@Article{info:doi/10.2196/51428,
author="Kim, KunJung
and Hwang, Hyunchan
and Bae, Sujin
and Kim, Mi Sun
and Han, Hyun Doug",
title="The Effectiveness of a Digital App for Reduction of Clinical Symptoms in Individuals With Panic Disorder: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="12",
volume="26",
pages="e51428",
keywords="digital app",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="functional near-infrared spectroscopy",
keywords="hemodynamic",
keywords="hemodynamics",
keywords="panic disorder",
keywords="anxiety",
keywords="panic",
keywords="mental",
keywords="fear",
keywords="spectroscopy",
keywords="digital therapy",
keywords="fNIRS",
keywords="brain",
keywords="imaging",
keywords="neurology",
keywords="neuroscience",
keywords="cortex",
keywords="cortices",
abstract="Background: Panic disorder is a common and important disease in clinical practice that decreases individual productivity and increases health care use. Treatments comprise medication and cognitive behavioral therapy. However, adverse medication effects and poor treatment compliance mean new therapeutic models are needed. Objective: We hypothesized that digital therapy for panic disorder may improve panic disorder symptoms and that treatment response would be associated with brain activity changes assessed with functional near-infrared spectroscopy (fNIRS). Methods: Individuals (n=50) with a history of panic attacks were recruited. Symptoms were assessed before and after the use of an app for panic disorder, which in this study was a smartphone-based app for treating the clinical symptoms of panic disorder, panic symptoms, depressive symptoms, and anxiety. The hemodynamics in the frontal cortex during the resting state were measured via fNIRS. The app had 4 parts: diary, education, quest, and serious games. The study trial was approved by the institutional review board of Chung-Ang University Hospital (1041078-202112-HR-349-01) and written informed consent was obtained from all participants. Results: The number of participants with improved panic symptoms in the app use group (20/25, 80\%) was greater than that in the control group (6/21, 29\%; $\chi$21=12.3; P=.005). During treatment, the improvement in the Panic Disorder Severity Scale (PDSS) score in the app use group was greater than that in the control group (F1,44=7.03; P=.01). In the app use group, the total PDSS score declined by 42.5\% (mean score 14.3, SD 6.5 at baseline and mean score 7.2, SD 3.6 after the intervention), whereas the PDSS score declined by 14.6\% in the control group (mean score 12.4, SD 5.2 at baseline and mean score 9.8, SD 7.9 after the intervention). There were no significant differences in accumulated oxygenated hemoglobin (accHbO2) at baseline between the app use and control groups. During treatment, the reduction in accHbO2 in the right ventrolateral prefrontal cortex (VLPFC; F1,44=8.22; P=.006) and the right orbitofrontal cortex (OFC; F1,44=8.88; P=.005) was greater in the app use than the control group. Conclusions: Apps for panic disorder should effectively reduce symptoms and VLPFC and OFC brain activity in patients with panic disorder. The improvement of panic disorder symptoms was positively correlated with decreased VLPFC and OFC brain activity in the resting state. Trial Registration: Clinical Research Information Service KCT0007280; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=21448 ",
doi="10.2196/51428",
url="https://www.jmir.org/2024/1/e51428",
url="http://www.ncbi.nlm.nih.gov/pubmed/38608270"
}


@Article{info:doi/10.2196/53659,
author="Shinno, Seina
and Matsumoto, Kazuki
and Hamatani, Sayo
and Inaba, Yosuke
and Ozawa, Yoshihito
and Kawasaki, Yohei
and Ikai, Tomoki
and Sutoh, Chihiro
and Hayashi, Hiroyuki
and Shimizu, Eiji",
title="Feasibility of Guided Internet-Based Cognitive Behavioral Therapy for Panic Disorder and Social Anxiety Disorder in Japan: Pilot Single-Arm Trial",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="29",
volume="8",
pages="e53659",
keywords="cognitive behavioral therapy",
keywords="internet intervention",
keywords="panic disorder",
keywords="social anxiety",
keywords="feasibility trail",
keywords="adult",
keywords="adults",
keywords="anxiety disorder",
keywords="internet-based",
keywords="e-learning",
keywords="Japan",
keywords="statistical analyses",
keywords="therapist",
keywords="therapists",
keywords="intervention",
keywords="severity",
keywords="symptoms",
keywords="therapeutic alliance",
keywords="mobile phone",
abstract="Background: Cognitive behavioral therapy (CBT) is effective in treating anxiety disorders. Accessibility to CBT has been limited in Japan due to the shortage of therapists. While an open-source e-learning system can be used to create a simple internet-based cognitive behavioral therapy (ICBT) program, the safety and outpatient acceptance of this treatment approach have not been explored in Japan. Objective: The aim of this study was to investigate whether outpatients with anxiety disorders could accept and successfully complete the ICBT program with guidance by CBT therapists when implementing therapeutic modules and CBT tasks. Due to being in the initial phase of a novel treatment in Japan, this study was intended for verification with a small sample size. Methods: In total, 6 adults, including 4 male participants and 2 female participants, were enrolled in a single-arm trial. The intervention involved guided ICBT comprising 12 sessions, including CBT text, comprehension confirmation tests, and explanatory videos about cognitive behavioral models, accessible through a website. The therapist guided the participants in accessing the ICBT program and answering their questions using a chat tool. The primary outcome was anxiety severity assessed using the State-Trait Anxiety Inventory-Trait. Secondary outcomes included the Panic Disorder Severity Scale, Liebowitz Social Anxiety Scale (LSAS), Beck Anxiety Inventory (BAI), Patient Health Questionnaire--9, Generalized Anxiety Disorder--7, and Working Alliance Inventory--Short Form (WAI-SF). Statistical analyses were performed using paired 2-tailed t tests to assess the changes in clinical symptoms. The total WAI-SF score at the final session was used to evaluate the therapeutic alliance. For statistical analyses, mean changes for total State-Trait Anxiety Inventory-Trait, BAI, Panic Disorder Severity Scale, LSAS, Patient Health Questionnaire--9, and Generalized Anxiety Disorder--7 scores were analyzed using the paired 2-tailed t test. The 2-sided significance level for hypothesis testing was set at 5\%, and 2-sided 95\% CIs were calculated. Results: Most participants diligently engaged with the ICBT program. No adverse events were reported. The mean total scores for the primary outcome decreased by 11.0 (SD 9.6) points (95\% CI --22.2 to 0.20; Hedges g=0.95), but it was not statistically significant. The mean total scores for the secondary outcomes that assess clinical symptoms decreased, with a significant reduction observed in the BAI of 15.7 (SD 12.1) points (95\% CI --28.4 to --3.0; P=.03; Hedges g=1.24). The mean total scores for PDSS and LSAS decreased significantly, by 12.0 (SD 4.24) points (95\% CI --50.1 to 26.1; P=.16; Hedges g=1.79) and 32.4 (SD 11.1) points (95\% CI --59.7 to --4.3; P=.04; Hedges g=1.38), respectively. Of the participants, 67\% (n=4) showed treatment response, and 50\% (n=3) achieved remission after the intervention. The therapeutic alliance, measured using the WAI-SF, was moderate. Conclusions: Guided ICBT may be feasible for the treatment of outpatients with panic disorder and social anxiety disorder in Japan. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN0000038118; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr\_view.cgi?recptno=R000043439 ",
doi="10.2196/53659",
url="https://formative.jmir.org/2024/1/e53659",
url="http://www.ncbi.nlm.nih.gov/pubmed/38421717"
}


