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.

Internet-based psychological and oral medical treatment compared to psychological treatment alone for ED

Introduction. Sexual function through pregnancy and the postpartum period is an important aspect of quality of life.
Despite this, prospective studies are limited, and the impact of body image on sexual function has not been explored.
Aims. The current study reports on a pilot study that evaluated the effectiveness of a combined Internet-based
psychological treatment program and oral medication compared to an Internet-based psychological program.
Methods. Twelve men with ED participated in the study.
Main Outcome Measures. Assessments were made pre and postintervention on ED, relationship satisfaction, sexual
satisfaction, self-esteem, and quality of life.
Results. Multivariate analyses of variance demonstrated that both treatment conditions showed improvements from
pretest to posttest in sexual functioning, relationships, and personal well-being.
Conclusions. This study indicates the importance of targeting psychological and relationship variables in the
treatment of ED. Further research with larger numbers of participants is necessary for a more rigorous evaluation
of treatment programs that combine psychological and medication interventions for ED.

Single session web-based counselling: a thematic analysis of content from the perspective of the client

Despite the exponential growth of non-appointment-based web counselling, there is limited information on what happens in a single session intervention. This exploratory study, involving a thematic analysis of 85 counselling transcripts of people seeking help for problem gambling, aimed to describe the presentation and content of online conversations. Observed from the perspective of the client, we found that presentations were related to immediate help with a crisis and non-urgent assistance in developing strategies and skills. Almost all clients spent a great deal of time telling their story (i.e., the pattern, context, progression and impact of the problem, motivation for continuing and previous attempts to change) with less time spent exploring opportunities, readiness or self-efficacy related to change or relevant options and strategies. These findings provide important information that informs the application of traditional counselling approaches within web-based environments.

Using technology to enhance decision making

We focus here on decision making in the everyday clinical situation and do not address decision making in politics and administration, although obviously it affects clinical practice and vice versa. For example, decisions against providing sufficient face-to-face psychotherapy is one factor that may increase the demand for Internet therapy, and vice versa—that is, the use of technology for therapy, as in Internet therapy, might influence to what extent face-to-face therapy needs to be provided. It is obvious that the aggregation of information for political and administrative decisions can take advantage of technology. If technology is used professionally, this should contribute to better informed decisions and less dependency on information provided by lobbyists who might not work in the interest of high-quality service for those who need it. An optimistic view is thus that technology works in favor of patients on this level as well. In the interest of keeping the focus of this chapter manageable, we also do not address treatments fully delivered over the Internet or computers, as for the example described in Comer and Barlow (2014), although such treatments, as they unfold, of course also include decision making.

Acceptability of cognitive-behaviour therapy via the Internet for cessation of benzodiazepine use

Introduction and Aims: Long-term use of benzodiazepines remains common, and conveys significant risk. Providing psychological intervention in association with gradual dose reduction increases cessation rates above dose reduction alone, but appropriate psychological support is difficult to obtain. This study was undertaken to assess the outcomes of an uncontrolled case series of an internet-based cognitive-behaviour therapy (I-CBT) for benzodiazepine cessation. Design and Method: Users of benzodiazepines for > 3 months who wanted to reduce or cease benzodiazepines participated in the trial. They completed online assessments and accessed 13 newsletters on managing withdrawal symptoms and developing alternate ways to cope with life events. Therapist assistance was provided by email. Follow-up was at 3 and 6 months and feedback was obtained via comments and emails. Results: Program ratings and emailed comments of the program were positive. Thirty-two people registered for the program and 14 (44%) completed a 6-month follow-up. Of these, 8 (57%) reduced weekly intake by at least half, including 5 (36%) who ceased use. Shorter duration of use and birth outside Australia predicted greater percentage reductions at 3 months, while being partnered and in paid employment predicted reductions at 6 months. Discussion and Conclusion: While results were encouraging, controlled research is required to confirm the efficacy of the program, and engagement of both users and prescribers needs further attention.

