Comparing two versions of online Cognitive Behavioural Therapy (CBT) for panic and anxiety in adults: A randomised controlled trial

The internet-delivered Exposure-based Cognitive Behavioural Therapy Program comprises 6 lessons completed over 8 weeks. It includes psychoeducation about panic and anxiety, graded exposure to test negative predictions, and relapse prevention. In contrast to the Multi-component Cognitive Behavioural Therapy Program (Control treatment), the Exposure-based program does not include controlled breathing or thought challenging (cognitive restructuring) techniques. The Exposure-based program introduces exposure in Lesson 2, whereas the Multi-component program teaches the other strategies first and introduces exposure in Lesson 4. A new lesson will become available after the preceding lesson has been completed (with a minimum of 5 day between lessons), with participants expected to take five to ten days to complete each lesson (8 weeks in total). Each lesson will take approximately 30-40 minutes to complete. Participants will have access to summaries of each lesson, homework exercises and extra resources for each lesson. Participants are advised to spend at least 3-4 hours per week working through the lesson material, revisiting the content and homework tasks/practicing the skills. Clinician guidance will be provided in the form of email or phone contact from the clinicians (registered clinical psychologist; registered provisional psychologist undertaking postgraduate training), including a scheduled call within the first two weeks and then as required. The participant is able to email or phone the clinician at any point during the trial.The participant completes a measure of panic symptoms before each lesson, and if their scores deteriorate by 4 or more points, the clinician is automatically alerted and initiates contact with the participant by phone or email. The participant also completes measures of depression, suicidal ideation and suicidal intent at the start of intervention, mid-intervention, post-treatment and all follow-up points. If the participant has an elevated distress or depression score, the clinician is automatically alerted and initiates contact with the participant by phone or email. The mode of contact is dependent on what is clinically indicated in terms of the participant's distress score and/or what the participant may have communicated (in the form of phone or email contact) to the clinician. The mode of contact (email or phone or both) therefore is dependent on the clinician's clinical judgement of the situation in hand. Strategies used to improved adherence to intervention protocols and procedures for monitoring adherence include: automated email reminders, monitoring the downloading of homework, and collection of data on how long participants spent reading lessons and practicing skills.