@Article{info:doi/10.2196/45362,
author="Karpov, Boris
and Lipsanen, Olavi Jari
and Ritola, Ville
and Rosenstr{\"o}m, Tom
and Saarni, Suoma
and Pihlaja, Satu
and Stenberg, Jan-Henry
and Laizane, Paula
and Joffe, Grigori",
title="The Overall Anxiety Severity and Impairment Scale as an Outcome Measure in Internet-Delivered Cognitive Behavioral Therapy for Anxiety Disorders: Observational Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="17",
volume="25",
pages="e45362",
keywords="Overall Anxiety Severity and Impairment Scale",
keywords="OASIS",
keywords="internet-delivered cognitive behavioral therapy",
keywords="iCBT",
keywords="anxiety",
keywords="social anxiety disorder",
keywords="panic disorder",
keywords="obsessive-compulsive disorder",
keywords="OCD",
abstract="Background: Internet-delivered cognitive behavioral therapy (iCBT) is effective in the treatment of anxiety disorders. iCBT clinical trials use relatively long and time-consuming disorder-specific rather than transdiagnostic anxiety measurements. Overall Anxiety Severity and Impairment Scale (OASIS) is a brief self-report scale that could offer a universal, easy-to-use anxiety measurement option in disorder-specific and transdiagnostic iCBT programs. Objective: We aimed to investigate relationships between OASIS and disorder-specific instruments in iCBT. We expected these relationships to be positive. Methods: We investigated patients in original nationwide iCBT programs for generalized anxiety disorder (GAD), obsessive-compulsive disorder, panic disorder, and social anxiety disorder, which were administered by Helsinki University Hospital, Finland. In each program, anxiety symptoms were measured using both disorder-specific scales (the 7-item Generalized Anxiety Disorder scale, Penn State Worry Questionnaire, revised Obsessive-Compulsive Inventory, Panic Disorder Severity Scale, and Social Phobia Inventory) and by OASIS. A general linear model for repeated measures (mixed models) and interaction analysis were used for investigating the changes and relationships in the mean scores of OASIS and disorder-specific scales from the first session to the last one. Results: The main effect of linear mixed models indicated a distinct positive association between OASIS and disorder-specific scale scores. Interaction analysis demonstrated relatively stable associations between OASIS and the revised Obsessive-Compulsive Inventory (F822.9=0.09; 95\% CI 0.090-0.277; P=.32), and OASIS and the Panic Disorder Severity Scale (F596.6=--0.02; 95\% CI --0.108 to --0.065; P=.63) from first the session to the last one, while the 7-item Generalized Anxiety Disorder scale (F4345.8=--0.06; 95\% CI --0.109 to --0.017; P=.007), Penn State Worry Questionnaire (F4270.8=--0.52; 95\% CI --0.620 to --0.437; P<.001), and Social Phobia Inventory (F862.1=--0.39; 95\% CI --0.596 to --0.187; P<.001) interrelated with OASIS more strongly at the last session than at the first one. Conclusions: OASIS demonstrates clear and relatively stable associations with disorder-specific symptom measures. Thus, OASIS might serve as an outcome measurement instrument for disorder-specific and plausibly transdiagnostic iCBT programs for anxiety disorders in regular clinical practice. ",
doi="10.2196/45362",
url="https://www.jmir.org/2023/1/e45362",
url="http://www.ncbi.nlm.nih.gov/pubmed/37590055"
}


@Article{info:doi/10.2196/33080,
author="Cloitre, Marylene
and Amspoker, Bush Amber
and Fletcher, L. Terri
and Hogan, B. Julianna
and Jackson, Christie
and Jacobs, Adam
and Shammet, Rayan
and Speicher, Sarah
and Wassef, Miryam
and Lindsay, Jan",
title="Comparing the Ratio of Therapist Support to Internet Sessions in a Blended Therapy Delivered to Trauma-Exposed Veterans: Quasi-experimental Comparison Study",
journal="JMIR Ment Health",
year="2022",
month="Apr",
day="27",
volume="9",
number="4",
pages="e33080",
keywords="PTSD",
keywords="depression",
keywords="veterans",
keywords="blended therapy",
keywords="iCBT",
keywords="web-based",
keywords="webSTAIR",
keywords="noninferiority",
keywords="mental health",
keywords="digital health",
abstract="Background: Blended models of therapy, which incorporate elements of both internet and face-to-face methods, have been shown to be effective, but therapists and patients have expressed concerns that fewer face-to-face therapy sessions than self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates, and poorer outcomes. Objective: A multisite quasi-experimental comparison study with a noninferiority design implemented in routine clinical care was used to assess webSTAIR, a 10-module blended therapy derived from STAIR (skills training in affective and interpersonal regulation) for trauma-exposed individuals delivered with 10 weekly therapist sessions (termed Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be as good as Coach10 in a range of outcomes. Methods: A total of 202 veterans were enrolled in the study with 101 assigned to Coach5 and 101 to Coach10. Posttraumatic stress disorder (PTSD) symptoms, depression, emotion regulation, interpersonal problems, and social functioning measures were collected pre-, mid-, and posttreatment, and at a 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons were made of continuous and categorical measures regarding participant and therapist activities. Results: Participants reported moderate to severe levels of baseline PTSD, depression, or both. Significant reductions were obtained in all symptom measures posttreatment and at the 3-month follow up. Coach5 was not inferior to Coach10 in any outcome. Therapeutic alliance was at an equivalently high level across the 2 treatment conditions; completion rates and web usage were similar. Total session time was substantially less for the Coach5 therapists than the Coach10 therapists. Both programs were associated with a low, but equal number of therapist activities related to scheduling and crisis or motivational sessions. Conclusions: A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions in individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes with high versus low doses of therapist support will help create flexible, technology-based intervention programming. ",
doi="10.2196/33080",
url="https://mental.jmir.org/2022/4/e33080",
url="http://www.ncbi.nlm.nih.gov/pubmed/35475777"
}


