Efficacy of telephone-administered behavioral therapy for panic disorder with agoraphobia

doi:10.1016/0005-7967(94)00061-N

Behaviour Research and Therapy

Volume 33, Issue 4, May 1995, Pages 465-469

https://doi.org/10.1016/0005-7967(94)00061-N Get rights and content

Abstract

The purpose of this study was to determine the efficacy of a structured exposure-based behavior therapy program delivered by telephone to agoraphobic individuals who were isolated from specialized treatment centres. Forty-two individuals with a DSM-III-R diagnosis of panic disorder with agoraphobia who were living in rural areas of Ontario were assigned to either an eight-session telephone behavior therapy program or wait-list control condition. There were significant treatment × time interaction effects on several outcome variables. Patients originally in the wait-list group then received the same type of therapy and they also significantly improved. All treatment gains were maintained at three-month and six-month follow-up. Telephone behavior therapy appears to be a cost-effective and efficacious treatment for agoraphobics living in remote regions where specialized anxiety disorder services are not readily available.

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Relative effects of cognitive and behavioral therapies on generalized anxiety disorder, social anxiety disorder and panic disorder: A meta-analysis
2016, Journal of Anxiety Disorders
Although cognitive and behavioral therapies are effective in the treatment of anxiety disorders, it is not clear what the relative effects of these treatments are. We conducted a meta-analysis of trials comparing cognitive and behavioral therapies with a control condition, in patients with social anxiety disorder (SAD), generalized anxiety disorder (GAD) and panic disorder. We included 42 studies in which generic measures of anxiety were used (BAI, HAMA, STAI-State and Trait). Only the effects of treatment for panic disorder as measured on the BAI (13.33 points; 95% CI: 10.58–16.07) were significantly (p = 0.001) larger than the effect sizes on GAD (6.06 points; 95% CI: 3.96–8.16) and SAD (5.92 points; 95% CI: 4.64–7.20). The effects remained significant after adjusting for baseline severity and other major characteristics of the trials. The results should be considered with caution because of the small number of studies in many subgroups and the high risk of bias in most studies.
Telephone-based continuing care counseling in substance abuse treatment: Economic analysis of a randomized trial
2016, Drug and Alcohol Dependence
Citation Excerpt :
By reducing patient travel expenses and time and facility overhead, TEL should also reduce costs. The telephone has proven to be a viable therapeutic tool in the treatment of several chronic disorders including alcoholism (Connors et al., 1992; Foote and Erfurt, 1991; McKay et al., 2010), panic disorder (Swinson et al., 1995), obsessive-compulsive disorder (Baer et al., 1993), depression (Baer et al., 1995) and congestive heart failure (Jerant et al., 2001). It has also been found to improve outcomes in smoking cessation (Lichtenstein et al., 1996; Stoffelmeyr et al., 2003) and cardiac rehabilitation (Bambauer et al., 2005), and reduces costs for patients in fair or poor overall health (Wasson et al., 1992).
To investigate whether telephone-based continuing care (TEL) is a promising alternative to traditional face-to-face counseling for clients in treatment for substance abuse.
Patients with alcohol and/or cocaine dependence who had completed a 4-week intensive outpatient program were randomly assigned through urn randomization into one of three 12-week interventions: standard continuing care (STD), in-person relapse prevention (RP), or telephone-based continuing care (TEL). This study performed cost, cost-effectiveness, and cost-benefit analyses of TEL and RP compared to STD, using results from the randomized clinical trial with two years of follow up (359 participants). In addition, the study examined the potential moderating effect of baseline patient costs on economic outcomes.
The study found that TEL was less expensive per client from the societal perspective ($569) than STD ($870) or RP ($1684). TEL also was also significantly more effective, with an abstinence rate of 57.1% compared to 46.7% for STD (p < 0.05). Thus TEL dominated STD, with a highly favorable negative incremental cost-effectiveness ratio (−$1400 per abstinent year). TEL also proved favorable under a benefit-cost perspective.
TEL proved to be a cost-effective and cost-beneficial contributor to long-term recovery over two years. Because TEL dominated STD care interventions, wider adoption should be considered.
Telehealth, Computer-, and Internet-Based Approaches to Treating Depression and Anxiety
2016, Encyclopedia of Mental Health: Second Edition
There is a great need for evidence-based treatments for depression and anxiety that are cost-effective, efficiently delivered, and highly accessible. Telehealth, computer, and Internet interventions are efficacious and have the potential to broaden access to treatment for depression and anxiety. These interventions are cost-effective and increase treatment accessibility for individuals who would otherwise be unlikely to receive appropriate care, and their anonymity reduces the stigma of help seeking. This article discusses these treatment approaches, their efficacy, and their limitations.
Panic Disorder
2015, International Encyclopedia of the Social & Behavioral Sciences: Second Edition
Panic disorder (PD) is a condition associated with recurrent, unexpected panic attacks, characterized by sudden surges of physical arousal symptoms and fear. PD occurs frequently in the general population and is often associated with other psychological problems, including other anxiety disorders, depression, and substance-use problems. PD appears to stem from an interaction of biological, psychological, and social factors. This article begins with a review of diagnostic criteria, and then provides a brief summary of the biological and psychological factors involved in the onset and maintenance of PD. This article concludes with a review of effective medications and psychological treatments.
You can't get anything perfect: "User perspectives on the delivery of cognitive behavioural therapy by telephone"
2010, Social Science and Medicine
Citation Excerpt :
Increasingly it is also attracting attention as an effective mediator for remote psychotherapy provision (Bee et al. 2008). Randomised controlled trials now report evidence of the efficacy of telephone-based Cognitive Behavioural Therapy (T-CBT) for depression (Mohr et al., 2005; Simon, Ludman, Tutty, Operskalski, & Von Korff, 2004); agoraphobia (Swinson, Fergus, Cox, & Wickwire, 1995) and obsessive-compulsive disorder (Lovell et al., 2006). Yet, despite this growing evidence base and the widespread familiarity of the telephone as a communication tool, telephone-delivered psychotherapies have been slow to penetrate the healthcare system.
Remote psychotherapy services such as telephone-administered cognitive behavioural therapy (T-CBT) have the potential to provide effective psychological treatment whilst simultaneously maximising efficiency, lowering costs and improving access to care. However, a lack of research examining the acceptability of non face-to-face psychotherapy means that little is known about users’ perceptions of these delivery models. This paper reports data from two qualitative evaluations of T-CBT delivered in the voluntary and occupational health sectors in the UK. It explores users’ acceptance of T-CBT, contrasting initial socially-construed expectations with more positive regard derived from experiential norms. User satisfaction with T-CBT was mixed. However, the relative ease with which most participants adapted to telephone-based care was suggestive of a shared construct of mental health service provision that prioritised the accessibility and availability of services over the social, professional and medico-legal perspectives that conventionally promote the co-location of practitioner and client.
Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis
2010, Clinical Psychology Review
Although the efficacy of psychological treatment for panic disorder (PD) with or without agoraphobia has been the subject of a great deal of research, the specific contribution of techniques such as exposure, cognitive therapy, relaxation training and breathing retraining has not yet been clearly established. This paper presents a meta-analysis applying random- and mixed-effects models to a total of 65 comparisons between a treated and a control group, obtained from 42 studies published between 1980 and 2006. The results showed that, after controlling for the methodological quality of the studies and the type of control group, the combination of exposure, relaxation training, and breathing retraining gives the most consistent evidence for treating PD. Other factors that improve the effectiveness of treatments are the inclusion of homework during the intervention and a follow-up program after it has finished. Furthermore, the treatment is more effective when the patients have no comorbid disorders and the shorter the time they have been suffering from the illness. Publication bias and several methodological factors were discarded as a threat against the validity of our results. Finally the implications of the results for clinical practice and for future research are discussed.

