Abstract
Internet-based cognitive behaviour therapy (ICBT) can be equally effective as traditional face-to-face cognitive behaviour therapy (CBT) for treating panic disorder (PD). However, little is known about the predictors and moderators of outcome of ICBT when delivered in psychiatric outpatient settings. This study investigated a selection of outcome predictors and moderators of ICBT for panic disorder based on data from a randomised controlled trial where therapist-guided ICBT was compared with group CBT (GCBT) for panic disorder. Participants (N = 104) received 10 weeks of ICBT or GCBT and were assessed before and after treatment, and after six months. Multiple regression analyses were used to test for significant predictors of treatment outcome. Predictors of positive treatment response for both modalities were having low levels of symptom severity and work impairment. In addition, anxiety sensitivity was found to have a small negative relationship with treatment outcome, suggesting that anxiety sensitivity may slightly enhance treatment response. Treatment modality had a moderating effect on the relationship between domestic impairment and outcome and on the relationship between initial age of onset of panic symptoms and treatment outcome, favouring ICBT for patients having had an early onset of PD symptoms and for patients having a high domestic functional impairment. These results suggest that both ICBT and GCBT are effective treatment modalities for PD and that it is possible to predict a significant proportion of the long-term outcome variance based on clinical variables.
Highlights
Cognitive behaviour therapy (CBT) is effective in treating panic disorder (PD) [1,2,3] and internet-based CBT (ICBT) with guided therapist contact has received empirical support as an alternative treatment delivery format [4,5,6,7]
As there is little information about the variables affecting the treatment response of ICBT for PD delivered in regular care settings and how it compares to traditional group CBT, this study was mainly exploratory with the aim of analysing a set of candidate predictor variables
Despite the limitations discussed above, this study provides further knowledge about patient characteristics that may have an impact on differences in panic disorder symptom severity at sixmonth follow up depending on treatment modality for patients with PD who seek treatment in psychiatric care
Summary
Cognitive behaviour therapy (CBT) is effective in treating panic disorder (PD) [1,2,3] and internet-based CBT (ICBT) with guided therapist contact has received empirical support as an alternative treatment delivery format [4,5,6,7]. Treatment significantly improved symptom severity in both groups with within-group effect sizes of d = 1.73 for ICBT and d = 1.63 for GCBT and no significant difference between groups. These results were sustained at 6-months follow-up. In a study by Dow et al [17] several significant outcome predictors of CBT for PD were identified, including agoraphobic avoidance, age of initial onset of panic symptoms, presence of co-morbid social phobia and fear of blood or injury. Sharp and Power [25] have found a negative relationship between agoraphobic avoidance and treatment outcome, and Haby et al [30] found in a meta-regression study that severity of panic symptoms was negatively associated with treatment effect. In a study of treatment for PD by Meuret et al [32] it was found that symptom appraisal (i.e. ‘‘fear of anxiety’’) had an effect on panic symptoms
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