@Article{info:doi/10.2196/21111,
author="Wiegersma, Sytske
and Hidajat, Maurice
and Schrieken, Bart
and Veldkamp, Bernard
and Olff, Miranda",
title="Improving Web-Based Treatment Intake for Multiple Mental and Substance Use Disorders by Text Mining and Machine Learning: Algorithm Development and Validation",
journal="JMIR Ment Health",
year="2022",
month="Apr",
day="11",
volume="9",
number="4",
pages="e21111",
keywords="supervised text classification",
keywords="multi-class classification",
keywords="screening",
keywords="mental health disorders",
keywords="computerized CBT",
keywords="automated intake and referral",
abstract="Background: Text mining and machine learning are increasingly used in mental health care practice and research, potentially saving time and effort in the diagnosis and monitoring of patients. Previous studies showed that mental disorders can be detected based on text, but they focused on screening for a single predefined disorder instead of multiple disorders simultaneously. Objective: The aim of this study is to develop a Dutch multi-class text-classification model to screen for a range of mental disorders to refer new patients to the most suitable treatment. Methods: On the basis of textual responses of patients (N=5863) to a questionnaire currently used for intake and referral, a 7-class classifier was developed to distinguish among anxiety, panic, posttraumatic stress, mood, eating, substance use, and somatic symptom disorders. A linear support vector machine was fitted using nested cross-validation grid search. Results: The highest classification rate was found for eating disorders (82\%). The scores for panic (55\%), posttraumatic stress (52\%), mood (50\%), somatic symptom (50\%), anxiety (35\%), and substance use disorders (33\%) were lower, likely because of overlapping symptoms. The overall classification accuracy (49\%) was reasonable for a 7-class classifier. Conclusions: A classification model was developed that could screen text for multiple mental health disorders. The screener resulted in an additional outcome score that may serve as input for a formal diagnostic interview and referral. This may lead to a more efficient and standardized intake process. ",
doi="10.2196/21111",
url="https://mental.jmir.org/2022/4/e21111",
url="http://www.ncbi.nlm.nih.gov/pubmed/35404261"
}


@Article{info:doi/10.2196/33063,
author="Tsai, Chan-Hen
and Chen, Pei-Chen
and Liu, Ding-Shan
and Kuo, Ying-Ying
and Hsieh, Tsung-Ting
and Chiang, Dai-Lun
and Lai, Feipei
and Wu, Chia-Tung",
title="Panic Attack Prediction Using Wearable Devices and Machine Learning: Development and Cohort Study",
journal="JMIR Med Inform",
year="2022",
month="Feb",
day="15",
volume="10",
number="2",
pages="e33063",
keywords="panic disorder",
keywords="panic attack",
keywords="prediction",
keywords="wearable device",
keywords="machine learning",
keywords="lifestyle",
abstract="Background: A panic attack (PA) is an intense form of anxiety accompanied by multiple somatic presentations, leading to frequent emergency department visits and impairing the quality of life. A prediction model for PAs could help clinicians and patients monitor, control, and carry out early intervention for recurrent PAs, enabling more personalized treatment for panic disorder (PD). Objective: This study aims to provide a 7-day PA prediction model and determine the relationship between a future PA and various features, including physiological factors, anxiety and depressive factors, and the air quality index (AQI). Methods: We enrolled 59 participants with PD (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, and the Mini International Neuropsychiatric Interview). Participants used smartwatches (Garmin V{\'i}vosmart 4) and mobile apps to collect their sleep, heart rate (HR), activity level, anxiety, and depression scores (Beck Depression Inventory [BDI], Beck Anxiety Inventory [BAI], State-Trait Anxiety Inventory state anxiety [STAI-S], State-Trait Anxiety Inventory trait anxiety [STAI-T], and Panic Disorder Severity Scale Self-Report) in their real life for a duration of 1 year. We also included AQIs from open data. To analyze these data, our team used 6 machine learning methods: random forests, decision trees, linear discriminant analysis, adaptive boosting, extreme gradient boosting, and regularized greedy forests. Results: For 7-day PA predictions, the random forest produced the best prediction rate. Overall, the accuracy of the test set was 67.4\%-81.3\% for different machine learning algorithms. The most critical variables in the model were questionnaire and physiological features, such as the BAI, BDI, STAI, MINI, average HR, resting HR, and deep sleep duration. Conclusions: It is possible to predict PAs using a combination of data from questionnaires and physiological and environmental data. ",
doi="10.2196/33063",
url="https://medinform.jmir.org/2022/2/e33063",
url="http://www.ncbi.nlm.nih.gov/pubmed/35166679"
}


