An Internet-Based Guided Self-Help Intervention for Panic Symptoms: Randomized Controlled Trial

Abstract

BackgroundInternet-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.ObjectiveTo 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.MethodsA 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.ResultsAnalyses 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.ConclusionsThe 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 RegistrationNederlands Trial Register: NTR1639; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1639 (Archived by WebCite at http://www.webcitation.org/6ITZPozs9).

Efficacy of a hybrid online training for panic symptoms and agoraphobia: study protocol for a randomized controlled trial

“…GET.ON PANIC is a hybrid internet-based self-help intervention with minimal therapeutic guidance based on CBT principles [ 18 , 44 – 46 ]. The hybrid online training consists of two components: a browser-based section (desktop PC or laptop) and a mobile application (smartphone app).…”

“…This lack of direct support from a therapist might increase the risk of clients not fully complying with the treatment, or dropping out of treatment completely. Studies that evaluate online trainings with self-exposure elements consistently report particularly high dropout rates [ 17 , 18 ].…”

Trastorno de pánico y su tratamiento psicológico. Revisión y actualización

“…Los tratamientos interactivos basados en los programas informáticos son más atractivos que la biblioterapia. Los estudios que han evaluado los tratamientos on-line para el trastorno de pánico indican mejoras significativas en los pacientes, en comparación a un grupo control de lista de espera, y los resultados fueron comparables a la terapia presencial (Ebenfeld et al, 2014;Kok, van Straten, Beekman y Cuijpers, 2014;Van Ballegooijen et al, 2013). También se está estudiando la utilidad de la realidad virtual para ayudar con el componente de exposición de la TCC, para los pacientes con trastorno de pánico (Pérez-Ara et al, 2010;Meyerbröker y Emmelkamp, 2010;Malbos, Rapee y Kavakli, 2013).…”

Anxiety — Is There an App for That? Considering Technology, Psychiatry, and Internet-Assisted Cognitive Behavioral Therapy

“…And while there are many reasons for nonadherence, unguided ICBT seems to have very high dropout rates. Different studies have different designs and interventions, but the pattern is clear: patients enrolled in MoodGym: 37% completed the self-directed program [43]; patients with mild panic symptoms enrolled in Don't Panic Online: 27% completed the unguided ICBT [44]; patients enrolled in This Way Up Clinic's Sadness program without therapist support: 33% completed it, compared to 77% in a clinician-assisted version [45]. Adding in the support of primary-care physicians, incidentally, helped, but not profoundly, as noted above (in the context of THIS WAY UP).…”