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Long-Distance CBT for Panic Disorder

Remotely administered cognitive-behavioral therapy via internet and telephone can significantly benefit patients with panic disorder.

Several studies suggest that cognitive-behavioral therapy delivered via the internet or telephone may be effective for various psychiatric disorders. These investigators in Sweden randomized 60 patients with panic disorder to remote CBT or a waiting list.

The treatment program consisted of 10 modules over 10 weeks. Each module involved about 25 pages of reading, supplemented with e-mails between patients and therapists (for therapists, averaging about 12 minutes weekly per patient, including administrative time) and weekly telephone calls (also averaging around 12 minutes). Weekly assignments included essays and end-of-module quizzes. The modules covered psychoeducation, breathing retraining, cognitive restructuring, interoceptive exposure, exposure in vivo, and, finally, relapse prevention and assertiveness training.

Eighty percent of the 30 active-treatment patients completed all 10 modules within the intended time limit. One month after treatment, 77% in the active-treatment group and none in the control group no longer met criteria for panic disorder. At follow-up 9 months post-treatment, 60% of active-treatment recipients were rated as clinically improved for bodily sensations, 67% for agoraphobic cognitions, 67% for mobility when alone, and 60% for mobility when accompanied.

Comment: The authors credit the use of supplemental telephone calls for these completion rates, which were higher than in their previous study. Participant satisfaction was quite high, although most would have preferred a less rushed pace or more treatment time. Internet- and phone-based therapies should be made more widely available, particularly to patients in rural areas and to those with agoraphobia, who can benefit from these therapies but may have limited access to care.

— Joel Yager, MD

Published in Journal Watch Psychiatry January 22, 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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