@Article{info:doi/10.2196/32982,
author="McGinnis, Ellen
and O'Leary, Aisling
and Gurchiek, Reed
and Copeland, E. William
and McGinnis, Ryan",
title="A Digital Therapeutic Intervention Delivering Biofeedback for Panic Attacks (PanicMechanic): Feasibility and Usability Study",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="3",
volume="6",
number="2",
pages="e32982",
keywords="mental health",
keywords="mHealth",
keywords="biofeedback",
keywords="panic attack",
keywords="digital medicine",
keywords="app",
keywords="mobile health",
keywords="application",
keywords="mobile phone",
abstract="Background: Panic attacks (PAs) are an impairing mental health problem that affects >11\% of adults every year. PAs are episodic, and it is difficult to predict when or where they may occur; thus, they are challenging to study and treat. Objective: The aim of this study is to present PanicMechanic, a novel mobile health app that captures heart rate--based data and delivers biofeedback during PAs. Methods: In our first analysis, we leveraged this tool to capture profiles of real-world PAs in the largest sample to date (148 attacks from 50 users). In our second analysis, we present the results from a pilot study to assess the usefulness of PanicMechanic as a PA intervention (N=18). Results: The results demonstrate that heart rate fluctuates by about 15 beats per minute during a PA and takes approximately 30 seconds to return to baseline from peak, cycling approximately 4 times during each attack despite the consistently decreasing anxiety ratings. Thoughts about health were the most common trigger and potential lifestyle contributors include slightly worse stress, sleep, and eating habits and slightly less exercise and drug or alcohol consumption than typical. Conclusions: The pilot study revealed that PanicMechanic is largely feasible to use but would be made more so with modifications to the app and the integration of consumer wearables. Similarly, participants found PanicMechanic useful, with 94\% (15/16) indicating that they would recommend PanicMechanic to others who have PAs. These results highlight the need for future development and a controlled trial to establish the effectiveness of this digital therapeutic for preventing PAs. ",
doi="10.2196/32982",
url="https://formative.jmir.org/2022/2/e32982",
url="http://www.ncbi.nlm.nih.gov/pubmed/35113031"
}


@Article{info:doi/10.2196/30590,
author="Shin, Bokyoung
and Oh, Jooyoung
and Kim, Byung-Hoon
and Kim, Erin Hesun
and Kim, Hyunji
and Kim, Suji
and Kim, Jae-Jin",
title="Effectiveness of Self-Guided Virtual Reality--Based Cognitive Behavioral Therapy for Panic Disorder: Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2021",
month="Nov",
day="22",
volume="8",
number="11",
pages="e30590",
keywords="virtual reality",
keywords="panic disorder",
keywords="cognitive behavioral therapy",
keywords="exposure therapy",
keywords="intervention",
abstract="Background: Virtual reality (VR) is as effective a technique as traditional cognitive behavioral therapy (CBT) and a promising tool for treating panic disorder symptoms because VR exposure can be safer and has better acceptability than in vivo exposure and is more immersive than exposure through imagination. CBT techniques can be delivered more effectively using VR as well. So far, VR has required high-quality devices, but the development of mobile VR technology has improved user availability. At the same time, a well-structured form of VR can be reproduced and used anywhere. This means that VR can be used to provide a self-guided form of treatment and address the high treatment costs of evidence-based therapy and the lack of professional therapists. This study aimed to investigate the potential of self-guided VR as an alternative to high-cost treatment. Objective: The main goal of this study was to offer data about the efficacy of a mobile app-based self-led VR CBT in the treatment of panic disorder. Methods: A total of 54 subjects with panic disorder were enrolled in this study and randomly assigned to either the VR treatment group or waitlist group. The VR treatment was designed to be total 12 sessions for 4 weeks. The VR treatment consists of 4 steps in which patients are gradually exposed to phobic stimuli while learning to cope with panic symptoms in each stage. The effectiveness of treatment was assessed through the Panic Disorder Severity Scale, Hamilton Rating Scale for Depression, Body Sensations Questionnaire, Albany Panic and Phobia Questionnaire, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, Korean Inventory of Social Avoidance and Distress Scale, Korean Inventory of Depressive Symptomatology, and Perceived Stress Scale. In addition, physiological changes using heart rate variability were evaluated. Results: In within-group analyses, the VR treatment group exhibited improvements in panic disorder symptoms, anxiety, and depression after 4 weeks, while the waitlist group did not show any significant improvement. Compared to the waitlist group, the VR treatment group showed significantly greater improvements in the Panic Disorder Severity Scale in both completer analysis and intention-to-treat analysis. Heart rate variability in the VR treatment group showed improvement in normalized high frequency from baseline to postassessment with no significant differences in any outcome measure between groups. Conclusions: The self-guided, mobile app-based VR intervention was effective in the treatment of panic symptoms and restoring the autonomic nervous system demonstrating the validity of the use of VR for self-guided treatment. VR treatment can be a cost-effective therapeutic approach. Trial Registration: ClinicalTrials.gov NCT04985019; https://clinicaltrials.gov/ct2/show/NCT04985019 ",
doi="10.2196/30590",
url="https://mental.jmir.org/2021/11/e30590",
url="http://www.ncbi.nlm.nih.gov/pubmed/34813486"
}


@Article{info:doi/10.2196/20829,
author="Ebenfeld, Lara
and Lehr, Dirk
and Ebert, Daniel David
and Kleine Stegemann, Stefan
and Riper, Heleen
and Funk, Burkhardt
and Berking, Matthias",
title="Evaluating a Hybrid Web-Based Training Program for Panic Disorder and Agoraphobia: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="4",
volume="23",
number="3",
pages="e20829",
keywords="panic disorder",
keywords="agoraphobia",
keywords="treatment",
keywords="internet",
keywords="mobile phone",
keywords="randomized controlled trial",
abstract="Background: Previous studies provide evidence for the effectiveness of web-based interventions for panic disorder with and without agoraphobia. Smartphone-based technologies hold significant potential for further enhancing the accessibility and efficacy of such interventions. Objective: This randomized controlled trial aims to evaluate the efficacy of a guided, hybrid web-based training program based on cognitive behavioral therapy for adults with symptoms of panic disorder. Methods: Participants (N=92) with total scores in the Panic and Agoraphobia Scale ranging from 9 to 28 were recruited from the general population and allocated either to a hybrid intervention (GET.ON Panic) or to a wait-list control group. The primary outcome was the reduction in panic symptoms, as self-assessed using a web-based version of the Panic and Agoraphobia Scale. Results: Analysis of covariance-based intention-to-treat analyses revealed a significantly stronger decrease in panic symptoms posttreatment (F=9.77; P=.002; Cohen d=0.66; 95\% CI 0.24-1.08) in the intervention group than in the wait-list control group. Comparisons between groups of the follow-up measures at 3 and 6 months yielded even stronger effects (3-month follow-up: F=17.40, P<.001, Cohen d=0.89, 95\% CI 0.46-1.31; 6-month follow-up: F=14.63, P<.001, Cohen d=0.81, 95\% CI 0.38-1.24). Conclusions: Hybrid web-based training programs may help reduce the symptoms of panic disorder and hence play an important role in improving health care for patients with this debilitating disorder. Trial Registration: German Clinical Trial Register DRKS00005223; https://tinyurl.com/f4zt5ran International Registered Report Identifier (IRRID): RR2-10.1186/1745-6215-15-427 ",
doi="10.2196/20829",
url="https://www.jmir.org/2021/3/e20829",
url="http://www.ncbi.nlm.nih.gov/pubmed/33661121"
}


