A Feasibility study on Combining Internet-Based Cognitive Behaviour Therapy with Physical Exercise as Treatment for Panic Disorder—Treatment Protocol and Preliminary Results

Abstract

Internet-based cognitive behaviour therapy (ICBT) is a recommended, cost-effective and efficacious treatment for panic disorder (PD). However, treatment effects in psychiatric settings indicate that a substantial proportion fail to achieve remission. Physical exercise improves symptoms in patients with PD, and acts through mechanisms that can augment the effect of ICBT. The feasibility of combining these two interventions has not previously been investigated, and this was the aim of this study. The intervention comprised guided ICBT combined with one weekly session of supervised and two weekly sessions of unsupervised physical exercise for a total of 12 weeks. Treatment rationale, procedures and protocols are presented together with preliminary results for four patients with PD who have currently finished treatment. Quantitative and qualitative results are reported on the feasibility of adhering to the treatments, treatment outcome as assessed by clinician rating and estimation of reliable and clinically significant change for outcome measures, and participants' satisfactions with the combined treatment. The preliminary results indicate that the combined treatment is feasible to complete, and that the combination is perceived by the participants as beneficial.

Feasibility of integrating vestibular rehabilitation and cognitive behaviour therapy for people with persistent dizziness

“…Since all the participants were able to complete the questionnaires, the Agoraphobic Cognition Questionnaire (ACQ), part of the standard packet used in panic anxiety research together with the BSQ [29, 40], was added to the questionnaire packet to allow for a more comprehensive assessment of panic-related symptomatology in the study population.…”

“…The Hospital Anxiety and Depression Scale (HADS) [36], the Body Sensation Questionnaire (BSQ) [37], and the Mobility Inventory of Agoraphobia-Alone (MI-A) [37] describe levels of anxiety, depression, panic-related symptoms, and avoidance behaviour. They have all shown satisfactory internal consistency and clinical cut-offs established (HADS 12 points, MI-A 1.65 points, and BSQ 2.31 points) [37–40]. A modified version of the Panic Attack Scale (PAS) [28] presents frequency and experienced severity of markedly increased bouts of dizziness.…”

Physical exercise as an add-on treatment to cognitive behavioural therapy for anxiety: a systematic review

“…We included eight studies with a total of 431 subjects for the planned meta-analysis (Bischoff et al, 2018;Cromarty et al, 2004;Gaudlitz et al, 2015;Hovland et al, 2015;Jacquart et al, 2017;McEntee and Halgin, 1999;Merom et al, 2008;Schwartz and Kaloupek, 1987). Figure 1 displays the selection of studies from a total of 11,437 articles identified through systematic search.…”

Exercise for Mood and Anxiety Disorders: The State-of-the Science

“…Sabourin, Stewart, Watt, and Krigolson (this issue) showed that running as interoceptive exposure followed by a 3-day group CBT intervention reduces AS. Hovland, Johansen, Sjøbø, Vøllestad, Nordhus, Pallesen, Havik, Martinsen, and Nordgreen (this issue) describe a feasibility study on combining internet-based cognitive behavior therapy with physical exercise as treatment for panic disorder. Their preliminary results suggest combined treatment is both feasible and beneficial.…”