title: Therapist-assisted, Internet-based treatment for panic disorder: can general practitioners achieve comparable patient outcomes to psychologists?
abstract: BACKGROUND
  Mental illness is an escalating concern worldwide. The management of disorders such as anxiety and depression largely falls to family doctors or general practitioners (GPs). However, GPs are often too time constrained and may lack the necessary training to adequately manage the needs of such patients. Evidence-based Internet interventions represent a potentially valuable resource to reduce the burden of care and the cost of managing mental health disorders within primary care settings and, at the same time, improve patient outcomes.
  
  
  OBJECTIVE
  The present study sought to extend the efficacy of a therapist-assisted Internet treatment program for panic disorder, Panic Online, by determining whether comparable outcomes could be achieved and maintained when Panic Online was supported by either GPs or psychologists.
  
  
  METHODS
  Via a natural groups design, 96 people with a primary diagnosis of panic disorder (with or without agoraphobia) completed the Panic Online program over 12 weeks with the therapeutic assistance of their GP (n = 53), who had received specialist training in cognitive behavioral therapy, or a clinical psychologist (n = 43). Participants completed a clinical diagnostic telephone interview, conducted by a psychologist, and a set of online questionnaires to assess panic-related symptoms at three time periods (pretreatment, posttreatment, and 6 month follow-up).
  
  
  RESULTS
  Both treatments led to clinically significant improvements on measures of panic and panic-related symptomatology from pretreatment to posttreatment. Both groups were shown to significantly improve over time. Improvements for both groups were maintained at follow-up; however, the groups did differ significantly on two quality of life domains: physical (F(1,82) = 9.13, P = .00) and environmental (F(1,82) = 4.41, P = .04). The attrition rate was significantly higher among those being treated by their GP (chi(2) (1) = 4.40, P = .02, N = 96).
  
  
  CONCLUSIONS
  This study provides evidence that Internet-based interventions are an effective adjunct to existing mental health care systems. Consequently, this may facilitate and enhance the delivery of evidence-based mental health treatments to increasingly large segments of the population via primary care systems and through suitably trained health professionals.
authors.affiliation: Swinburne University of Technology, Faculty of Life and Social Sciences, Mail H31, PO Box 218, Hawthorn, Victoria 3122, Australia. kshandley@swin.edu.au
authors.forename: Kerrie
authors.initials: K
authors.lastname: Shandley
authors.forename: David William
authors.initials: DW
authors.lastname: Austin
authors.forename: Britt
authors.initials: B
authors.lastname: Klein
authors.forename: Ciaran
authors.initials: C
authors.lastname: Pier
authors.forename: Peter
authors.initials: P
authors.lastname: Schattner
authors.forename: David
authors.initials: D
authors.lastname: Pierce
authors.forename: Victoria
authors.initials: V
authors.lastname: Wade
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001315:Australia; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D034742:Electronic Mail; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D016584:Panic Disorder / Q000628:therapy*; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011584:Psychology; D011788:Quality of Life; D012944:Social Support; D016896:Treatment Outcome