Disorder-specific internet-based cognitive-behavioral therapy in treating panic disorder, comorbid symptoms and improving quality of life: A meta-analytic evaluation of randomized controlled trials

Martin Polak; Norbert K Tanzer; Kathrin Bauernhofer; Gerhard Andersson

doi:10.1016/j.invent.2021.100364

Disorder-specific internet-based cognitive-behavioral therapy in treating panic disorder, comorbid symptoms and improving quality of life: A meta-analytic evaluation of randomized controlled trials

Internet Interv. 2021 Jan 7:24:100364. doi: 10.1016/j.invent.2021.100364. eCollection 2021 Apr.

Authors

Martin Polak¹, Norbert K Tanzer¹, Kathrin Bauernhofer¹, Gerhard Andersson²

Affiliations

¹ Department of Psychology, University of Graz, Austria.
² Department of Behavioural Sciences and Learning, Linköping University, Sweden.

Abstract

Compared to conventional face-to-face psychological treatments, internet-based cognitive-behavioral therapy (iCBT) presents an innovative alternative that has been found to be effective in the treatment of anxiety disorders. The current study provides a meta-analysis investigating the efficacy of disorder-specific guided self-help (Gsh) iCBT compared to various active and inactive control conditions, with focus on adult panic disorder sufferers with or without agoraphobia (PD/A). Systematic literature search yielded 13 randomized controlled trials (RCTs) (N = 1214) that met the eligibility criteria for this study. We found no statistically significant differences between Gsh iCBT and various active CBT interventions in reducing PD/A symptoms at both post-test (g = 0.015, k = 10) and follow-up (g = 0.113, k = 6) levels. Also, comorbid anxiety and depression were reduced equivalently at post-test (g = 0.004, k = 6) and follow-up (g = 0.004, k = 6). Quality of life was equally improved at post-test (g = -0.100, k = 5) and follow-up (g = 0.074, k = 2). When compared to inactive controls, we found large effect sizes in PD/A (g = -0.892, k = 9) and comorbid anxiety and depression (g = -0.723, k = 9) symptoms, and moderate change in quality of life (g = -0.484, k = 3) at post-test. There was no difference between Guided self-help iCBT and Self-help iCBT in PD/A (g = -0.025, k = 3) and comorbid anxiety and depression (g = -0.025, k = 3) at post-test. Baseline severity, country of original research and adherence to the treatment in form of initial uptake were identified as statistically significant moderators of the iCBT treatment.

Keywords: CBT, Cognitive-behavioral therapy; Comorbid symptoms; Gsh, Guided self-help; Guided self-help; Internet-based cognitive-behavioral therapy; Meta-analysis; PD, Panic disorder; PD/A, Panic disorder with or without agoraphobia; Panic disorder with or without agoraphobia; RCT, Randomized controlled trial; Randomized controlled trials; Self-help; Sh, Self-help; fCBT, Face-to-face cognitive-behavioral therapy; iCBT, Internet-based cognitive-behavioral therapy.