Are Internet- and mobile-based interventions effective in adults with diagnosed panic disorder and/or agoraphobia? A systematic review and meta-analysis

Matthias Domhardt; Josefine Letsch; Jonas Kybelka; Josephine Koenigbauer; Philipp Doebler; Harald Baumeister

doi:10.1016/j.jad.2020.06.059

Are Internet- and mobile-based interventions effective in adults with diagnosed panic disorder and/or agoraphobia? A systematic review and meta-analysis

J Affect Disord. 2020 Nov 1:276:169-182. doi: 10.1016/j.jad.2020.06.059. Epub 2020 Jul 15.

Authors

Matthias Domhardt¹, Josefine Letsch², Jonas Kybelka³, Josephine Koenigbauer³, Philipp Doebler⁴, Harald Baumeister³

Affiliations

¹ Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany. Electronic address: matthias.domhardt@uni-ulm.de.
² Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Ulm, Germany.
³ Department of Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee-47, 89081 Ulm, Germany.
⁴ Statistical Methods in the Social Sciences, Department of Statistics, TU Dortmund University, Germany.

PMID: 32697696
DOI: 10.1016/j.jad.2020.06.059

Abstract

Background: There is no meta-analysis that specifically evaluates the effectiveness of Internet- and mobile-based interventions (IMIs) in adults with diagnosed panic disorder and/or agoraphobia (PD/A) so far. The current meta-analysis aims to fill this gap (PROSPERO CRD 42016034016).

Methods: Systematic literature searches in six databases for randomised and controlled clinical trials investigating IMIs in adults, who met diagnostic criteria for PD/A. Study selection and data extraction were conducted independently by two reviewers. Random-effects meta-analyses, pre-planned subgroup and sensitivity analyses were conducted when appropriate. Primary outcomes were PD and A symptom severity. In addition, adherence, response, remission, quality of life, anxiety and depression symptom severity were examined.

Results: A total of 16 trials (1015 patients), with 21 comparisons (9 IMI vs. waitlist; 7 IMI vs. IMI; 5 IMI vs. active treatment condition), were included. IMIs revealed beneficial effects on panic (Hedges' g range -2.61 to -0.25) and agoraphobia symptom severity when compared to waitlist (pooled g = -1.15, [95%-CI = -1.56; -0.74]). Studies comparing IMIs to active controls (i.e., face-to-face CBT and applied relaxation) did not find significant differences for reductions in panic (g = -0.02, [95%-CI = -0.25; 0.21]) and agoraphobia symptom severity (g = -0.10, [95%-CI = -0.39; 0.19]). Furthermore, IMIs were superior to waitlist controls regarding anxiety and depression symptom severity and quality of life.

Limitations: Tests for publication bias were not feasible due to the limited number of trials per comparison, and the risk of bias assessment indicated some methodological shortcomings.

Conclusions: Findings from this meta-analytic review provide support for the effectiveness of IMIs in patients with verified PD/A. However, before IMIs can be included in treatment guidelines for PD/A, future high quality research is needed that substantiates and extends the evidence base, especially in regard to intervention safety.

Keywords: Agoraphobia; Anxiety disorder; Panic disorder; Psychotherapy; eHealth; mHealth.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Adult
Agoraphobia* / therapy
Anxiety Disorders
Humans
Internet
Panic Disorder* / therapy
Quality of Life