Exploring the feasibility and efficacy of intensive online Cognitive Behavioural Therapy for panic and anxiety: A pilot study

The internet-delivered Exposure-based Cognitive Behavioural Therapy Program comprises 6 lesson completed over 7 days. It includes psychoeducation about panic and anxiety, graded exposure to test negative predictions, and relapse prevention. A new lesson will become available each day (with the exception of Day 6, which is devoted to practicing challenging skills), with participants expected to complete one lesson per day. Each lesson will take approximately 30-40 minutes to read. 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 day (for a 7 days) 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 two scheduled calls within the treatment week and additional contact 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 the first lesson, on Day 7, 1 week post-treatment, and at 2 month follow-up. 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, 1 week post-treatment and 2 month follow-up. 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.