The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

66 Chapter 4. Online CBT of Panic Symptomsanalyses showed that approximately 70 participants (35 per group) were needed todetect a large, d = .8, between-group effect (with ANCOVA, an estimated pre-postcorrelation of .5 and Holm-Bonferroni corrections for comparisons on 10 outcomemeasures).Screening. Respondents were screened through web-administered self-report questionnairesand a semi-structured 15-minute telephonic interview. Participants firstcompleted the self-report questionnaires. Next, the results were used to prepare theclinical interview. In this interview, the presence of at least subsyndromal PD/A wasestablished, according to the guidelines as listed in Diagnostic and Statistical Manualof Mental Disorders (DSM-IV; American Psychiatric Association, 2000), i.e., respondentswere included only if they experienced at least one full or limited symptompanic attack in the previous month. Diagnoses were made by trained interviewers andchecked by supervising researchers.The following inclusion criteria applied: age 18 years or older; no heightened riskof dissociation, psychosis, or suicide; no history of serious mental illness; no otherprevailing mental illnesses; absence of a medical condition that might explain panicsymptoms; no drug abuse; no use of neuroleptic medication; no use of anxiolyticsor antidepressants for less than 3 months or use of unstable doses (i.e., clients tookmedications as prescribed and in the targeted dosage); and no concurrent othertreatment. Excluded respondents were referred to their general practitioner, toother mental health institutions or to other Web-CBT programs. Eligible respondentsdownloaded, signed and returned an Informed Consent form.Risk of dissociation was assessed using the Somatoform Dissociation Questionnaire(SDQ-5; citeNPNijenhuis1997). Respondents who scored above the cut-off (8),completed the more specific Dissociation Questionnaire (DIS-Q) (Vanderlinden, vanDyck, Vandereycken, & Vertommen, 1991; cut-off: 3.0). The Screening Device forPsychotic Disorder (SDPD; Lange, Schrieken, et al., 2000) was used to assess the riskof psychotic episodes, with a cut-off value of 5 on the Hallucination scale. Hypochondriasiswas assessed using the Whitely Index (Speckens, Spinhoven, Sloekers, Bolk, &van Hemert, 1996; cut-off: 15). The occurrence of a prevailing posttraumatic stressdisorder was assessed using the Dutch version of the Impact of Events Scale - Revised(IES-R; Weiss & Marmar, 1996; cut-off 36: Neal et al., 1994). Obsessive compulsive