title: Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial.
abstract: BACKGROUND
  Internet administered cognitive behaviour therapy (CBT) is a promising new way to deliver psychological treatment, but its effectiveness in regular care settings and in relation to more traditional CBT group treatment has not yet been determined. The primary aim of this study was to compare the effectiveness of Internet-and group administered CBT for panic disorder (with or without agoraphobia) in a randomised trial within a regular psychiatric care setting. The second aim of the study was to establish the cost-effectiveness of these interventions.
  
  
  METHODS
  Patients referred for treatment by their physician, or self-referred, were telephone-screened by a psychiatric nurse. Patients fulfilling screening criteria underwent an in-person structured clinical interview carried out by a psychiatrist. A total of 113 consecutive patients were then randomly assigned to 10 weeks of either guided Internet delivered CBT (n = 53) or group CBT (n = 60). After treatment, and at a 6-month follow-up, patients were again assessed by the psychiatrist, blind to treatment condition.
  
  
  RESULTS
  Immediately after randomization 9 patients dropped out, leaving 104 patients who started treatment. Patients in both treatment conditions showed significant improvement on the main outcome measure, the Panic Disorder Severity Scale (PDSS) after treatment. For the Internet treatment the within-group effect size (pre-post) on the PDSS was Cohen's d = 1.73, and for the group treatment it was d = 1.63. Between group effect sizes were low and treatment effects were maintained at 6-months follow-up. We found no statistically significant differences between the two treatment conditions using a mixed models approach to account for missing data. Group CBT utilised considerably more therapist time than did Internet CBT. Defining effect as proportion of PDSS responders, the cost-effectiveness analysis concerning therapist time showed that Internet treatment had superior cost-effectiveness ratios in relation to group treatment both at post-treatment and follow-up.
  
  
  CONCLUSIONS
  This study provides support for the effectiveness of Internet CBT in a psychiatric setting for patients with panic disorder, and suggests that it is equally effective as the more widely used group administered CBT in reducing panic-and agoraphobic symptoms, as well as being more cost effective with respect to therapist time.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00845260.
authors.affiliation: Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden. jan.o.bergstrom@ki.se
authors.forename: Jan
authors.initials: J
authors.lastname: Bergström
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.forename: Brjánn
authors.initials: B
authors.lastname: Ljótsson
authors.forename: Christian
authors.initials: C
authors.lastname: Rück
authors.forename: Sergej
authors.initials: S
authors.lastname: Andréewitch
authors.forename: Andreas
authors.initials: A
authors.lastname: Karlsson
authors.forename: Per
authors.initials: P
authors.lastname: Carlbring
authors.forename: Erik
authors.initials: E
authors.lastname: Andersson
authors.forename: Nils
authors.initials: N
authors.lastname: Lindefors
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet / Q000191:economics; D008297:Male; D017063:Outcome Assessment, Health Care; D016584:Panic Disorder / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D011567:Psychiatric Department, Hospital; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011615:Psychotherapy, Group / Q000191:economics* / Q000379:methods*; D012648:Self Care / Q000379:methods; D016896:Treatment Outcome