiety, and social phobia [10,12,13].”
Cuijpers, P., Cristea, I. A., Ebert, D. D., Koot, H. M., Auerbach, R. P., Bruffaerts, R., & Kessler, R. C. (2016) · Depression and Anxiety · doi:10.1002/da.22461 · Cited by 137 · see citing works
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“Perini (2009) [42] community guided iCBT, 8 45 PHQ-9, BDI-ii SDS WL 8 weeks 27% replaced by pretreatment scores Australia”
BackgroundWeb-Based Intervention Programs for Depression: A Scoping Review and Evaluation
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“Examining the existing literature, completion rates in RCTs of Web-delivered treatments for depression have primarily ranged from 55%-67% [49-54] with rates as low as 20% [55].”
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
“Controlled trials have been conducted in for example Australia (Perini et al. 2009; Titov et al. 2010), The Netherlands (Ruwaard et al.”
MethodMomMoodBooster Web-Based Intervention for Postpartum Depression: Feasibility Trial Results
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Self-citationInsomnia before and after treatment for anxiety and depression
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“For more detailed information about the content of the courses, please refer to the trials of the courses used in this study (Newby et al., 2013; Perini et al., 2009; Robinson et al., 2010; Titov et al., 2008; Wims et al., 2010).”
MethodRelational Agents in Clinical Psychiatry
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Step-by-Step: a new WHO digital mental health intervention for depression
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- Authors
- Wims, E., Titov, N., Andrews, G., & Choi, I.
- Affiliations
- St Vincent's Hospital Sydney (AU)
- UNSW Sydney (AU)
- Corresponding author
- Titov, Nickolai
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2010-07
- Volume
- 44
- Issue
- 7
- Pages
- 599-607
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- OpenAlex
- W2118402635
- Cited by
- 290
- References
- 63
- Citations by year
- 2025: 2 · 2024: 6 · 2023: 15 · 2022: 4 · 2021: 16 · 2020: 10 · 2019: 12 · 2018: 14 · 2017: 22 · 2016: 28 · 2015: 27 · 2014: 32 · 2013: 32 · 2012: 26
- FWCI
- 44.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Australian & New Zealand Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- 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, online therapy, cognitive behavioral therapy, treatment efficacy, depression, symptom severity
- MeSH terms
- Adult, Agoraphobia, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome, Remote Consultation, Internet, Diagnostic and Statistical Manual of Mental Disorders, Intention to Treat Analysis
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