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ICBT for Panic Disorder and Agoraphobia: From the Computer at Home to Real-Life ‘In Vivo’ Exposure

  • Wouter van Ballegooijen
  • Britt Klein
  • Nils Lindefors
Chapter

Abstract

Panic disorder with or without agoraphobia (PD/A) is a disabling disorder that involves physical anxiety symptoms, maladaptive cognitions and avoidance behaviour. Internet-based cognitive behavioural therapy (ICBT) can provide accessible mental health care to those who suffer from PD/A, which may increase the uptake of psychological treatment. The literature on ICBT for PD/A shows largely positive results, especially for therapist-guided ICBT among the general population. Unguided ICBT for PD/A is less studied. It has also demonstrated positive results, but is commonly associated with higher attrition than guided ICBT. There is also some evidence that guided ICBT for PD/A is effective for inpatients. Cost-effectiveness of ICBT for PD/A has only been minimally studied, but some evidence indicates it can be cost saving compared with face-to-face CBT. This chapter further describes the existing ICBT programmes for PD/A, a case study and implementation examples from Sweden and Australia. Finally, this chapter discusses the feasibility of minimally guided ICBT and current innovations in ICBT for PD/A, such as the use of mobile technology and virtual reality, and provides future directions for research and development.

Keywords

Cognitive Behavioural Therapy Social Anxiety Disorder Panic Disorder Panic Attack Cognitive Restructuring 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. AL-Asadi AM, Klein B, Meyer D (2014) Posttreatment attrition and its predictors, attrition bias, and treatment efficacy of the anxiety online programs. J Med Internet Res 16(10):e232CrossRefPubMedPubMedCentralGoogle Scholar
  2. Alcañiz M, Botella C, Baños R, Perpiñá C, Rey B, Lozano JA, Guillén V, Barrera F, Gil JA (2003) Internet-based telehealth system for the treatment of agoraphobia. CyberPsychol Behav 6(4):355–358CrossRefPubMedGoogle Scholar
  3. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th edition, text revision. American Psychiatric Association, Washington, DCGoogle Scholar
  4. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Author, Washington, DCCrossRefGoogle Scholar
  5. Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N (2010) Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One 5(10):e13196CrossRefPubMedPubMedCentralGoogle Scholar
  6. Australian Bureau of Statistics (2007) National survey of mental health and wellbeing (2007). Australian Bureau of Statistics, CanberraGoogle Scholar
  7. Bergström J, Andersson G, Ljótsson B, Rück C, Andréewitch S, Karlsson A, Carlbring P, Andersson E, Lindefors N (2010) Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial. BMC Psychiatry 10(1):54CrossRefPubMedPubMedCentralGoogle Scholar
  8. Botella C, García‐Palacios A, Villa H, Baños RM, Quero S, Alcañiz M, Riva G (2007) Virtual reality exposure in the treatment of panic disorder and agoraphobia: a controlled study. Clin Psychol Psychother 14(3):164–175CrossRefGoogle Scholar
  9. Buist-Bouwman MA, De Graaf R, Vollebergh WA, Alonso J, Bruffaerts R, Ormel J (2006) Functional disability of mental disorders and comparison with physical disorders: a study among the general population of six European countries. Acta Psychiatr Scand 113(6):492–500CrossRefPubMedGoogle Scholar
  10. Carlbring P, Westling BE, Ljungstrand P, Ekselius L, Andersson G (2001) Treatment of panic disorder via the Internet: a randomized trial of a self-help program. Behav Ther 32(4):751–764CrossRefGoogle Scholar
  11. Carlbring P, Bohman S, Brunt S, Buhrman M, Westling B, Ekselius L, Andersson G (2006) Remote treatment of panic disorder: a randomized trial of internet-based cognitive behavior therapy supplemented with telephone calls. Am J Psychiatry 163(12):2119–2125CrossRefPubMedGoogle Scholar
  12. Carlbring P, Maurin L, Torngren C, Linna E, Eriksson T, Sparthan E et al (2011) Individually-tailored, Internet-based treatment for anxiety disorders: a randomized controlled trial. Behav Res Ther 49(1):18–24CrossRefPubMedGoogle Scholar
  13. De Graaf R, ten Have M, van Dorsselaer S (2010) [De psychische gezondheid van de Nederlandse bevolking. NEMESIS-2: Opzet en eerste resultaten.]. Trimbos-instituut, UtrechtGoogle Scholar
