ABSTRACT
The UK system FearFighter (FF ) is recommended by NICE, the English regulatory body like the USA's FDA, for managing phobia and panic, and is in commercially licensed use on the internet around the UK. In naturalistic studies and RCTs, FF improved phobia, panic, anxiety, disability and comorbid depression when present, in 274 patients in all, while in two RCTs FF 's educational version helped medical and nursing students learn about exposure therapy to help FF users. Swedish net biblioCBT systems for panic/agoraphobia and for social phobia were also studied extensively in open studies and RCTs. Panic/agoraphobic and social-phobic users of the Swedish workbook-type systems improved more than if they were on a waiting list (e.g. on cognitions, avoidance, anxiety, depression, quality of life), and especially if they also had an online discussion group plus email and sometimes phone support with therapist input to a total of around three hours which is less than is usual in ftf CBT. It is unclear how much users would improve with even briefer support and how well less-educated subjects would improve with the netbiblio systems which demand regular exam-type answers as in a college course. The RCTs using waitlist comparisons did not exclude potential placebo effects. When an Australian Panic Online (PO) net biblioCBT system was given with substantial support, this helped panic sufferers more than being on a waitlist, leaving open possible placebo effects; adding stress-management modules did not enduringly enhance ef®cacy. In an open study of the unmonitored Canadian Panic Program on a website, massive attrition occurred after session one though the 13% who used the system for 3 sessions improved. Time spent in ftf CBT for phobia/panic was cut without impairing outcome when sufferers also used CP on handheld devices to facilitate homework or on a handheld capnometer plus an audiotape to promote breathing retraining. Australian CAVE vicarious exposure displays on a PC in different RCTs improved adult but not young spider phobics to varying extents and in an open study improved agoraphobics slightly with irrelevant exposure, while a Spanish display system improved ¯ying phobics but saved no therapist time.
