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Internet-Guided Self-Help with or without Exposure Therapy for Phobic and Panic Disorders

2005; Karger Publishers; Volume: 74; Issue: 3 Linguagem: Inglês

10.1159/000084000

1423-0348

Andreas Schneider, David Mataix‐Cols, Isaac Marks, Martin Bachofen,

Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes

<i>Background:</i> As many sufferers from phobic and panic (phobia/panic) disorders cannot get to suitable therapists, routine aspects of therapy were delegated to internet-accessed computer-aided self-help with or without exposure instructions. <i>Methods:</i> Phobia/panic referrals were randomised to computer-aided self-help via the internet at home in a 2:1 ratio either by self-exposure cognitive behaviour therapy (CBT) [<i>FearFighter (FF),</i> n = 45] or by minimal CBT without exposure [<i>Managing Anxiety (MA),</i> n = 23]. All had brief backup phone advice from a clinician concerning their computer guidance. <i>Results:</i> On self-ratings and blinded assessor ratings, patients improved equally with each form of self-help over 10 treatment weeks but significantly more on 5 out of 10 measures by week 14 (1-month follow-up) when the self-help included self-exposure instructions than when it did not. In accord with this, standardised effect sizes (Cohen’s d) indicated superiority of <i>FF</i> over <i>MA</i> on 5 measures by week 14. Satisfaction with treatment in all patients pooled correlated positively with improvement after treatment and at 1-month follow-up. <i>Conclusions:</i> At the end of treatment, computer-aided CBT self-help at home via the internet plus brief live helpline support was effective with or without exposure instructions, and at 1-month follow-up it was more effective on some measures if exposure instructions had been included. Analysis is needed of how non-exposure CBT produced its shorter-term effect.