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Online CBT Effective for Panic, Agoraphobia?

Online CBT Effective for Panic, Agoraphobia? In the first phase of the Internet in the 1990s, we witnessed how it broke down mental health barriers by providing individuals with information about mental disorders and treatment options. Before 1990 or so, the only way to look up the “official” symptoms for a disorder was either to get to a local library that had a copy of the diagnostic and statistical manual of mental disorders, or ask a mental health professional or advocacy group about the symptoms (and hope they don’t leave out anything).

But the Internet broke down the arbitrary wall — that this information was somehow “special” and shouldn’t be given to people directly. People suddenly could learn about depression, or anxiety, or ADHD on their own without ever leaving their home. With greater education comes greater awareness of these concerns, and hopefully more people seeking treatment when the problem significantly interferes or impacts their life.

In the past decade, we’ve seen the rise of the second phase of the online mental health revolution — interactive self-help programs that can help alleviate the symptoms of significant mental health concerns. Online cognitive behavioral therapy (CBT) is one such intervention and the one used by a recent study. Could online CBT be just as effective as regular CBT to treat a common anxiety concern, panic disorder (with or without agoraphobia)?

Jan Bergström and Swedish colleagues studied 113 people with panic disorder (with or without agoraphobia). The patients were randomly assigned to 10 weeks of either guided Internet delivered CBT (n = 53) or group CBT (n = 60). After treatment, and at a 6-month follow-up, patients were again assessed by a psychiatrist, blind to treatment condition.

Could online, guided CBT be as effective as face-to-face group CBT? Yes:

We found no statistically significant differences between the two treatment conditions using a mixed models approach to account for missing data. […]

A majority of patients were considered as responders to treatment, both when this was defined as a significant drop in panic symptoms as well as when defined as degree of global improvement and end-state functioning. Moreover, a majority of patients no longer fulfilled DSM-IV criteria of panic disorder after treatment, and this proportion of patients increased somewhat at the 6-month follow-up.

In other words, both treatment groups experienced significant response to the cognitive behavioral interventions, no matter if they were administered face-to-face in a traditional group therapy setting, or if they were administered through an online, interactive program.

Why the push for online interventions? Because they can be extremely cost effective and reach a much broader population than traditional psychotherapy modalities can.

The cost-effectiveness analysis showed that Internet treatment had superior cost-effectiveness ratios in relation to group treatment both at post-treatment and follow-up concerning direct costs of therapist time and psychiatrist assessment.

That’s good news for everyone, because it means that someone who presents to their family doctor’s office for panic symptoms can still enjoy a psychotherapy intervention even if they don’t want to see a mental health professional for traditional psychotherapy. Such interventions can likely be used just as effectively on a population-wide scale too, with an appropriate panic disorder screening measure used to help a person understand if panic is a concern in their life.

This is just one of dozens of studies in recent years demonstrating the effectiveness of online psychotherapy-based interventions to treat mental disorders — everything from depression and eating disorders to panic disorder and alcohol abuse, and more. If you want to learn more about such interventions, check out this article about research-backed online mental health interventions and a database that lets you research ones of interest to you.


Bergström, J., et al (2010). Internet- versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial. BMC Psychiatry, 10:54. doi:10.1186/1471-244X-10-54

Online CBT Effective for Panic, Agoraphobia?

John M. Grohol, Psy.D.

Dr. John Grohol is the founder of Psych Central. He is a psychologist, author, researcher, and expert in mental health online, and has been writing about online behavior, mental health and psychology issues since 1995. Dr. Grohol has a Master's degree and doctorate in clinical psychology from Nova Southeastern University. Dr. Grohol sits on the editorial board of the journal Computers in Human Behavior and is a founding board member of the Society for Participatory Medicine. You can learn more about Dr. John Grohol here.

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APA Reference
Grohol, J. (2018). Online CBT Effective for Panic, Agoraphobia?. Psych Central. Retrieved on October 21, 2020, from
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Last updated: 8 Jul 2018 (Originally: 10 Aug 2010)
Last reviewed: By a member of our scientific advisory board on 8 Jul 2018
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