  14. Ebenfeld L, Stegemann SK, Lehr D, Ebert DD, Jazaieri H, Van Ballegooijen W, et al (2014) Efficacy of a hybrid online training for panic symptoms and agoraphobia: study protocol for a randomized controlled trial. Trials 15(1):427Google Scholar
  15. El Alaoui S, Hedman E, Ljótsson B, Bergström J, Andersson E, Rüch C, Andersson G, Lindefors N (2013) Predictors and moderators of internet- and group-based cognitive behaviour therapy for panic disorder. PLoS One 8(11):e79024CrossRefPubMedPubMedCentralGoogle Scholar
  16. Farvolden P, Denisoff E, Selby P, Bagby RM, Rudy L (2005) Usage and longitudinal effectiveness of a Web-based self-help cognitive behavioral therapy program for panic disorder. J Med Internet Res 7(1):e7CrossRefPubMedPubMedCentralGoogle Scholar
  17. Hedman E, Ljótsson B, Rück C, Bergström J, Andersson G, Kaldo V, Jansson L, Andersson E, Andersson E, Blom K, El Alaoui S, Falk L, Ivarsson J, Nasri B, Rydh S, Lindefors N (2013) Effectiveness of internet‐based cognitive behaviour therapy for panic disorder in routine psychiatric care. Acta Psychiatr Scand 128(6):457–467CrossRefPubMedGoogle Scholar
  18. Kelders SM, Kok RN, Ossebaard HC, Van Gemert-Pijnen JE (2012) Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res 14(6):e152CrossRefPubMedPubMedCentralGoogle Scholar
  19. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):617–627CrossRefPubMedPubMedCentralGoogle Scholar
  20. Kiropoulos LA, Klein B, Austin DW, Gilson K, Pier C, Mitchell J, Ciechomski L (2008) Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? J Anxiety Disord 22(8):1273–1284CrossRefPubMedGoogle Scholar
  21. Klein B, Richards JC (2001) A brief internet-based treatment for panic disorder. Behav Cogn Psychother 29(01):113–117CrossRefGoogle Scholar
  22. Klein B, Richards JC, Austin DW (2006) Efficacy of internet therapy for panic disorder. J Behav Ther Exp Psychiatry 37(3):213–238CrossRefPubMedGoogle Scholar
  23. Klein B, Shandley K, Austin D, Nordin S (2008) Pilot trial of panic online self-guided version: internet-based treatment for panic disorder. J Appl Psychol 4(2):25–30Google Scholar
  24. Klein B, Austin D, Pier C, Kiropoulos L, Shandley K, Mitchell J, Gilson K, Ciechomski L (2009) Internet-based treatment for panic disorder: does frequency of therapist contact make a difference? Cogn Behav Ther 38(2):100–113CrossRefPubMedGoogle Scholar
  25. Klein B, Meyer D, Austin DW, Kyrios M (2011) Anxiety online—a virtual clinic: preliminary outcomes following completion of five fully automated treatment programs for anxiety disorders and symptoms. J Med Internet Res 13(4):e89CrossRefPubMedPubMedCentralGoogle Scholar
  26. Lindner P, Ivanova E, Ly KH, Andersson G, Carlbring P (2013) Guided and unguided CBT for social anxiety disorder and/or panic disorder via the Internet and a smartphone application: study protocol for a randomised controlled trial. Trials 14(1):437Google Scholar
  27. Meulenbeek P, Herzmanatus J, Smit F, Willemse G, van der Zanden R (2005) Cursusmap: Geen Paniek, leren omgaan met paniekklachten. Trimbos-instituut/GGNet, UtrechtGoogle Scholar
  28. Meulenbeek P, Willemse G, Smit F, van Balkom A, Spinhoven P, Cuijpers P (2010) Early intervention in panic: pragmatic randomised controlled trial. Br J Psychiatry 196(4):326–331CrossRefPubMedGoogle Scholar
  29. Meyerbröker K, Emmelkamp PM (2010) Virtual reality exposure therapy in anxiety disorders: a systematic review of process‐and‐outcome studies. Depress Anxiety 27(10):933–944CrossRefPubMedGoogle Scholar
  30. Meyerbröker K, Morina N, Kerkhof GA, Emmelkamp PMG (2013) Virtual reality exposure therapy does not provide any additional value in agoraphobic patients: a randomized controlled trial. Psychother Psychosom 82(3):170–176CrossRefGoogle Scholar
  31. Peñate W, Pitti CT, Bethencourt JM, de la Fuente J, Gracia R (2008) The effects of a treatment based on the use of virtual reality exposure and cognitive-behavioral therapy applied to patients with agoraphobia. Int J Clin Health Psychol 8(1):5–22Google Scholar
  32. Pier C, Austin DW, Klein B, Mitchell J, Schattner P, Ciechomski L, Wade V (2008) 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. Mental Health Fam Med 5(1):29Google Scholar