@Article{info:doi/10.2196/13234,
author="Zargaran, David
and Walsh, Caoimhe
and Koumpa, Stefania Foteini
and Ashraf, Arsalan Muhammad
and White, Jayne Amelia
and Patel, Nikhil
and Tanna, Ravina
and Trepekli, Anna
and Zargaran, Alexander",
title="Comment on ``Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder: Pilot Single-Arm Trial''",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="12",
volume="22",
number="8",
pages="e13234",
keywords="internet",
keywords="CBT",
keywords="cognitive behavioral therapy",
keywords="telemedicine",
keywords="telehealth",
doi="10.2196/13234",
url="https://www.jmir.org/2020/8/e13234",
url="http://www.ncbi.nlm.nih.gov/pubmed/32784172"
}


@Article{info:doi/10.2196/17157,
author="Matsumoto, Kazuki
and Hamatani, Sayo
and Nagai, Kazue
and Sutoh, Chihiro
and Nakagawa, Akiko
and Shimizu, Eiji",
title="Long-Term Effectiveness and Cost-Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder in Japan: One-Year Follow-Up of a Single-Arm Trial",
journal="JMIR Ment Health",
year="2020",
month="Apr",
day="23",
volume="7",
number="4",
pages="e17157",
keywords="long-term effectiveness",
keywords="cost-effectiveness",
keywords="videoconference-delivered cognitive behavioral therapy",
keywords="internet-based cognitive behavioral therapy",
keywords="obsessive-compulsive disorder",
keywords="panic disorder",
keywords="social anxiety disorder",
abstract="Background: Face-to-face individual cognitive behavioral therapy (CBT) and internet-based CBT (ICBT) without videoconferencing are known to have long-term effectiveness for obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). However, videoconference-delivered CBT (VCBT) has not been investigated regarding its long-term effectiveness and cost-effectiveness. Objective: The purpose of this study was to investigate the long-term effectiveness and cost-effectiveness of VCBT for patients with OCD, PD, or SAD in Japan via a 1-year follow-up to our previous 16-week single-arm study. Methods: Written informed consent was obtained from 25 of 29 eligible patients with OCD, PD, and SAD who had completed VCBT in our clinical trial. Participants were assessed at baseline, end of treatment, and at the follow-up end points of 3, 6, and 12 months. Outcomes were the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Panic Disorder Severity Scale (PDSS), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire--9 (PHQ-9), General Anxiety Disorder--7 (GAD-7), and EuroQol-5D-5L (EQ-5D-5L). To analyze long-term effectiveness, we used mixed-model analysis of variance. To analyze cost-effectiveness, we employed relevant public data and derived data on VCBT implementation costs from Japanese national health insurance data. Results: Four males and 21 females with an average age of 35.1 (SD 8.6) years participated in the 1-year follow-up study. Principal diagnoses were OCD (n=10), PD (n=7), and SAD (n=8). The change at 12 months on the Y-BOCS was ?4.1 (F1=4.45, P=.04), the change in PDSS was ?4.4 (F1=6.83, P=.001), and the change in LSAS was ?30.9 (F1=6.73, P=.01). The change in the PHQ-9 at 12 months was ?2.7 (F1=7.72, P=.007), and the change in the GAD-7 was ?3.0 (F1=7.09, P=.009). QALY at 12 months was 0.7469 (SE 0.0353, 95\% Cl 0.6728-0.821), and the change was a significant increase of 0.0379 (P=.01). Total costs to provide the VCBT were {\textyen}60,800 to {\textyen}81,960 per patient. The set threshold was {\textyen}189,500 (\$1723, {\texteuro}1579, and {\textsterling}1354) calculated based on willingness to pay in Japan. Conclusions: VCBT was a cost-effective way to effectively treat Japanese patients with OCD, PD, or SAD. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000026609; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000030495 ",
doi="10.2196/17157",
url="http://mental.jmir.org/2020/4/e17157/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32324150"
}


@Article{info:doi/10.2196/15747,
author="Matsumoto, Kazuki
and Yoshida, Tokiko
and Hamatani, Sayo
and Sutoh, Chihiro
and Hirano, Yoshiyuki
and Shimizu, Eiji",
title="Prognosis Prediction Using Therapeutic Agreement of Video Conference--Delivered Cognitive Behavioral Therapy: Retrospective Secondary Analysis of a Single-Arm Pilot Trial",
journal="JMIR Ment Health",
year="2019",
month="Nov",
day="15",
volume="6",
number="11",
pages="e15747",
keywords="therapeutic alliance",
keywords="cognitive behavioral therapy",
keywords="obsessive-compulsive disorder",
keywords="panic disorder",
keywords="social anxiety disorder",
keywords="video conferencing",
abstract="Background: The therapist-patient therapeutic alliance is known to be an important factor in cognitive behavioral therapy (CBT). However, findings by previous studies for obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD) have not been consistent regarding whether this alliance provides symptomatic improvements. Objective: This study investigated predictors of symptom improvement in patients receiving CBT via video conferencing. Methods: A total of 29 patients who participated in a previous clinical trial were recruited for the current study. Therapeutic alliance and clinical background in patients with OCD, PD, and SAD were measured at first session or the eighth session, which were calculated by multiple regression analyses to estimate the impact on therapeutic response percentage change. Results: The multiple regression analyses showed that, among the independent variables, only patients' agreement in the therapeutic alliance remained viable, as other variables were a best fit for the excluded model (P=.002). The results show that patients' agreement on therapeutic goals and tasks explains the prognosis, as the normalization factor beta was 0.54 (SE 32.73; 95\% CI 1.23-5.17; P=.002) and the adjusted R2 was .266. Conclusions: Patients' agreement on therapeutic goals and tasks predicts improvement after CBT via video conferencing. Trial Registration: UMIN Clinical Trial Repository UMIN000026609;?https://tinyurl.com/ye6dcbwt ",
doi="10.2196/15747",
url="http://mental.jmir.org/2019/11/e15747/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31730037"
}