Internet-based cognitive behaviour therapy for erectile dysfunction

This thesis involved the development and evaluation of "Rekindle", an internet-based cognitive behaviour therapy (CBT) for erectile dysfunction (ED). For highly motivated couples, "Rekindle" was more effective than no treatment for improving sexual function and relationships. Most men who completed "Rekindle" had maintained treatment gains at 3-month follow-up. The professional portfolio presented 4 case studies which demonstrate that barriers to recovery from early psychosis are often complex and challenging issues, and that effective strategies need to be implemented to overcome these issues during treatment. When insufficient intervention is provided to address these barriers, the likelihood of successful outcome following early psychosis is significantly reduced.

Dissemination of therapist-assisted internet cognitive behaviour therapy : development and open pilot study of a workshop

There is considerable research suggesting that therapist-assisted Internet cognitive behaviour therapy (ICBT) is efficacious in the treatment of depression and anxiety. Given this research, there is a growing interest in training students in therapist-assisted ICBT in order to assist with the dissemination of this emerging modality into routine clinical practice. In this study, we developed, delivered, and evaluated a therapist-assisted ICBT workshop for clinical psychology graduate students (n = 20). The workshop provided both research evidence and practical information related to the delivery of therapist-assisted ICBT. The workshop also incorporated an experiential component with students working on and discussing responses to client e-mails. Before and after the workshop, we measured knowledge of therapist-assisted ICBT research and professional practice issues, as well as attitudes towards and confidence in delivering therapist-assisted ICBT. Statistically significant changes were observed in all areas. Eighty-five per cent of students are now offering therapist-assisted ICBT under supervision. We conclude by discussing future research directions related to disseminating therapist-assisted ICBT.

Internet cognitive behavioural therapy for panic disorder : does the inclusion of stress management information improve end-state functioning?

Previous research has established Internet-based cognitive behavioural therapy (CBT) for panic disorder (PD) as effective in reducing panic severity and frequency. There is evidence, however, that such programs are less effective at improving overall end-state functioning, defined by a PD clinician severity rating of ≤2 and panic free. In order to test the effect on end-state functioning of the incorporation of stress management material within a CBT program for PD, 32 people with PD were randomised to either Internet-based CBT (PO1), Internet-based CBT plus stress management (PO2) or an Internet-based information-only control condition (IC). Both CBT treatments were more effective at posttreatment assessment than the control condition in reducing PD severity, panic and agoraphobia-related cognition, negative affect and self-ratings of health. PO2 was more effective than PO1 at posttreatment assessment on PD severity and general anxiety, although at 3-month follow-up these differences were no longer apparent. This study provides further support for the efficacy of Internet-based CBT for PD and suggests that although the incorporation of stress management material confers short-term advantages over a standard program, it is not associated with any longer term improvements on panic severity and related cognitions, negative affect, general wellbeing and end-state functioning.

The role of the therapeutic alliance in internet-delivered cognitive-behaviour therapy

My research tested the importance of the client–practitioner relationship to therapeutic outcomes, utilising an Internet-based treatment for panic disorder. Results indicate that, while the relationship remains important when shared online, it matters less than in face-to-face settings. This calls into question conventional models of what makes psychological treatments effective.

Study protocol for a randomised controlled trial of internet-based cognitive-behavioural therapy for obsessive-compulsive disorder.

Obsessive-Compulsive Disorder (OCD) is a common chronic psychiatric disorder that constitutes a leading cause of disability. Although Cognitive-Behaviour Therapy (CBT) has been shown to be an effective treatment for OCD, this specialised treatment is unavailable to many due to access issues and the social stigma associated with seeing a mental health specialist. Internet-based psychological treatments have shown to provide effective, accessible and affordable treatment for a range of anxiety disorders, and two Randomised Controlled Trials (RCTs) have demonstrated the efficacy and acceptability of internet-based CBT (iCBT) for OCD, as compared to waitlist or supportive therapy. Although these initial findings are promising, they do not isolate the specific effect of iCBT. This paper details the study protocol for the first randomised control trial evaluating the efficacy of therapist-assisted iCBT for OCD, as compared to a matched control intervention; internet-based therapist-assisted progressive relaxation training (iPRT). It will aim to examine whether therapist-assisted iCBT is an acceptable and efficacious treatment, and to examine how effectiveness is influenced by patient characteristics.