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
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
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
Faculty of Life and Social Sciences
Swinburne University of Technology
beyondblue Victorian Centre of Excellence
Project completion year
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.