@Article{info:doi/10.2196/12091,
author="Matsumoto, Kazuki
and Sutoh, Chihiro
and Asano, Kenichi
and Seki, Yoichi
and Urao, Yuko
and Yokoo, Mizue
and Takanashi, Rieko
and Yoshida, Tokiko
and Tanaka, Mari
and Noguchi, Remi
and Nagata, Shinobu
and Oshiro, Keiko
and Numata, Noriko
and Hirose, Motohisa
and Yoshimura, Kensuke
and Nagai, Kazue
and Sato, Yasunori
and Kishimoto, Taishiro
and Nakagawa, Akiko
and Shimizu, Eiji",
title="Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder: Pilot Single-Arm Trial",
journal="J Med Internet Res",
year="2018",
month="Dec",
day="17",
volume="20",
number="12",
pages="e12091",
keywords="clinical trial",
keywords="cognitive behavioral therapy",
keywords="feasibility study",
keywords="obsessive-compulsive disorder",
keywords="panic disorder",
keywords="social anxiety disorder",
keywords="videoconference",
abstract="Background: Cognitive behavioral therapy (CBT) is the first-line treatment for adults with obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). Patients in rural areas can access CBT via the internet. The effectiveness of internet-delivered cognitive behavioral therapy (ICBT) has been consistently shown, but no clinical studies have demonstrated the feasibility of ICBT with real-time therapist support via videoconference for OCD, PD, and SAD at the same time. Objectives: This study aimed to evaluate the feasibility of videoconference-delivered CBT for patients with OCD, PD, or SAD. Methods: A total of 30 Japanese participants (mean age 35.4 years, SD 9.2) with OCD, SAD, or PD received 16 sessions of individualized videoconference-delivered CBT with real-time support of a therapist, using tablet personal computer (Apple iPad Mini 2). Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. The primary outcomes were reduction in symptomatology, using the Yale-Brown obsessive-compulsive scale (Y-BOCS) for OCD, Panic Disorder Severity Scale (PDSS) for PD, and Liebowitz Social Anxiety Scale (LSAS) for SAD. The secondary outcomes included the EuroQol-5 Dimension (EQ-5D) for Quality of Life, the Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder (GAD-7) questionnaire for anxiety, and Working Alliance Inventory-Short Form (WAI-SF). All primary outcomes were assessed at baseline and at weeks 1 (baseline), 8 (midintervention), and 16 (postintervention) face-to-face during therapy. The occurrence of adverse events was observed after each session. For the primary analysis comparing between pre- and posttreatments, the participants' points and 95\% CIs were estimated by the paired t tests with the change between pre- and posttreatment. Results: A significant reduction in symptom of obsession-compulsion (Y-BOCS=?6.2; Cohen d=0.74; 95\% CI ?9.4 to ?3.0, P=.002), panic (PDSS=?5.6; Cohen d=0.89; 95\% CI ?9.83 to ?1.37; P=.02), social anxiety (LSAS=?33.6; Cohen d=1.10; 95\% CI ?59.62 to ?7.49, P=.02) were observed. In addition, depression (PHQ-9=?1.72; Cohen d=0.27; 95\% CI ?3.26 to ?0.19; P=.03) and general anxiety (GAD-7=?3.03; Cohen d=0.61; 95\% CI ?4.57 to ?1.49, P<.001) were significantly improved. Although there were no significant changes at 16 weeks from baseline in EQ-5D (0.0336; Cohen d=-0.202; 95\% CI ?0.0198 to 0.00869; P=.21), there were high therapeutic alliance (ie, WAI-SF) scores (from 68.0 to 73.7) throughout treatment, which significantly increased (4.14; 95\% CI 1.24 to 7.04; P=.007). Of the participants, 86\% (25/29) were satisfied with videoconference-delivered CBT, and 83\% (24/29) preferred videoconference-delivered CBT to face-to-face CBT. An adverse event occurred to a patient with SAD; the incidence was 3\% (1/30). Conclusions: Videoconference-delivered CBT for patients with OCD, SAD, and SAD may be feasible and acceptable. ",
doi="10.2196/12091",
url="http://www.jmir.org/2018/12/e12091/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30559094"
}


@Article{info:doi/10.2196/jmir.7747,
author="Christoforou, Marina
and S{\'a}ez Fonseca, Andr{\'e}s Jos{\'e}
and Tsakanikos, Elias",
title="Two Novel Cognitive Behavioral Therapy--Based Mobile Apps for Agoraphobia: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2017",
month="Nov",
day="24",
volume="19",
number="11",
pages="e398",
keywords="agoraphobia",
keywords="anxiety",
keywords="eHealth",
keywords="computerized interventions",
keywords="mobile applications",
keywords="randomized controlled trial",
keywords="RCT",
abstract="Background: Despite the large body of literature demonstrating the effectiveness of cognitive behavioral treatments for agoraphobia, many patients remain untreated because of various barriers to treatment. Web-based and mobile-based interventions targeting agoraphobia may provide a solution to this problem, but there is a lack of research investigating the efficacy of such interventions. Objective: The objective of our study was to evaluate for the first time the effectiveness of a self-guided mobile-based intervention primarily targeting agoraphobic symptoms, with respect to a generic mobile app targeting anxiety. Methods: A Web-based randomized controlled trial (RCT) compared a novel mobile app designed to target agoraphobia (called Agoraphobia Free) with a mobile app designed to help with symptoms of anxiety in general (called Stress Free). Both interventions were based on established cognitive behavioral principles. We recruited participants (N=170) who self-identified as having agoraphobia and assessed them online at baseline, midpoint, and end point (posttreatment) over a period of 12 weeks. The primary outcome was symptom severity measured by the Panic and Agoraphobia Scale. Results: Both groups had statistically significant improvements in symptom severity over time (difference --5.97, 95\% CI --8.49 to --3.44, P<.001 for Agoraphobia Free and --6.35, 95\% CI --8.82 to --3.87, P<.001 for Stress Free), but there were no significant between-group differences on the primary outcome (difference 0.38, 95\% CI --1.96 to 3.20, P=.64). Conclusions: This is, to our knowledge, the first RCT to provide evidence that people who identify as having agoraphobia may equally benefit from a diagnosis-specific and a transdiagnostic mobile-based intervention. We also discuss clinical and research implications for the development and dissemination of mobile mental health apps. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 98453199; http://www.isrctn.com /ISRCTN98453199 (Archived by WebCite at http://www.webcitation.org/6uR5vsdZw) ",
doi="10.2196/jmir.7747",
url="http://www.jmir.org/2017/11/e398/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29175809"
}


