Master of Science / The current study aimed to test the efficacy of individual, synchronous Internet Therapy for panic disorder compared to traditional face-to-face therapy. Thirty participants diagnosed with panic disorder were randomly allocated to either Internet Therapy or face-to-face therapy, and received a manualised cognitive-behavioural treatment program. When analysed separately, results indicated that face-to-face treatment significantly reduced panic symptomatology overall, however significant gains were not shown for the Internet Therapy condition. However, a direct comparison of the two active treatments failed to show significant differences, as measured by a Multivariate Analysis of Variance (MANOVA) on pre- and post-treatment variables. Internet Therapy did, however, significantly reduce certain symptoms of panic disorder, indicating that Internet Therapy may be useful as an adjunctive treatment to face-to-face therapy. Intention-to-treat analyses suggested that face-to-face treatment may be more effective than Internet Therapy for treating panic disorder. Additionally, there were no differences between treatment conditions in levels of working alliance, indicating that among those who stay in treatment, working alliance can be established online at a similar level to that of face-to-face therapy. However a high number of dropouts in the Internet Therapy condition warranted consideration. A thorough explanation of the results is offered in addition to recommendations for the future directions of the research and clinical implementation of Internet Therapy.

Although the prevalence rate of panic disorder (PD) among adolescents is relatively low, epidemiological research suggests that panic attacks and subclinical panic disorder symptoms occur in a substantial portion of the adolescent population. Retrospective and prospective studies also suggest that adolescence is a critical developmental period for the onset of PD symptoms. Given the negative academic, social, and emotional outcomes associated with undetected and untreated PD, effective prevention and intervention are warranted. Identifying adolescents with current PD or who may be at-risk for future PD is an important step in such treatment efforts. Among professionals working with youth, physicians and medical staff may be at a particularly advantageous position to screen for adolescent panic symptoms, given the high utilization of medical services among those experiencing such PD symptoms. Although limited time and resources within primary care settings frequently hinder effective mental health screening procedures, the use of time-and cost-effective screening instruments may aid professionals in detection efforts. With this in mind, the current study sought to validate a brief screening tool previously studied with adults for use with adolescents seen at pediatrics primary care practices. The screening instrument was evaluated both in terms of its ability to effectively detect adolescents with PD and in terms of the association between positive screen status and cognitive, symptom, and broader impairment variables associated with PD. Participants included 165 adolescents (57% male) ages 12 to 17 (M = 14.40; SD = 1.77) recruited from two general pediatrics clinics in Miami-Dade County, Florida. The sample was 42.3% White, Non-Hispanic, 41.1% Hispanic, 7.9% Black (African-American and Caribbean American), 1.2% Asian American, 7.4% mixed ethnicity or other, and 1.2% unknown. At Time 1, while in the waiting room of a pediatrics clinic, participants completed the Autonomic Nervous System Questionnaire (ANS; Stein et al., 1999), a five-item screening measure of panic symptoms. Of this larger sample, 45 participants (25 screening positive for potential panic disorder and 20 with negative screens, matched by age and gender to the positive screen group) completed telephone-administered follow-up measures at Time 2. Follow-up measures included a more comprehensive diagnostic assessment of PD and agoraphobia, as well as adolescent-report measures of anxiety sensitivity, interpretive biases, overall anxiety and depression, and functional impairment. At Time 1, 65 participants (39.4%) screened positive on the ANS, as indicated by endorsing the first and/or second item on the measure. Of those screening positive, roughly one-third of participants (33.84% of positive screens) endorsed moderate to severe anticipatory anxiety about future panic attacks. The ANS displayed excellent sensitivity (Se = 1.00), with two participants from the positive screen group meeting criteria for PD, and no control participants meeting criteria. However, as expected, specificity of the ANS was lower (Sp = .43), indicating a high degree of false positives (e.g., those screening positive but not meeting criteria for PD). In addition, as hypothesized, the ANS demonstrated good test-retest reliability (r = .74). Independent samples t-tests revealed that positive screen participants had significantly higher self-reported anxiety sensitivity, interpretive biases, anxious and depressive symptoms (including panic), and functional impairment than negative screen participants. This difference remained significant for overall symptom T-scores on the Revised Child Anxiety and Depression Scales (RCADS; Chorpita et al., 2000), even after controlling for group differences in anxiety sensitivity and interpretive biases. Finally, further analyses revealed that participants endorsing both starter items on the ANS (n = 7) had higher elevations on self-reported anxiety sensitivity and panic symptoms, compared to those not endorsing either item or those endorsing the first item (e.g., "In the past six months, did you ever have a spell or an attack when all of a sudden you felt frightened, anxious, or very uneasy?"), but not higher than those endorsing only the second item ("In the past six months, did you ever have a spell or attack when for no reason your heart suddenly began to race, you felt faint, or you couldn't catch your breath?"). These findings offer preliminary validation for the ANS as a screening measure for PD in adolescence, given its high sensitivity and ability to adequately "catch" patients with PD (e.g., low false negative rate). Perhaps even more importantly, those screening positive on the ANS demonstrated higher scores on cognitive correlates of PD and elevated internalizing symptoms and functional impairment, compared to participants screening negative. Based on these analyses, current recommendations for physicians and medical staff are to monitor and follow-up with adolescents screening positive on the ANS for the development of anxiety and panic disorder symptoms, particularly among those who endorse both starter items. However, given the relatively small sample size, replication of these findings in a larger sample is needed to further validate these recommendations. Finally, implications for prevention and intervention within pediatrics settings are discussed.

