title: A controlled trial of internet-based cognitive-behavioural therapy for panic disorder with face-to-face support from a general practitioner or email support from a psychologist.
abstract: Background Panic disorder (PD) is one of the most common anxiety disorders seen in general practice, but provision of evidence-based cognitive-behavioural treatment (CBT) is rare. Many Australian GPs are now trained to deliver focused psychological strategies, but in practice this is time consuming and costly.Objective To evaluate the efficacy of an internet-based CBT intervention (Panic Online) for the treatment of PD supported by general practitioner (GP)-delivered therapeutic assistance.Design Panic Online supported by GP-delivered face-to-face therapy was compared to Panic Online supported by psychologist-delivered email therapy.Methods Sixty-five people with a primary diagnosis of PD (78% of whom also had agoraphobia) completed 12 weeks of therapy using Panic Online and therapeutic assistance with his/her GP (n = 34) or a clinical psychologist (n = 31). The mean duration of PD for participants allocated to these groups was 59 months and 58 months, respectively. Participants completed a clinical diagnostic interview delivered by a psychologist via telephone and questionnaires to assess panic-related symptoms, before and after treatment.Results The total attrition rate was 20%, with no group differences in attrition frequency. Both treatments led to significant improvements in panic attack frequency, depression, anxiety, stress, anxiety sensitivity and quality of life. There were no statistically significant differences in the two treatments on any of these measures, or in the frequency of participants with clinically significant PD at post assessment.Conclusions When provided with accessible online treatment protocols, GPs trained to deliver focused psychological strategies can achieve patient outcomes comparable to efficacious treatments delivered by clinical psychologists. The findings of this research provide a model for how GPs may be assisted to provide evidence-based mental healthcare successfully.
authors.affiliation: Lecturer in Psychology, School of Psychology, Deakin University, Victoria, Australia.
authors.forename: Ciaran
authors.initials: C
authors.lastname: Pier
authors.forename: David W
authors.initials: DW
authors.lastname: Austin
authors.forename: Britt
authors.initials: B
authors.lastname: Klein
authors.forename: Joanna
authors.initials: J
authors.lastname: Mitchell
authors.forename: Peter
authors.initials: P
authors.lastname: Schattner
authors.forename: Lisa
authors.initials: L
authors.lastname: Ciechomski
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Gilson
authors.forename: David
authors.initials: D
authors.lastname: Pierce
authors.forename: Kerrie
authors.initials: K
authors.lastname: Shandley
authors.forename: Victoria
authors.initials: V
authors.lastname: Wade