A Comparison of Delivery Methods of Cognitive-Behavioral Therapy for Panic Disorder: An International Multicenter Trial.

Abstract

Cognitive--behavioral therapy (CBT) is the psychological treatment of choice for panic disorder (PD). However, given limited access to CBT, it must be delivered with maximal cost-effectiveness. Previous researchers have found that a brief computer-augmented CBT was as effective as extended therapistdelivered CBT. To test this finding, this study randomly allocated 186 patients with PD across 2 sites in Scotland and Australia to 12 sessions of therapist-delivered CBT (CBT12), 6 sessions of therapistdelivered (CBT6) or computer-augmented CBT (CBT6-CA), or a waitlist control. On a composite measure, at posttreatment, the outcome for CBT12 was statistically better than the outcome for CBT6. The outcome for CBT6-CA fell between CBT12 and CBT6, but could not be statistically distinguished from either treatment. The active treatments did not differ statistically at 6-month follow-up. The study provided some support for the use of computers as an innovative adjunctive-therapy tool and merits further investigation.Substantial research evidence indicates that the psychological treatment of choice for panic disorder is cognitive-behavioral therapy (CBT) intervention (Barlow, Gorman, Shear, & Woods, 2000;Hofmann & Spiegel, 1999;Otto, Pollack, & Maki, 2000). As a result, there has been a corresponding growth of demand for treatment, an increase in waiting times in some health care systems, and consequently, pressure for more accessible and efficient forms of treatment delivery.This need is further highlighted by the high prevalence of panic disorder (Kessler et al., 1994) as well as by the nature of the condition, which often involves a level of agoraphobic avoidance. This may limit patients' regular clinic attendance and their access to conventional therapist-administered treatment (Co ˆte ´, Gauthier, Laberge, Cormier, & Plamondon, 1994). To date, one of the main alternatives to conventional CBT delivery has involved the use of written self-help materials, or bibliotherapy.Bibliotherapy (Dow, 1982) has proven to be as effective as eight sessions of group or individual CBT (Lidren et al., 1994), although Power, Sharp, Swanson, andSimpson (2000) found a totally self-administered bibliotherapy condition to be significantly less effective on a range of outcome measures compared with "standard" therapist-delivered CBT. This may be related to the inaccessibility and inconvenience of bibliotherapy during daily activities. One possible solution to the limits of bibliotherapy lies in computer-assisted therapy.Computers can increase patient access to treatment programs (Kenardy, McCafferty, & Rosa, 2003); extend therapy to the patient's own environment; and enhance cost-effectiveness, with costs reduced to between one third and one sixth that of conventional behavioral treatment (Kenardy & Adams, 1993;Newman, 2000). Computer programs have been shown to be effective adjuncts to more conventional treatment for a variety of anxiety disorders, including panic disorder, agoraphobia, social phobia, obsessive-compulsive disorder, and gener...

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Does Expectancy and Homework Compliance Predict Change in CBT?

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Ambulantes Assessment in der Klinischen Psychologie und Psychiatrie

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