Maria and Andrea: Comparing Positive and Negative Outcome Cases in an Online, Clinician-Guided, Self-Help Intervention for Panic Disorder

Abstract

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.

Case Studies of Clinician-Guided, Online Therapy: Towards a Fuller Understanding of How and Under What Conditions Such Therapy Works

“…It is very likely that established alliance measures do not capture specific aspects of Online relationships. This may especially be the case in therapies based on asynchronous written communication (e.g., Schulz et al, 2017), but also in therapies which include real-time video sessions (e.g., Ciuca et al, 2017). There is evidence showing that therapists and clients make adjustments in their behavior when conducting therapy via real-time video.…”

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ABSTRACT Ciuca, Berger, and Miclea (2017) and Schulz, Vincent, & Berger (2017) each present a pair of process-focused, systematic case studies, one with good outcome and one with a poorer outcome. These cases were drawn from a randomized controlled trial (RCT) of an Online self-help therapy for panic disorder and social anxiety disorder, respectively.

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“…Therapists are actively involved, although to a lesser degree than in traditional therapy. While a client works his or her way through the Online self-help program, a therapist assists and supports the client via real-time video sessions (e.g., Ciuca et al, 2017) or via e-mail (e.g., Schulz et al, 2017).…”

Why Do Some Psychotherapy Clients Get Better Than Others?

“…This commentary explores reasons why one client's outcome was better than the other's in two comparative case studies: the cases of "Maria" and "Andrea," involving panic disorder (Ciuca, Berger, & Miclea, 2017); and the cases of "Daydreamer" and "Night Owl," involving social anxiety (Schulz, Vincent, & Berger, 2017). Findings suggest that both specific and common factors may explain the difference.…”

“…The case studies of "Maria" and "Andrea" involving panic disorder (Ciuca, Berger, & Miclea, 2017), and of "Daydreamer" and "Night Owl" involving social anxiety (Schulz, Vincent, & Berger, 2017), are good examples of the "Case Studies Within Psychotherapy Trials" (CWT) mixed-methods research model described by Fishman, Messer, Edwards, and Datillio (2017). The case studies extend the application of the approach by examining positive and negative outcomes in the burgeoning area of computer-assisted psychotherapy (Arnberg, Linton, Hultcrantz, Heintz, & Jonsson, 2014) while also affording the opportunity to explore a key claim made of the CWT mixed-models approach.…”