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

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.

Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT

This study compared Panic Online (PO), an internet-based CBT intervention, to best-practice face-to-face CBT for people with panic disorder with or without agoraphobia. Eighty-six people with a primary diagnosis of panic disorder were recruited from Victoria, Australia. Participants were randomly assigned to either PO (n = 46) or best practice face-to-face CBT (n = 40). Effects of the internet-based CBT program were found to be comparable to those of face-to-face CBT. Both interventions produced significant reductions in panic disorder and agoraphobia clinician severity ratings, self reported panic disorder severity and panic attack frequency, measures of depression, anxiety, stress and panic related cognitions, and displayed improvements in quality of life. Participants rated both treatment conditions as equally credible and satisfying. Participants in the face-to-face CBT treatment group cited higher enjoyment with communicating with their therapist. Consistent with this, therapists’ ratings for compliance to treatment and understanding of the CBT material was higher in the face-to-face CBT treatment group. PO required significantly less therapist time than the face-to-face CBT condition.

Sharing the moment : on the Olympic Games as spectacle

Article examining the 'sale' of Olympics drawing on Kant's aesthetics of beauty in the Critique of Judgment.

Internet administration of three commonly used questionnaires in panic research : equivalence to paper administration in Australian and Swedish samples of people with panic disorder

This study assessed the degree of equivalence between paper and Internet administration of three measures of panic and agoraphobia-related cognition and behavior: Body Sensations Questionnaire (BSQ), Agoraphobic Cognitions Questionnaire (ACQ), and Mobility Inventory (MI). Participants were 110 people with panic disorder who had registered for an Internet-based treatment program in Sweden (n = 54) or Australia (n = 56). Participants were randomly assigned to complete the questionnaires via the differing administration formats in a counterbalanced order. Results showed broadly equivalent psychometric properties across administrations, with strong significant intraclass correlations between them, and comparable Cronbach's alpha coefficients. A significant mean difference between administration formats was found for the BSQ only. In contrast to previous research, Internet administration did not generate higher scores than paper administration. No effect was found for order of administration. The findings suggest that each questionnaire can be validly administered via the Internet and used with confidence.

The relationship between attachment style, anxiety sensitivity and interpretive bias among adolescent nonclinical panickers

Elevated anxiety sensitivity and the tendency to catastrophically misinterpret ambiguous bodily sensations has been demonstrated in people who experience nonclinical levels of panic (Richards, Austin, & Alvarenga, 2001), and anxiety sensitivity has been shown to be associated with insecure attachment in adolescents and young adults (Weems, Berman, Silverman, and Saavedra, 2001). This study investigated the relationship between attachment style, anxiety sensitivity and catastrophic misinterpretation among 11 nonclinical panickers and 58 nonanxious controls aged 18 to 19 years. Participants completed the Brief Bodily Sensations Interpretation Questionnaire (BBSIQ), Anxiety Sensitivity Index (ASI) and an attachment questionnaire. The hypothesis that insecurely attached individuals would demonstrate greater catastrophic misinterpretation and higher anxiety sensitivity than securely attached individuals was not supported; however, nonclinical panickers gave more anxiety-related interpretations of ambiguous internal stimuli than nonanxious controls. Results do not support the notion that attachment style is related to anxiety sensitivity or catastrophic misinterpretation (regardless of panic experience). Results do, however, support the notion that anxiety-related misinterpretation of ambiguous somatic sensations precedes the onset of panic disorder.

A test of core assumptions of the catastrophic misinterpretation model of panic disorder

The catastrophic misinterpretation model of panic disorder proposes that spontaneous panic attacks are the result of misinterpretation of harmless autonomic arousal as precursors to physical (e.g. heart attack) or psychological (e.g. insanity) emergency. Mixed research findings to date have provided equivocal support. A modified form of the Body Sensations Interpretation Questionnaire was used to investigate core assumptions of the model amongst 38 people with panic disorder (PD), 20 with non-clinical panic, 21 with social anxiety disorder, and 34 non-anxious controls. The PD group gave more harm-related interpretations of ambiguous internal stimuli than all other groups only when anxiety-related responses (e.g. “I'm going to panic”) were scored as harm, however there was no evidence that anxiety-related interpretations were masking perceived catastrophic physical or psychological outcomes. Despite this, people with PD rated harm and anxiety outcomes as more negative than non-anxious controls. Results failed to unequivocally support core assumptions of the model.

