PAXonline: A Randomized Controlled Trial Assessing the Efficacy of an Internet-Based Cognitive Behavior Intervention for Panic Disorder

The PAXonline Program for Panic Disorder is an internet-based treatment of twelve weeks, which consists of cognitive-behavioral therapy modules, delivered with or without assistance from a therapist . The Panic Disorder Program contains 16 modules which address important cognitive behavioral psychotherapy elements such as: psychoeducation on the disorder and means of intervention (Module 1. Understand what’s happening to you and Module 2. Understand what you have to do), techniques for decreasing neurophysiologic hyper-activation (module for breathing regulation, autogenic training relaxation, physical exercise), techniques for cognitive restructuring (attention modification and conscious and unconscious dysfunctional beliefs modification), exposure techniques (interoceptive and exteroceptive), skills training (problem solving) and positive emotions training (positive psychology), behavioral activation and cognitive restructuring of possible comorbid depression symptoms and relapse prevention. Each module can be completed in 30-40 minutes and the participants are provided with a recommended timetable (one or two modules per week, depending on the complexity of the content and the homework assignments). In this trial Romanian adults with Panic disorder will be randomly allocated to one of three groups: Group 1: Guided panic disorder program. Participants in this group will complete the panic disorder treatment program with support from a therapist (weekly emails and regular 15 minutes Skype sessions; in total, there will be 9 Skype sessions). Group 2: Self-guided panic disorder program. Participants in this group will complete the treatment program in a self-guided format, that is, without support from a therapist. Group 3: Wait-list control group. The modules and the entire therapeutic environment is carefully designed in order to catalyze the psychotherapeutic process in the mind of the patients. The program contains also certain techniques to improve adherence and compliance with the treatment e.g. rewards after module completion (short movies that induce positive emotions), The daily thought, which is sent through e-mail every other 5 days etc. The participants adherence is carefully monitored through several applications that register: overall usage time, the modules completed and the time spent on each module and each module component. There is also an application, the participants use to report the completion of homework assignments for each module.