Thesis (Ph. D.)--University of Texas at Austin, 2001. / Vita. Includes bibliographical references (leaves 162-174). Available also in a digital version from Dissertation Abstracts.

Not available / text

Interest in mental health problems in the military has been growing. However, the research to date has focused on posttraumatic stress disorder and depression. This study focuses on panic disorder and panic attacks, which are common, potentially disabling, and associated with a number of other mental health problems. This study is the first to examine panic disorder in detail in the military and extends the literature to include panic attacks, which have never been examined in this population. Using the Canadian Community Health Survey: Canadian Forces Supplement (n=8441), I investigated associations between panic disorder and panic attacks with a wide range of mental and social variables. Panic attacks and panic disorder were both positively associated with reduction of activities, two-week disability, psychological distress, mental disorders, suicidal ideation, and using self-soothing and avoidant coping strategies. These results have important implications for treatment and prevention efforts in the Canadian military.

Interest in mental health problems in the military has been growing. However, the research to date has focused on posttraumatic stress disorder and depression. This study focuses on panic disorder and panic attacks, which are common, potentially disabling, and associated with a number of other mental health problems. This study is the first to examine panic disorder in detail in the military and extends the literature to include panic attacks, which have never been examined in this population. Using the Canadian Community Health Survey: Canadian Forces Supplement (n=8441), I investigated associations between panic disorder and panic attacks with a wide range of mental and social variables. Panic attacks and panic disorder were both positively associated with reduction of activities, two-week disability, psychological distress, mental disorders, suicidal ideation, and using self-soothing and avoidant coping strategies. These results have important implications for treatment and prevention efforts in the Canadian military.

No description available.

Master of Science / The current study aimed to test the efficacy of individual, synchronous Internet Therapy for panic disorder compared to traditional face-to-face therapy. Thirty participants diagnosed with panic disorder were randomly allocated to either Internet Therapy or face-to-face therapy, and received a manualised cognitive-behavioural treatment program. When analysed separately, results indicated that face-to-face treatment significantly reduced panic symptomatology overall, however significant gains were not shown for the Internet Therapy condition. However, a direct comparison of the two active treatments failed to show significant differences, as measured by a Multivariate Analysis of Variance (MANOVA) on pre- and post-treatment variables. Internet Therapy did, however, significantly reduce certain symptoms of panic disorder, indicating that Internet Therapy may be useful as an adjunctive treatment to face-to-face therapy. Intention-to-treat analyses suggested that face-to-face treatment may be more effective than Internet Therapy for treating panic disorder. Additionally, there were no differences between treatment conditions in levels of working alliance, indicating that among those who stay in treatment, working alliance can be established online at a similar level to that of face-to-face therapy. However a high number of dropouts in the Internet Therapy condition warranted consideration. A thorough explanation of the results is offered in addition to recommendations for the future directions of the research and clinical implementation of Internet Therapy.

Thesis (Ph.D.)--University of Tulsa, 1992. / Bibliography: leaves 126-143.

Thesis (D.C.P. / M. Sc.)--Faculty of Science, University of Sydney, 2006. / Submitted in fulfilment of the requirements for the degree of Doctor of Clinical Psychology/Master of Science to the Faculty of Science. Title from title screen (viewed 2 August 2007). Bibliography: leaves 95-107.