Hundreds of clinical trials offer strong efficacy evidence that Internet-Based CognitiveBehavioral Treatment (ICBT) interventions can contribute substantially to reducing the gap between mental health care needs and service use by providing better access to quality treatments. However, in order to use these interventions more efficiently, we need to find the best ways to tailor the interventions according to individual client characteristics, such as severity of symptoms, comorbidity problems, personality traits, life context, and position on the stage-of-change continuum. In line with this, this article documents how the individual process of psychological treatment unfolds during a specific IBCT program for Panic Disorder, called "PAXonline," with therapist guidance via Skype. The challenges and progress made by the two clients-a positive-outcome client named "Maria," and a negative-outcome client named "Andrea"-are presented using the particular mixed-methods model approach proposed by Fishman (2008;, called the "Individual-Case-Comparison" (ICC) method. Contrasting Maria and Andrea's case studies explores the role that individual client characteristics can play in determining outcome in ICBT treatment.
BackgroundEfficacy of self-help internet-based cognitive behavior therapy (ICBT) for anxiety disorders has been confirmed in several randomized controlled trials. However, the amount and type of therapist guidance needed in ICBT are still under debate. Previous studies have shown divergent results regarding the role of therapist guidance and its impact on treatment outcome. This issue is central to the development of ICBT programs and needs to be addressed directly. The present study aims to compare the benefits of regular therapist guidance via online real-time audio-video communication (i.e. Skype) to no therapist guidance during a 12-week Romanian self-help ICBT program for Panic Disorder. Both treatments are compared to a waiting-list control group.Methods/DesignA parallel group randomized controlled trial is proposed. The participants, 192 Romanian adults fulfilling diagnostic criteria for panic disorder according to a diagnostic interview, conducted via secured Skype or telephone, are randomly assigned to one of the three conditions: independent use of the internet-based self-help program PAXonline, the same self-help treatment with regular therapist support via secured Skype, and waiting-list control group. The primary outcomes are severity of self-report panic symptoms (PDSS-SR) and diagnostic status (assessors are blind to group assignment), at the end of the intervention (12 weeks) and at follow-up (months 3 and 6). The secondary measures address symptoms of comorbid anxiety disorders, depression, quality of life, adherence and satisfaction with ICBT. Additional measures of socio-demographic characteristics, personality traits, treatment expectancies, catastrophic cognitions, body vigilance and working alliance are considered as potential moderators and/ or mediators of treatment outcome.DiscussionTo the best of our knowledge, the present study is the first effort to investigate the efficacy of a self-help internet-based intervention with therapist guidance via real-time video communication. A direct comparison between therapist guided versus unguided self-directed intervention for panic disorder will also be addressed for the first time. Findings from this study will inform researchers and practitioners about the added value of online video-therapy guidance sessions and the type of patients who may benefit the most from guided and unguided ICBT for Panic disorder.Trial registrationACTRN12614000547640 (Australian New Zealand Clinical Trials Registry). Registered 22/05/2014.
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