@Article{info:doi/10.2196/jmir.3513,
author="AL-Asadi, M. Ali
and Klein, Britt
and Meyer, Denny",
title="Posttreatment Attrition and Its Predictors, Attrition Bias, and Treatment Efficacy of the Anxiety Online Programs",
journal="J Med Internet Res",
year="2014",
month="Oct",
day="14",
volume="16",
number="10",
pages="e232",
keywords="posttreatment attrition",
keywords="posttreatment predictors",
keywords="treatment efficacy",
keywords="online therapy",
keywords="e-mental health",
keywords="cognitive behavioral therapy",
keywords="Internet interventions",
keywords="fully automated",
keywords="self-help",
keywords="Web treatment",
keywords="generalized anxiety disorder",
keywords="obsessive compulsive disorder",
abstract="Background: Although relatively new, the field of e-mental health is becoming more popular with more attention given to researching its various aspects. However, there are many areas that still need further research, especially identifying attrition predictors at various phases of assessment and treatment delivery. Objective: The present study identified the predictors of posttreatment assessment completers based on 24 pre- and posttreatment demographic and personal variables and 1 treatment variable, their impact on attrition bias, and the efficacy of the 5 fully automated self-help anxiety treatment programs for generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder with or without agoraphobia (PD/A), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). Methods: A complex algorithm was used to diagnose participants' mental disorders based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders were offered an online 12-week disorder-specific treatment program. A total of 3199 individuals did not formally drop out of the 12-week treatment cycle, whereas 142 individuals formally dropped out. However, only 347 participants who completed their treatment cycle also completed the posttreatment assessment measures. Based on these measures, predictors of attrition were identified and attrition bias was examined. The efficacy of the 5 treatment programs was assessed based on anxiety-specific severity scores and 5 additional treatment outcome measures. Results: On average, completers of posttreatment assessment measures were more likely to be seeking self-help online programs; have heard about the program from traditional media or from family and friends; were receiving mental health assistance; were more likely to learn best by reading, hearing and doing; had a lower pretreatment Kessler-6 total score; and were older in age. Predicted probabilities resulting from these attrition variables displayed no significant attrition bias using Heckman's method and thus allowing for the use of completer analysis. Six treatment outcome measures (Kessler-6 total score, number of diagnosed disorders, self-confidence in managing mental health issues, quality of life, and the corresponding pre- and posttreatment severity for each program-specific anxiety disorder and for major depressive episode) were used to assess the efficacy of the 5 anxiety treatment programs. Repeated measures MANOVA revealed a significant multivariate time effect for all treatment outcome measures for each treatment program. Follow-up repeated measures ANOVAs revealed significant improvements on all 6 treatment outcome measures for GAD and PTSD, 5 treatment outcome measures were significant for SAD and PD/A, and 4 treatment outcome measures were significant for OCD. Conclusions: Results identified predictors of posttreatment assessment completers and provided further support for the efficacy of self-help online treatment programs for the 5 anxiety disorders. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial\_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). ",
doi="10.2196/jmir.3513",
url="http://www.jmir.org/2014/10/e232/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25316533"
}


@Article{info:doi/10.2196/jmir.3429,
author="Kok, N. Robin
and van Straten, Annemieke
and Beekman, F. Aartjan T.
and Cuijpers, Pim",
title="Short-Term Effectiveness of Web-Based Guided Self-Help for Phobic Outpatients: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2014",
month="Sep",
day="29",
volume="16",
number="9",
pages="e226",
keywords="phobias",
keywords="phobic disorders",
keywords="anxiety disorders",
keywords="Web-based intervention",
keywords="Internet therapy",
keywords="randomized controlled trial",
keywords="outpatients",
abstract="Background: Internet-based guided self-help has been successfully used in the general population, but it is unknown whether this method can be effectively used in outpatient clinics for patients waiting for face-to-face psychotherapy for phobias. Objective: The aim was to assess the clinical effectiveness of Phobias Under Control, an Internet-based intervention based on exposure therapy with weekly guidance. Methods: We conducted a randomized controlled trial, recruiting 212 outpatients scheduled to receive face-to-face psychotherapy for any type of phobia at an outpatient clinic. Participants suffering from at least 1 DSM-IV or ICD-10 classified phobia (social phobia, agoraphobia with or without panic disorder, and/or specific phobia as ascertained by a telephone interview at baseline) were randomly allocated to either a 5-week Internet-based guided self-help program based on exposure therapy with weekly student support followed by face-to-face psychotherapy (n=105) or a wait-list control group followed by face-to-face psychotherapy (n=107). Primary outcome was the Fear Questionnaire (FQ). Secondary outcomes were the Beck Anxiety Inventory (BAI) and Center of Epidemiological Studies-Depression scale (CES-D). Assessments took place by telephone at baseline (T0) and on the Internet at posttest (T1, self-assessment at 5 weeks after baseline). Missing data at T1 were imputed. Results: At posttest, analysis of covariance on the intention-to-treat sample showed significant but small effect sizes between intervention and control groups on the FQ (d=0.35, P=.02), CES-D (d=0.34, P=.03), and a nonsignificant effect size on the BAI (d=0.28. P=.05). Although initial acceptance was good, high nonresponse was observed, with 86 of 212 participants (40.5\%) lost to follow-up at T1 and only 14 of 105 (13.3\%) intervention participants finishing all 5 weeks. Conclusions: Phobias Under Control is modestly effective in lowering phobic and depressive symptoms in a relatively short period and may be clinically beneficial when implemented in routine outpatient practice. Trial Registration: Netherlands Trial Register NTR2233; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2233 (Archived by WebCite at http://www.webcitation.org/6O2ioOQSs). ",
doi="10.2196/jmir.3429",
url="http://www.jmir.org/2014/9/e226/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25266929"
}


