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Long-Distance Treatment for Panic Disorder: Does It Work?

Treatment administered via the internet and telephone was beneficial to individuals with PD.

Panic disorder (PD) affects twice as many women as men and may lead to severe functional impairment. Despite highly effective therapies, people with PD (particularly those with agoraphobia) often find it prohibitively difficult to seek treatment. To assess the benefit of remote cognitive behavior therapy, investigators randomized 60 adults (60% women) with PD to 10 weeks of treatment via the internet, e-mail, and telephone or a waiting list (control).

The treatment consisted of 10 modules of cognitive therapy techniques distributed via e-mail, plus brief (about 10 minutes/week) therapist contact by telephone to motivate treatment adherence. The modules covered psycho-education, socialization, breathing retraining, relapse prevention, and assertiveness training. Each module included information, exercises, and homework; feedback was provided within 24 hours of homework completion. At the end of the study, treatment and control groups were reassessed; the control group was offered a different treatment format, and the treatment group was followed up again 9 months later.

At the end of the therapy period, the treatment group showed significant improvement compared with controls, as assessed with standardized instruments (e.g., the Body Sensations Questionnaire, Mobility Inventory, and Beck Anxiety Inventory). Moreover, clinical telephone interviews conducted 1 month after completion of treatment revealed that 77% of treated patients no longer suffered from PD, whereas all untreated patients still met the criteria for this disorder. Nine-month follow-up showed sustained clinical improvement in the treatment group.

Comment: This small study included highly motivated, relatively well-educated adults, half of whom were receiving concomitant medications. Although the results might not be applicable to the general population of patients with PD, they are provocative and should stimulate further research. During certain periods in life, such as the postpartum period, regular attendance at treatment sessions might be particularly problematic. Internet-based self-help therapies are an excellent treatment alternative for women who have new or recurrent symptoms of PD and who would not otherwise seek treatment. If this type of therapy proves to be cost-effective on a larger scale, clinicians might face the challenge of convincing insurance plans to cover it.

— Claudio N. Soares MD, PhD

Published in Journal Watch Women's Health February 8, 2007

Citation(s):

Carlbring P et al. Remote treatment of panic disorder: A randomized trial of internet-based cognitive behavior therapy supplemented with telephone calls. Am J Psychiatry 2006 Dec; 163:2119-25.

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