  33. Pitti C, Peñate W, de la Fuente J, Bethencourt J, Acosta L, Villaverde M, Gracia R (2007) Agoraphobia: combined treatment and virtual reality. Preliminary results. Actas Esp Psiquiatr 36(2):94–101Google Scholar
  34. Richards D, Richardson T (2012) Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev 32(4):329–342CrossRefPubMedGoogle Scholar
  35. Richards JC, Klein B, Austin DW (2006) Internet cognitive behavioural therapy for panic disorder: does the inclusion of stress management information improve end-state functioning? Clin Psychologist 10(1):2–15CrossRefGoogle Scholar
  36. Robinson E, Titov N, Andrews G, McIntyre K, Schwencke G, Solley K (2010) Internet treatment for generalized anxiety disorder: a randomized controlled trial comparing clinician vs. technician assistance. PLoS One 5(6):e10942CrossRefPubMedPubMedCentralGoogle Scholar
  37. Ruwaard J, Broeksteeg J, Schrieken B, Emmelkamp P, Lange A (2010) Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: a randomized controlled trial with a three-year follow-up. J Anxiety Disord 24(4):387–396CrossRefPubMedGoogle Scholar
  38. Shandley K, Austin D, Klein B, Pier C, Schattner P, Pierce D, Wade T (2008) Therapist assisted, internet – based treatment for panic disorder: can general practitioners achieve comparable patient outcomes to psychologists? J Med Internet Res 10:e14CrossRefPubMedPubMedCentralGoogle Scholar
  39. Silfvernagel K, Carlbring P, Kabo J, Edström S, Eriksson J, Månson L, Andersson G (2012) Individually tailored internet-based treatment for young adults and adults with panic attacks: randomized controlled trial. J Med Internet Res 14(3):e65CrossRefPubMedPubMedCentralGoogle Scholar
  40. Smit F, Cuijpers P, Oostenbrink J, Batelaan N, De Graaf R, Beekman A (2006) Costs of nine common mental disorders: implications for curative and preventive psychiatry. J Ment Health Policy Econ 9(4):193–200PubMedGoogle Scholar
  41. Spek V, Cuijpers P, Nyklíček I, Smits N, Riper H, Keyzer J, Pop V (2008) One-year follow-up results of a randomized controlled clinical trial on internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years. Psychol Med 38(05):635–639CrossRefPubMedGoogle Scholar
  42. Svanborg P, Åsberg M (1994) A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand 89(1):21–28CrossRefPubMedGoogle Scholar
  43. Titov N, Andrews G, Davies M, McIntyre K, Robinson E, Solley K (2010) Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. PLoS One 5(6):e10939CrossRefPubMedPubMedCentralGoogle Scholar
  44. Titov N, Dear BF, Schwencke G, Andrews G, Johnston L, Craske MG et al (2011) Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial. Behav Res Ther 49(8):441–452CrossRefPubMedGoogle Scholar
  45. Van Ballegooijen W, Riper H, van Straten A, Kramer J, Conijn B, Cuijpers P (2011) The effects of an Internet based self-help course for reducing panic symptoms – Don’t Panic Online: study protocol for a randomised controlled trial. Trials 12:75CrossRefPubMedPubMedCentralGoogle Scholar
  46. Van Ballegooijen W, Riper H, Klein B, Ebert DD, Kramer J, Meulenbeek P, Cuijpers P (2013) An internet-based guided self-help intervention for panic symptoms: randomized controlled trial. J Med Internet Res 15(7):e154CrossRefPubMedPubMedCentralGoogle Scholar
  47. Warmerdam L, van Straten A, Twisk J, Riper H, Cuijpers P (2008) Internet-based treatment for adults with depressive symptoms: randomized controlled trial. J Med Internet Res 10(4):e44CrossRefPubMedPubMedCentralGoogle Scholar
  48. Wims E, Titov N, Andrews G, Choi I (2010) Clinician-assisted Internet-based treatment is effective for panic: a randomized controlled trial. Aust N Z J Psychiatry 44(7):599–607CrossRefPubMedGoogle Scholar
  49. World Health Organisation (2014) ICD-10 version: 2015. From: http://apps.who.int/classifications/icd10/browse/2015/en. Accessed 4th Dec 2014

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Wouter van Ballegooijen
    • 1
  • Britt Klein
    • 2
  • Nils Lindefors
    • 3
  1. 1.Department of Clinical Psychology and PsychiatryVrije Universiteit Amsterdam/GGZ inGeestAmsterdamThe Netherlands
  2. 2.Department of PsychologyFederation UniversityMount HelenAustralia
  3. 3.Department of Clinical NeuroscienceKarolinska InstitutetSolnaSweden

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