An investigation of porphyrinuria in Australian children with autism

Two recent studies, from France (Nataf et al., 200614. Nataf, R., Skorupka, C., Amet, L., Lam, A., Springbett, A. and Lathe, R. 2006. Porphyrinuria in childhood autistic disorder: Implications for environmental toxicity. Toxicol. Appl. Pharmacol., 214: 99–108. [CrossRef], [PubMed], [Web of Science ®] View all references) and the United States (Geier & Geier, 20079. Geier, D. A. and Geier, M. R. 2007. A prospective study of mercury toxicity biomarkers in autistic spectrum disorders. J. Toxicol. Environ. Health, A, 70: 1723–1730. [Taylor & Francis Online], [PubMed], [Web of Science ®] View all references), identified atypical urinary porphyrin profiles in children with an autism spectrum disorder (ASD). These profiles serve as an indirect measure of environmental toxicity generally, and mercury (Hg) toxicity specifically, with the latter being a variable proposed as a causal mechanism of ASD (Bernard et al., 20012. Bernard, S., Enayati, A., Redwood, L., Roger, H. and Binstock, T. 2001. Autism: A novel form of mercury poisoning. Med. Hypoth., 56: 462–471. [CrossRef], [PubMed], [Web of Science ®] View all references; Mutter et al., 200515. Mutter, J., Naumann, J., Schneider, R., Walach, H. and Haley, B. 2005. Mercury and autism: Accelerating evidence?. Neuroendocrinol. Lett., 26: 439–446. [PubMed], [Web of Science ®] View all references). To examine whether this phenomenon occurred in a sample of Australian children with ASD, an analysis of urinary porphyrin profiles was conducted. A consistent trend in abnormal porphyrin levels was evidenced when data was compared with those previously reported in the literature. The results are suggestive of environmental toxic exposure impairing heme synthesis. Three independent studies from three continents have now demonstrated that porphyrinuria is concomitant with ASD, and that Hg may be a likely xenobiotic to produce porphyrin profiles of this nature.

Mercury in vaccines from the Australian childhood immunization program schedule

Despite the removal of the mercury (Hg)-based preservative thimerosal from vaccines listed on the Australian Immunization Program Schedule for children, concerns remain among some researchers and parents for the safety of the present schedule, in part due to a fear of residual trace levels of Hg. The purpose of this study was to independently assess childhood vaccines for the presence of Hg. Eight vaccines administered to children under the age of 5 yr were assessed for Hg content via a DMA-80 direct mercury analyzer. Seven of the 8 vaccines contained no detectable levels of Hg (less than 1 ppb); however, 1 vaccine (Infanrix hexa) tested positive for Hg at 10 ppb. The result was confirmed and validated by retesting the original sample. Follow-up testing was conducted on three additional samples of Infanrix hexa (one from the same production lot and two from a different lot). All three tested positive for Hg (average of 9.7 ppb). Although the levels of Hg detected are substantially lower than any established exposure safety limits, the results of this study reveal that inaccuracies exist in public health messages, professional communications, and official documentation regarding Hg content in at least one childhood vaccine. In the interests of public health, it is incumbent on vaccine manufacturers and responsible agencies such as the Therapeutic Goods Administration and the Federal Department of Health and Ageing to address this issue as a matter of urgency.

Commentary : Fatty acids, breastfeeding and Autism Spectrum Disorder

Fatty acid deficiencies are linked to Autism Spectrum Disorder. This commentary discusses the protective role of breastfeeding and the urgency of research into the human infant's intake of colostrum to prevent fatty acid deficiency.

Maternal transfer of mercury to the developing embryo/fetus : is there a safe level?

Mercury (Hg) exposure is ubiquitous in modern society via vaccines, fish/crustacea, dental amalgam, food, water, and the atmosphere. This article examines Hg exposure in the context of primary exposure to pregnant women and secondary exposure experienced by their unborn babies. Babies in utero are particularly at risk of higher Hg exposure than adults (on a dose/weight basis through maternal Hg transfer via the placenta), and are more susceptible to adverse effects from mercury and its biologically active compounds. It is, therefore, critical that regulatory advisories around maximum safe Hg exposures account for pregnant women and secondary exposure that children in utero experience. This study focused on standardized embryonic and fetal Hg exposures via primary exposure to the pregnant mother of two common Hg sources (dietary fish and parenteral vaccines). Data demonstrated that Hg exposures, particularly during the first trimester of pregnancy, at well-established dose/weight ratios produced severe damage to humans including death. In light of research suggestive of a mercuric risk factor for childhood conditions such as tic disorders, cerebral palsy, and autism, it is essential that Hg advisories account for secondary prenatal human exposures.