@Article{info:doi/10.2196/jmir.2989,
author="AL-Asadi, M. Ali
and Klein, Britt
and Meyer, Denny",
title="Pretreatment Attrition and Formal Withdrawal During Treatment and Their Predictors: An Exploratory Study of the Anxiety Online Data",
journal="J Med Internet Res",
year="2014",
month="Jun",
day="17",
volume="16",
number="6",
pages="e152",
keywords="pretreatment attrition",
keywords="treatment withdrawal dropouts",
keywords="predictors, anxiety disorders",
keywords="eTherapy",
keywords="e-mental health",
keywords="Internet interventions",
abstract="Background: Although in its infancy, the field of e-mental health interventions has been gaining popularity and afforded considerable research attention. However, there are many gaps in the research. One such gap is in the area of attrition predictors at various stages of assessment and treatment delivery. Objective: This exploratory study applied univariate and multivariate analysis to a large dataset provided by the Anxiety Online (now called Mental Health Online) system to identify predictors of attrition in treatment commencers and in those who formally withdrew during treatment based on 24 pretreatment demographic and personal variables and one clinical measure. Methods: Participants were assessed using a complex online algorithm that resulted in primary and secondary diagnoses in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders (generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder) were offered an online 12-week disorder-specific treatment program. Results: Of 9394 potential participants, a total of 3880 clients enrolled and 5514 did not enroll in one of the treatment programs following the completion of pretreatment assessment measures (pretreatment attrition rate: 58.70\%). A total of 3199 individuals did not formally withdraw from the 12-week treatment cycle, whereas 142 individuals formally dropped out (formal withdrawal during treatment dropout rate of 4.25\%). The treatment commencers differed significantly (P<.001-.03) from the noncommencers on several variables (reason for registering, mental health concerns, postsecondary education, where first heard about Anxiety Online, Kessler-6 score, stage of change, quality of life, relationship status, preferred method of learning, and smoking status). Those who formally withdrew during treatment differed significantly (P=.002-.03) from those who did not formally withdraw in that they were less likely to express concerns about anxiety, stress, and depression; to rate their quality of life as very poor, poor, or good; to report adequate level of social support; and to report readiness to make or were in the process of making changes. Conclusions: This exploratory study identified predictors of pretreatment attrition and formal withdrawal during treatment dropouts for the Anxiety Online program. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial\_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). ",
doi="10.2196/jmir.2989",
url="http://www.jmir.org/2014/6/e152/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24938311"
}


@Article{info:doi/10.2196/jmir.1918,
author="Klein, Britt
and Meyer, Denny
and Austin, William David
and Kyrios, Michael",
title="Anxiety Online---A Virtual Clinic: Preliminary Outcomes Following Completion of Five Fully Automated Treatment Programs for Anxiety Disorders and Symptoms",
journal="J Med Internet Res",
year="2011",
month="Nov",
day="04",
volume="13",
number="4",
pages="e89",
keywords="eTherapy",
keywords="Internet interventions",
keywords="e-mental health",
keywords="cognitive behavior therapy",
keywords="generalized anxiety disorder",
keywords="panic disorder",
keywords="obsessive compulsive disorder",
keywords="social anxiety disorder",
keywords="posttraumatic stress disorder",
keywords="self-help",
keywords="fully automated",
keywords="Web treatment",
abstract="Background: The development of e-mental health interventions to treat or prevent mental illness and to enhance wellbeing has risen rapidly over the past decade. This development assists the public in sidestepping some of the obstacles that are often encountered when trying to access traditional face-to-face mental health care services. Objective: The objective of our study was to investigate the posttreatment effectiveness of five fully automated self-help cognitive behavior e-therapy programs for generalized anxiety disorder (GAD), panic disorder with or without agoraphobia (PD/A), obsessive--compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (SAD) offered to the international public via Anxiety Online, an open-access full-service virtual psychology clinic for anxiety disorders. Methods: We used a naturalistic participant choice, quasi-experimental design to evaluate each of the five Anxiety Online fully automated self-help e-therapy programs. Participants were required to have at least subclinical levels of one of the anxiety disorders to be offered the associated disorder-specific fully automated self-help e-therapy program. These programs are offered free of charge via Anxiety Online. Results: A total of 225 people self-selected one of the five e-therapy programs (GAD, n = 88; SAD, n = 50; PD/A, n = 40; PTSD, n = 30; OCD, n = 17) and completed their 12-week posttreatment assessment. Significant improvements were found on 21/25 measures across the five fully automated self-help programs. At postassessment we observed significant reductions on all five anxiety disorder clinical disorder severity ratings (Cohen d range 0.72--1.22), increased confidence in managing one's own mental health care (Cohen d range 0.70--1.17), and decreases in the total number of clinical diagnoses (except for the PD/A program, where a positive trend was found) (Cohen d range 0.45--1.08). In addition, we found significant improvements in quality of life for the GAD, OCD, PTSD, and SAD e-therapy programs (Cohen d range 0.11--0.96) and significant reductions relating to general psychological distress levels for the GAD, PD/A, and PTSD e-therapy programs (Cohen d range 0.23--1.16). Overall, treatment satisfaction was good across all five e-therapy programs, and posttreatment assessment completers reported using their e-therapy program an average of 395.60 (SD 272.2) minutes over the 12-week treatment period. Conclusions: Overall, all five fully automated self-help e-therapy programs appear to be delivering promising high-quality outcomes; however, the results require replication. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial\_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG) ",
doi="10.2196/jmir.1918",
url="http://www.jmir.org/2011/4/e89/",
url="http://www.ncbi.nlm.nih.gov/pubmed/22057287"
}