Treatment interventions via telephone, Internet, and through other telemedical services are gaining popularity, especially in rural areas where licensed clinicians might not be available. Dr Per Carlbring and colleagues recently evaluated a 10-week, Internet-based, self-help program with weekly telephone calls for patients who had panic disorder with or without agoraphobia. The results were published in the December 2006 issue of the American Journal of Psychiatry.
A total of 60 participants were selected by administering the Structured Clinical Interview for DSM-IV via telephone. The patients were then randomly assigned to either a wait-listed control group or a multimodal treatment based on cognitive-behavioral therapy plus therapist contact via e-mail. A 10-minute phone call was made weekly to support each patient. Mean time spent on each participant during the 10 weeks was 3.9 hours.
The multimodal treatment was manualized and divided into 10 modules, each of which was converted into interactive Web pages. The modules all included essay questions, multiple-choice quizzes, and homework that participants needed to complete in order to proceed to the next module. Homework was evaluated by clinicians and returned within 24 hours. Participants were also required to post messages on an online discussion board about a predetermined topic.
At the conclusion of the 10 weeks, all participants who were treated using the remote therapy improved significantly ( P < .0001) on all measured dimensions (body interpretations, maladaptive cognitions, avoidance, general anxiety and depression levels, and quality of life). A blind telephone interview conducted posttreatment revealed that 77% of these participants no longer fulfilled criteria for panic disorder while all wait-listed patients did.
