Research projects

Evaluation of an Internet-based therapy for panic disorder in general medical practice

Principal Researchers

Dr David Austin

Prof Jeff Richards (2003-2005), Dept. Of general Practice, Monash University

Dr David Austin (2005-2007), Faculty of Life and Social Sciences, Swinburne University of Technology

Other Investigators:

Dr Peter Shattner, Dept. of General Practice, Monash University

Dr Victoria Wade, Department of General Practice, Flinders University

Dr David Pierce, Department of general Practice, University of Melbourne

Gwenda Cannard, CEO, TRANX/PADA Inc, Melbourne

Dr Ciaran Pier, Dept. of General Practice, Monash University

Dr Britt Klein, Dept. of General Practice, Monash University

Research staff:

Joanna Mitchell, Dept. of General Practice, Monash University

Dr Lisa Ciechomski, Dept. of General Practice, Monash University

Dr Kathryn Gilson, Dept. of General Practice, Monash University

Kerrie Shandley, Dept. of General Practice, Monash University

Institution

Faculty of Life and Social Sciences

Swinburne University of Technology

Funding

$264,000

Award Type

beyondblue Victorian Centre of Excellence

Project completion year

2007

Project brief

Panic disorder (PD) is one of the most common anxiety disorders seen in general practice, but provision of evidence-based cognitive behavioural treatment is rare. Many Australian GPs are now trained to deliver focused psychological strategies but in practice this is time-consuming and costly. The purpose of this study was to evaluate the efficacy of an internet-based CBT intervention (Panic Online) for the treatment of PD supported by GP-delivered therapeutic assistance. Specifically, Panic Online supported by GP-delivered (face-to-face) therapy was compared to Panic Online supported by psychologist-delivered email therapy. In total, 96 people with a primary diagnosis of PD completed 12-weeks of therapy using Panic Online and therapeutic assistance with his/her GP (n = 53) or a clinical psychologist (n = 43). Participants completed a clinical diagnostic interview and questionnaires to assess panic-related symptoms before and after treatment, and at 6 months follow-up.

Main outcomes / key project findings

Both treatments led to significant improvements in panic attack frequency, depression, anxiety, stress, anxiety sensitivity, agoraphobia avoidance and quality of life. There was a statistically significant difference from pre to post between the two treatments on agoraphobia symptomatology with the psychologist supported group showing a greater decrease. At 6 month follow-up,  improvement was maintained for both groups. Furthermore, both groups continued to show a significant decrease in their clinical panic disorder status and agoraphobia avoidance behaviour. These findings suggest that, when PD sufferers are provided with accessible online treatment protocols, GPs trained to deliver focused psychological strategies can achieve patient outcomes comparable to efficacious treatments delivered by clinical psychologists. The findings of this research provide a model for how GPs may be assisted to provide evidence-based mental health care successfully. Further research will be required to evaluate e-based programs for other mental health conditions, however, we anticipate, based on our research, that effective e-based treatments for other high prevalence conditions such as generalised anxiety disorder, post-traumatic stress disorder and social anxiety disorder will soon be developed.

Implications for policy and practice

This is the first study to evaluate the use of an evidence-based internet-based mental health treatment within general practice. At present, very few GPs are using electronic mental health resources despite the fact that they recognise several advantages to doing so, such as high patient acceptance, time-efficiency, and perceived high quality. Results of this study, however, suggest that GPs may be confident that, in the near future, electronic clinical mental health tools will facilitate their provision of effective mental health treatments and lead to improved patient outcomes.

Our team views it as of paramount importance that steps be taken to increase the availability of evidence-based internet-delivered treatments. At present, there is no Medicare or other subsidy available to users of these programs. We would argue that, where demonstrated efficacy exists (as for Panic Online), then there is justification for Medicare rebate availability on such a service.