The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

78 Chapter 4. Online CBT of Panic Symptoms10), and their satisfaction with their therapists with a mean score of 9.0 (SD = 1.2).Eighty-one percent reported a large impact on their daily functioning, 81% thought theparticipant-therapist contact to be personal, and 71% indicated they had not missedface-to-face contact. At follow-up, these aspects were rated similarly. Participantswere also asked to rate the degree to which they would recommend the treatment toothers, on a 10-point scale ranging from 1 (No) to 10 (Yes). The average score on thisitem was M = 8.9 (SD = 1.5).Progress during treatment. During treatment, after each treatment phase, participantsrated the degree to which their panic symptoms impaired daily functioning. Asshown by Figure 4.2, impairment declined over the course of treatment, with an effectsize of d = 1.2 between the first and last measure. Noticeable improvement occurredonly after the cognitive restructuring phase. Post-hoc, we tested mean impairmentvalues before this phase with mean impairment values after this phase. This contrastwas highly significant (z = 8.2, P < .001).Predictors of outcome. Using post-treatment PDSS-SR scores and attack frequencyas the outcome variables of interest, we tested several predictors of posttreatmentsymptomatology through two separate multiple regression analyses. Specifically, wetested the significance of pre-treatment symptom severity, agoraphobic avoidance(MI-AAL), gender, education level (low/high), pretest medication status (no/yes), andtime of measurement (posttest/follow-up). Further, we explored interaction effects ofImpairment2.5 3.0 3.5 4.0 4.5 5.0 5.5●●●●●●●Awareness Relaxation Cognitions Relapse Prev.Monitoring Exposure 1 Exposure 2Treatment PhaseFigure 4.2: Change in impairment during treatment.