Journal Mobile Options
Table of Contents
Vol. 74, No. 3, 2005
Issue release date: April 2005
Psychother Psychosom 2005;74:154–164

Internet-Guided Self-Help with or without Exposure Therapy for Phobic and Panic Disorders

Schneider A.J. · Mataix-Cols D. · Marks I.M. · Bachofen M.
Departments of Psychological Medicine, Imperial College London and Institute of Psychiatry, King’s College London, London, UK

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: As many sufferers from phobic and panic (phobia/panic) disorders cannot get to suitable therapists, routine aspects of therapy were delegated to internet-accessed computer-aided self-help with or without exposure instructions. Methods: Phobia/panic referrals were randomised to computer-aided self-help via the internet at home in a 2:1 ratio either by self-exposure cognitive behaviour therapy (CBT) [FearFighter (FF), n = 45] or by minimal CBT without exposure [Managing Anxiety (MA), n = 23]. All had brief backup phone advice from a clinician concerning their computer guidance. Results: On self-ratings and blinded assessor ratings, patients improved equally with each form of self-help over 10 treatment weeks but significantly more on 5 out of 10 measures by week 14 (1-month follow-up) when the self-help included self-exposure instructions than when it did not. In accord with this, standardised effect sizes (Cohen’s d) indicated superiority of FF over MA on 5 measures by week 14. Satisfaction with treatment in all patients pooled correlated positively with improvement after treatment and at 1-month follow-up. Conclusions: At the end of treatment, computer-aided CBT self-help at home via the internet plus brief live helpline support was effective with or without exposure instructions, and at 1-month follow-up it was more effective on some measures if exposure instructions had been included. Analysis is needed of how non-exposure CBT produced its shorter-term effect.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Bebbington PE, Brugha TS, Farrell M, Jenkins R, Ceresa C, Lewis G: Unequal access and unmet need: Neurotic disorders and the use of primary care services. Psychol Med 2000;30:1259–1367.
  2. Croft Jeffreys C, Wilkinson G: Estimated costs of neurotic disorder in UK general practice. Psychol Med 1989;19:549–558.
  3. Marks IM, Shaw S, Parkin R: Computer-aided treatments of mental health problems. Clin Psychol Sci Pract 1998;5:151–170.
  4. Marks IM, Kenwright M, McDonough M, Whittaker M, Mataix-Cols D: Saving clinicians’ time by delegating routine aspects of therapy to a computer: A randomised controlled trial in phobia/panic disorder. Psychol Med 2004;34:9–18.
  5. Kenwright M, Liness S, Marks IM: Reducing demands on clinicians by offering computer-aided self-help for phobia/panic: Feasibility study. Br J Psychiatry 2001;179:456–459.
  6. Marks IM, Mataix-Cols D, Kenwright K, Cameron R, Hirsch S, Gega L: Pragmatic evaluation of computer-aided self help for anxiety and depression. Br J Psychiatry 2003;183:57–65.
  7. Kenwright M, Marks IM, Gega L, Mataix-Cols D: Computer-aided self-help for phobia/panic via internet at home: A pilot study. Br J Psychiatry 2004;184:448–449.
  8. Marks IM, Dar R: Fear reduction by psychotherapies: Recent findings, future directions. Br J Psychiatry 2000;176:507–511.
  9. Yates F: Mental Health Foundation Report. London, Mental Health Foundation, 1996.
  10. Marks IM: Behavioural Psychotherapy: Maudsley Pocket Book of Clinical Management. Bristol, Wright, 1986.
  11. Al-Kubaisy T, Marks IM, Logsdail S, Marks MP, Lovell K, Sungur M, Araya R: Role of exposure homework in phobic reduction: A controlled study. Behav Ther 1992;23:599–622.

    External Resources

  12. Marks IM, Swinson RP, Basoglu M, Kuch K, Noshirvani H, O’Sullivan G, Lelliot PT, Kirl M, McNamee G, Sengun S, Wickwire K: Alprazolam and exposure alone and combined in panic disorder with agoraphobia: Controlled study in London and Toronto. Br J Psychiatry 1993;162:776–787.
  13. Marks IM, Mathews AM: Brief standard self-rating for phobic patients. Behav Res Ther 1979;23:563–569.
  14. Mundt JC, Marks IM, Greist JH, Shear K: The Work and Social Adjustment Scale: A simple accurate measure of impairment in functioning. Br J Psychiatry 2002;180:461–464.
  15. Mataix-Cols D, Cowley AJ, Hankins M, Schneider A, Bachofen M, Kenwright M, Gega L, Marks IM: Reliability and validity of the Work and Social Adjustment Scale in phobic disorders. Compr Psychiatry, in press.
  16. Everitt BS: Statistical Methods for Medical Investigations, ed 2. London, Arnold, 1994.
  17. Everitt BS: Analysis of longitudinal data. Beyond MANOVA. Br J Psychiatry 1998;172:7–10.
  18. Stangier U, Heidenreich T, Peitz M, Lauterbach, Clark DM: Cognitive therapy for social phobia: Individual versus group treatment. Behav Res Ther 2003;41:991–1007.
  19. Marks IM, Grey S, Cohen SD, Hill R, Mawson D, Ramm E, Stern RS: Imipramine and brief-therapist-aided exposure in agoraphobics having self-exposure homework. A controlled trial. Arch Gen Psychiatry 1983;40:153–162.
  20. Zitrin CM, Klein DF, Woerner MG: Behavior therapy, supportive psychotherapy, imipramine, and phobias. Arch Gen Psychiatry 1978;35:307–316.
  21. McDonald R, Sartory G, Grey SJ, Cobb J, Stern R, Marks IM: The effects of self-exposure instructions on agoraphobic outpatients. Behav Res Ther 1979;17:83–85.
  22. Marks IM: Controlled trial of psychiatric nurse therapists in primary care. Br Med J 1985;290:1181–1184.
  23. Stravynski A, Marks IM, Yule W: Social skills training with and without cognitive modification. Arch Gen Psychiatry 1982;39:1378–1385.
  24. Stravynski A: Improving the social functioning of social phobic patients: A controlled test of an interpersonal approach. Unpubl. paper, Imperial College, 2005.
  25. Mataix-Cols D, Cameron R, Gega L, Kenwright M, Marks IM: Effect of referral source on outcome with CBT self-help. Unpubl. paper, Imperial College, 2005.
  26. Bornas X, Tortella-Feliu M, Llabrés J, García de la Banda G, Barceló F: Do all treatments work for flight phobia? Computer-assisted exposure versus a brief multi-component non-exposure treatment. Psychother Res, in press.
  27. Greist JH, Marks IM, Baer L, Kobak KA, Wenzel KW, Hirsch, MJ, Mantle JM, Clary CM: Behaviour therapy for obsessive compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. J Clin Psychiatry 2002;63:138–145.
  28. Osgood-Hynes DJ, Greist JH, Marks IM, Baer L, Heneman SW, Wenzel KW, Manzo PA, Parkin JR, Spierings CJ, Dottl SL, Vitse HM: Self-administered psychotherapy for depression using a telephone-accessed computer system plus booklets: An open US-UK study. J Clin Psychiatry 1998;58:358–365.

    External Resources

  29. Gega L, Kenwright M, Mataix-Cols D, Cameron R, Marks IM: Questionnaire to screen suitability for self-help in primary care of self-referrals for anxiety/depression. Cogn Behav Ther, in press.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50