Panic Disorder and Online Cognitive Behavioural Therapy

T. Wragg

Counselling Methodologies: Behavioural and Cognitive Modalities

Panic Disorder and Online Cognitive Behavioural Therapy Anxiety disorders (AD) are the most prevalent of mental health illnesses in contemporary Canadian society, and currently affect approximately one in ten individuals (Health Canada, 2009). In 2006, panic disorder (PD) was listed by the World Health Organization as a major cause of “years of life lived with disability” in persons 15 to 44 years of age. Left untreated, PD chronically impairs a person’s ability to function socially, at school, and in the workplace, and significantly reduces quality of life (Davison, Blankstein, Flett, & Neale, 2010). Socioeconomic and health care costs associated with ADs are astronomical. The price tag is estimated at a staggering $65 billion, “unsurpassed by other major mental illness groups, including schizophrenia and depression” (Anxiety Disorders Association of Canada, ADAC, 2003, p. 2). Additionally, Robinson (2013) reported Canadians struggling with mental health problems typically face long waitlists, and fail to gain access to the type of treatment required to get well once they make it into the system. Clearly, federal and provincial governments need to step up to the plate, and radically improve accessibility to evidenced-based psychosocial treatments for Canadians suffering with ADs.
According to Payne and Myhr (2010), international research findings confirmed cognitive behavioural therapy (CBT) is effective as a first-line treatment for ADs, and leads to “improved clinical and health economic outcomes – and in some circumstances even cost savings” (p. e181). Presently CBT receives minimal public health funding in Canada, and certified CBT therapists are in short supply (Payne & Myhr, p. e179). As of 2010, “only 54 CBT providers in Canada were formally accredited by [the Academy of Cognitive Therapy]” (Payne & Myhr, p. e179). The main purpose of this paper is to review a few of most recent studies evaluating the efficacy of an alternative method of delivery; computerized CBT for PD. In the writer’s opinion, internet-based CBT (iCBT) offers a way to alleviate the suffering of people with PD who find it too fearful or difficult to seek help for their symptoms. In particular, the 33% of PD sufferers who develop agoraphobia, during the first year of onset, and find face-to-face CBT aversive. In addition, this paper provides a description of the diagnostic criteria for PD, Canadian prevalence rates, and presents the findings of a mega comprehensive review conducted by Hofmann, Asnaani, Vonk, Sawyer, and Fang (2012) examining the efficacy of CBT as an efficacious treatment for a wide range of problems including anxiety disorders.
Diagnostic Criteria for Panic Disorder
Panic disorder is listed in the section on ADs, under Axis I of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000). The hallmark characteristics of PD include “unexpected, recurrent panic attacks [that are accompanied by excessive worry over possible future attacks]” (Ramage-Morin, 2004, p. 34). Individuals with PD experience discreet episodes of intense fear accompanied by no less than four of the following symptoms: “heart palpitations, sweating, trembling or shaking, shortness of breath, feeling of choking, chest pain, nausea, feeling dizzy, derealization or depersonalization, fear of losing control or going crazy, fear of dying, numbness, chills or hot flushes” (B.J. Sadock & Sadock, 2007, p. 590).
Typical attacks occur spontaneously day or night, or while sleeping, without any logical explanation; attacks generally last up to 10 minutes, with frequency varying from one person to another (Craske et al., 2010; Langlois et al., 2012). A DSM-IV-TR diagnosis of PD requires that an individual experience at least four uncued panic attacks over