Abstract
BackgroundInternet 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.MethodsPatients 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.ResultsImmediately 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.ConclusionsThis 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.Trial registrationClinicalTrials.gov NCT00845260
Highlights
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
Panic Disorder with or without agoraphobia (PD/A) is a common and, if untreated, usually chronic psychiatric disorder shown to be associated with impaired function and an elevated risk of suicide and premature death [1,2]
Group CBT for PD/A has been tested in a number of clinical trials [8], and has been evaluated in a regular care setting [9]
Summary
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 Internetand group administered CBT for panic disorder (with or without agoraphobia) in a randomised trial within a regular psychiatric care setting. Effective pharmacological treatment for PD/A is principally in the form of the selective serotonin reuptake inhibitors (SSRI) [3], whereas the psychological treatment with the clearest evidence base is cognitive behaviour therapy (CBT) [4]. While access to pharmacological treatments can be considered satisfactory in most cases, access to CBT is, in contrast, often limited [7] This is probably in large part due to a lack of trained therapists, especially outside of specialised health care centres and larger cities. Group CBT for PD/A has been tested in a number of clinical trials [8], and has been evaluated in a regular care setting [9]
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