Panic Online (net PO ; Version 1) Panic Online (netPO) was tested in a RCT in Australia (Klein, Richards, &

RCT 2: Panic Online (net PO ; Version 1) Panic Online (netPO) was tested in a RCT in Australia (Klein, Richards, &

Austin, 2006). A panic website yielded 130 self-referrals. In a 90-minute live phone interview a clinician screened and rated subjects who also self-rated online. Of the 55 panic disorder subjects enrolled, 82% had agoraphobia and 53% were on a psychotropic drug. They were randomized (concealed) to have six weeks of either: (a) net PO at home (n=19); or (b) therapist- aided CBT manual at home ( M astery of Your Anxiety and Panic [ M AP] ; Barlow & Craske, 2000; n=18); or (c) net-panic-information waitlist control ( Panic Resource; n=18). NetPO and M AP each guided the same CBT tasks (controlled breathing, cognitive restructuring, interoceptive and situational exposure, relapse prevention), while a CBT therapist guided users through net PO by email with answers to queries within 24 hours. M AP subjects were posted a copy of the manual and a CBT therapist phoned weekly to monitor progress. Net-information controls were told to wait six weeks for CBT. Clinical psychology students phoned controls weekly to check their status. Assessments were not blind.

Of the 55 enrollees, 9 (16%) dropped out by week 6 (respectively 1, 3, 5). Analyses carried forward the last available observation. Compared to the net-information waitlist, at week 6 both net PO and M AP improved on every measure (panic, cognitions, anxiety and stress, number of GP visits, and physical health). Net PO was better than M AP in reducing clinician-rated agoraphobia and number of GP visits. At three months followup (20 weeks post-entry) both CBT groups maintained gains, with net PO being better on self-rated physical health and reduced GP visits. Subjects rated PO and M AP as equally credible and satisfying. Total psychologist time spent per client over the six-week study was appreciable: 5.5 hrs for PO, 4 hrs for M AP, 1 hr for controls. A psychologist sent a mean of 16 emails to PO clients and received a mean of 13 emails from them, and phoned M AP clients a mean of

8 times and controls a mean of 4 times. Total therapist-contact cost was A$350 net PO, A$379 M AP, A$55 control. Subjects' number of days in the RCT was 46 net PO, 63 M AP, 40 control. The MAP manual had more content than the PO website and took longer to get through.

It is unclear how much the greater gains with net PO and with M AP re¯ected greater expectancies of change than in the control waitlist. The low dropout rate might re¯ect the 90-minute live phone screening interview and appreciable human contact during the RCT ± the control waitlist had the least contact and the most dropouts.

That panic/agoraphobia improved with CBT comparably whether guided at home by net or manual plus appreciable remote support resembles a ®nding by Ghosh et al. (1988). In that RCT gains in panic/agoraphobia and other phobias were similar whether self-exposure was guided in a clinic

2. CP FOR PHOBIC/PANIC DISORDER 41

either by a standalone computer or by the manual L iving With Fear (or guided face to face by a therapist).

I n brief, improvement in the RCT of netPanic Online was similar whether CBT was guided by the net or by a manual with each also having substantial email or phone guidance. It is unclear how much their superiority to net-panic-information waitlist controls re¯ected a greater therapeutic expectancy.

RCT 3: 6-module net PO (Version 1) vs 13-module net PO + STRESS (Version 2; net PSO ) vs information-only control WL

This small Australian RCT (Richards et al., 2006) tested net PSO which is net PO plus six more modules on coping with stress, time and anger management, tuning into one's thoughts, relaxation, and social connected- ness. Net PSO took about 90 more minutes to read than netPO.

Of 68 self-referrals from an Australian panic website 63 were screened by 90-minute phone clinical interviews and online questionnaires; 32 met trial criteria including DSM-IV panic disorder. Entrants were randomized (con- cealed) to eight weeks of either: (a) net PO as in RCT 2 (n=12); (b) netPSO (n=11); or (c) net-panic-information waitlist control (n=9). Net PO, netPSO and netcontrol each had email support for respective means per participant of 376, 309 and about 52 minutes in all over eight weeks. Mean problem duration was 13 years, mean age was 37, and mean number of years of education was 13. Net PSO had more males than the other groups. Dropouts were 2 net PO, 1 netPSO, 2 control.

For missing data, analyses carried forward last observations. Net PSO was marginally better than net PO at week eight (post-treatment) but not at follow-up three months later. Net PO and netPSO were superior to the waitlist control on almost every measure.

I n brief, netPanic Online plus extra stress-management modules did not enduringly enhance the ef®cacy of net PO. This RCT is a ®ne example of how netCP facilitates dismantling research concerning which treatment ingredients are useful. It is unclear how much the superiority to the waitlist of net PO and netPSO re¯ected their better expectancies and far longer email durations of support.

42 HANDS-ON HELP: COMPUTER-AIDED PSYCHOTHERAPY