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Background Anxiety disorders are common problems that result in enormous suffering and economic costs. The efficacy of Web-based self-help approaches for anxiety disorders has been demonstrated in a number of controlled trials. However, there is little data regarding the patterns of use and effectiveness of freely available Web-based interventions outside the context of controlled trials.Objective To examine the use and longitudinal effectiveness of a freely available, 12-session, Web-based, cognitive behavioral therapy (CBT) program for panic disorder and agoraphobia.Methods Cumulative anonymous data were analyzed from 99695 users of the Panic Center. Usage statistics for the website were examined and a longitudinal survey of self-reported symptoms for people who registered for the CBT program was conducted. The primary outcome measures were self-reported panic-attack frequency and severity at the beginning of each session (sessions 2-12).Results Between September 1, 2002 and February 1, 2004, there were 484695 visits and 1148097 page views from 99695 users to the Panic Center. In that same time period, 1161 users registered for the CBT program. There was an extremely high attrition rate with only 12 (1.03%) out of 1161 of registered users completing the 12-week program. However, even for those who remained in the program less than 12 weeks we found statistically significant reductions (P<.002) in self-reported panic attack frequency and severity, comparing 2 weeks of data against data after 3, 6, or 8 weeks. For example, the 152 users completing only 3 sessions of the program reduced their average number of attacks per day from 1.03 (week 2) to 0.63 (week 3) (P<.001).Conclusions Freely available Web-based self-help will likely be associated with high attrition. However, for the highly self-selected group who stayed in the program, significant improvements were observed.

One of the most popular measures of social phobia is the Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987). The LSAS is a 24-item semi-structured interview measure of fear and avoidance experienced in a range of social and performance situations. Recently, the LSAS has been modified to a self-report version (LSAS-SR) by several independent groups (Cox, Ross, Swinson, & Direnfeld, 1998; Fresco et al., 2001; Mancini, Van Ameringen, & Oakman, 1999). A self-report version offers ease of administration, but it may differ from the structured interview version in its psychometric properties. We conducted confirmatory factor analyses of the self-report version of the LSAS using data from a sample of 188 outpatients with anxiety disorders. The structure and psychometric properties of the LSAS-SR are highly similar to that of the LSAS and robust across groups of patients with a variety of primary anxiety disorders. We argue in favor of adopting the 4-factor model for the LSAS proposed by Safren et al. (1999) instead of the models implied by the scoring instructions for the LSAS.

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