Internet-guided self-help with or without exposure therapy for phobic and panic disorders.
BACKGROUND
As many sufferers from phobic and panic (phobia/panic) disorders cannot get to suitable therapists, routine aspects of therapy were delegated to internet-accessed computer-aided self-help with or without exposure instructions.


METHODS
Phobia/panic referrals were randomised to computer-aided self-help via the internet at home in a 2:1 ratio either by self-exposure cognitive behaviour therapy (CBT) [FearFighter (FF), n = 45] or by minimal CBT without exposure [Managing Anxiety (MA), n = 23]. All had brief backup phone advice from a clinician concerning their computer guidance.


RESULTS
On self-ratings and blinded assessor ratings, patients improved equally with each form of self-help over 10 treatment weeks but significantly more on 5 out of 10 measures by week 14 (1-month follow-up) when the self-help included self-exposure instructions than when it did not. In accord with this, standardised effect sizes (Cohen's d) indicated superiority of FF over MA on 5 measures by week 14. Satisfaction with treatment in all patients pooled correlated positively with improvement after treatment and at 1-month follow-up.


CONCLUSIONS
At the end of treatment, computer-aided CBT self-help at home via the internet plus brief live helpline support was effective with or without exposure instructions, and at 1-month follow-up it was more effective on some measures if exposure instructions had been included. Analysis is needed of how non-exposure CBT produced its shorter-term effect.
Schneider
Andreas J
AJ
Department of Psychological Medicine, Imperial College London and Institute of Psychiatry, King's College London, London, UK.
Mataix-Cols
David
D
Marks
Isaac M
IM
Bachofen
Martin
M
D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D020407:Internet / Q000295:instrumentation*; D016584:Panic Disorder / Q000628:therapy*; D010698:Phobic Disorders / Q000628:therapy*; D012657:Self-Help Groups