Internet-based treatment for panic disorder : does frequency of therapist contact make a difference?

Internet-based interventions with therapist support have proven effective for treating a range of mental health conditions. This study examined whether frequency of therapist contact affected treatment outcomes. Fifty-seven people with panic disorder (including 32 with agoraphobia) were randomly allocated to an 8-week Internet-based cognitive behavioural treatment intervention (Panic Online) with either frequent (three e-mails per week) or infrequent (one e-mail per week) support from a psychologist. Posttreatment, intention-to-treat analyses revealed that both treatments were effective at improving panic disorder and agoraphobia severity ratings, panicrelated cognitions, negative affect, and psychological and physical quality of life domains, with no differences between conditions. High end-state functioning was achieved by 28.6% of the frequent and infrequent participants, respectively. Therapist alliance, treatment credibility, and satisfaction also did not differ between groups, despite significantly greater therapist time invested in the frequent contact condition. The results provide evidence that the effectiveness of Internet-based mental health interventions may be independent of the frequency of therapist support and may, therefore, be more cost-effective than previously reported.<br /

Training clinicians online to be e-therapists : the 'Anxiety online' model

Anxiety Online is a "virtual" online clinical assessment and treatment service, funded by the Australian Department of Health and Ageing and provided by Swinburne University's National e-therapy Centre (NeTC). This chapter describes an online clinician training program for online low intensity practitioners ('etherapists') to work in the Anxiety Online virtual clinic (http://www.anxietyonline.org.au). and the challenges and solutions involved ." From the introduction"

Best practices in online therapy

This article discusses important issues in delivery of best practice Internet-based therapy (etherapy). Etherapy is first defined as the interaction between a consumer and a therapist via the Internet (commonly via e-mail) in association with the use of a structured web-based clinical treatment program. A summary of the professional and ethical issues is provided, along with illustrated examples of best-practice principles experienced in clinical and research work by members of the Swinburne University of Technology Etherapy Unit (formerly the Etherapy Research, Education, and Training Unit in the Department of General Practice at Monash University). Etherapy has been found to be effective in treating a range of psychological disorders. Future research investigating methods of enhancing consumers' ability to engage in etherapy should further increase the effectiveness of this type of therapy

Mindfulness and Mindfulness-Based Psychotherapy

Recent studies have highlighted the promising benefits of mindfulness-based interventions for a range of clinical issues. The growing interest among practitioners in using mindfulness as an intervention raises issues of therapeutic potential, practical application and potential adverse effects. Mindfulness meditation is defined as paying attention to ongoing sensory experiences and mental contents, deliberately and intentionally, and in a non-elaborative and non-judgmental way. The history and psychological mechanisms of mindfulness meditation is discussed as well as the ways it differs from traditional cognitive therapies. Empirical evidence for mindfulness meditation as a therapeutic technique is considered in addition to costs and benefits, potential adverse effects and practitioner issues such as skills and training. Finally, we examine the proposition that interest in mindfulness meditation has spawned a number of new therapies that appear to have high efficacy and represent a new conceptualization of potentially active ingredients in psychotherapy and psychological change

Training postgraduate psychology students to deliver psychological services online

Information and communication technologies are increasingly being used to remotely deliver psychological services. This delivery method confers clear advantages to both client and therapist, including the accessibility of services by otherwise unserved populations and cost-effective treatment. Remote services can be delivered in a real-time or delayed manner, providing clients with a wealth of therapy options not previously available. The proliferation of these services has outstripped the development and implementation of all but the most rudimentary of regulatory frameworks, potentially exposing clients to substandard psychological services. Integrating mandatory training on the delivery of online psychological services into accredited postgraduate psychology courses would aid in addressing this issue. The purpose of this article is to outline issues of consideration in the development and implementation of such a training programme. An online etherapy training programme developed by Swinburne University\u27s National eTherapy Centre will be used as an example throughout

After hours palliative care provision in rural and urban Victoria, Australia

Objective: This paper reports the preliminary findings of a project exploring after hours palliative care service provision in three regions of Victoria, Australia. The outcomes of this phase will inform the subsequent quantitative survey in the next phase. Design: Qualitative: thematic analysis of transcribed semi-structured interviews. Setting: Of the three participating regions, one is classed as urban (highly accessible), one both urban and rural areas (45 % highly accessible, 65 %accessible), while the third is entirely rural (19% accessible, 65% moderately accessible, 16% not classified). Participants: Thirty-eight interviews were completed with general practitioners (12), nurses (12), managers (5), terminally ill people and their carers interviewed together (9). Participants were recruited from across the three participating regions through the relevant Divisions of General Practice and the participating palliative care services. Result: Some examples of satisfaction with services were indicated, however, gaps in the provision of after hours palliative care services, such as training, remuneration and availability of general practitioners, care planning that includes after hours care, interdisciplinary team communication issues, staff safety and after hours telephone support and information for families, were all identified by stakeholders. These results will be used to inform the development of a quantitative study to explore these issues with a larger number of participants. Conclusion: Further research is needed to explore these gaps and to test alternative or modified models of after hours care. Awareness of these problems can be used to inform policy development for after hours service arrangements

The role of general practitioner based research in the development of national policy: case studies from Ireland and Australia

Jane E. Pirkis , Grant A. Blashki , Andrew W. Murphy , Ian B. Hickie and Lisa Ciechomski describe the influence of GP-based research on the development of two specific policy initiatives, the Heartwatch Programme in Ireland and the Better Outcomes in Mental Health Care initiative in Australia. They explore the extent to which relevant GP-based research shaped these initiatives

Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT

This study compared Panic Online (PO), an internet-based CBT intervention, to best-practice face-to-face CBT for people with panic disorder with or without agoraphobia. Eighty-six people with a primary diagnosis of panic disorder were recruited from Victoria, Australia. Participants were randomly assigned to either PO (n = 46) or best practice face-to-face CBT (n = 40). Effects of the internet-based CBT program were found to be comparable to those of face-to-face CBT. Both interventions produced significant reductions in panic disorder and agoraphobia clinician severity ratings, self reported panic disorder severity and panic attack frequency, measures of depression, anxiety, stress and panic related cognitions, and displayed improvements in quality of life. Participants rated both treatment conditions as equally credible and satisfying. Participants in the face-to-face CBT treatment group cited higher enjoyment with communicating with their therapist. Consistent with this, therapists&rsquo; ratings for compliance to treatment and understanding of the CBT material was higher in the face-to-face CBT treatment group. PO required significantly less therapist time than the face-to-face CBT condition.<br /