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^☆: A portion of this paper was presented at the annual meeting of the American Psychiatric Association, San Francisco, May 1993.

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Behaviour Research and Therapy

Abstract

References (20)

A meta-anaylsis of treatments for panic disorder with agoraphobia: Imipramine, alprazolam, and in vivo exposure

Journal of Behavior Therapy and Experimental Psychiatry

Self-treatment of agoraphobia by exposure

Behavior Therapy

The use of bibliotherapy in the treatment of panic: A preliminary investigation

Behavior Therapy

Brief standard self-rating for phobic patients

Behaviour Research and Therapy

Telephone-guided treatment for housebound agoraphobics with panic disorder: Exposure vs Relaxation

Behavior Therapy

The use of meta-analysis to assess the clinical significance of behavior therapy for agoraphobia

Behavior Therapy

An inventory for measuring depression

Archives of General Psychiatry

Use of mental health services for the treatment of panic disorder

American Journal of Psychiatry

Frequency of panic as an outcome measure in agoraphobia research: Latent effects of exposure on panic

Journal of Anxiety Disorders

Cited by (63)

Relative effects of cognitive and behavioral therapies on generalized anxiety disorder, social anxiety disorder and panic disorder: A meta-analysis

Telephone-based continuing care counseling in substance abuse treatment: Economic analysis of a randomized trial

Telehealth, Computer-, and Internet-Based Approaches to Treating Depression and Anxiety

Panic Disorder

You can't get anything perfect: "User perspectives on the delivery of cognitive behavioural therapy by telephone"

Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis

Case history and shorter communicationEfficacy of telephone-administered behavioral therapy for panic disorder with agoraphobia☆

Abstract

Journal of Behavior Therapy and Experimental Psychiatry

Behavior Therapy

Behavior Therapy

Behaviour Research and Therapy

Behavior Therapy

Behavior Therapy

An inventory for measuring depression

Archives of General Psychiatry

Use of mental health services for the treatment of panic disorder

American Journal of Psychiatry

Frequency of panic as an outcome measure in agoraphobia research: Latent effects of exposure on panic

Journal of Anxiety Disorders

Case history and shorter communication
Efficacy of telephone-administered behavioral therapy for panic disorder with agoraphobia☆