Internet-delivered cognitive behavioral therapy for panic disorder with or without agoraphobia: a systematic review and meta-analysis

ABSTRACT

The current systematic review and meta-analysis examined the efficacy and effectiveness of internet-delivered cognitive behavioral therapy (iCBT) on panic disorder and agoraphobia symptom severity. Twenty-seven studies were identified. Results from nine randomised controlled trials (RCTs) showed that iCBT outperformed waiting list and information controls for panic (g = 1.22) and agoraphobia (g = .91) symptoms, but the quality of RCTs varied and heterogeneity was high. Results from three RCTs suggested iCBT may have similar outcomes to face-to-face CBT in reducing panic and agoraphobia symptoms. Within-group effect sizes between baseline and post-treatment were large for panic (n = 29, g = 1.16) and medium for agoraphobia symptom severity (n = 18, g = .73). Subgroup analyses of within-group pre/post treatment effect sizes showed larger within-group effect sizes for efficacy studies (n = 15) compared to effectiveness studies (n = 14) for panic severity (g = 1.38 vs. g = .98) but not agoraphobia severity. There was no impact of program length, inclusion or arousal reduction techniques, or degree of clinician support. Within-group effects of iCBT suggest the reduction in panic and agoraphobia symptom severity is maintained at 3–6 month follow-up (n = 12).     

A RESTIVE LEGACY

In the last century feminist psychologists have contributed to refining and improving research in experimental psychology. While the accomplishments are cause for celebration during the American Association of Psychology's (APA) Centennial year, especially given the sexism that has accompanied scientific practices, we need to examine more care–fully the difficulties–past and present-that attend feminist efforts in the discipline. This brief article explores the strategies that feminist researchers have used to eliminate androcentrism and sexism from experimental and, more recently, cognitive psychology. Such historical reassessment not only reveals the multiple and insightful means by which feminist psychologists have proceeded, but also indicates that feminist work must continue to focus on epistemological and theoretical problems as well as methodological ones.     

The relationship between resting heart rate and aggression in males is racially variant

Although resting heart rate is thought to be a generalizable risk factor for aggression, very little research has examined whether this relationship varies by race. We addressed this limitation using longitudinal data from the Pittsburgh Youth Study. Current data are from 197 men who participated in a teenage biosocial study (mean age = 15.7 years) and adult follow-up study (mean age = 32.1 years). Teenage resting heart rate interacted with race to predict teenage and adult aggression. The relationship between heart rate and aggression was significant in White, but not in Black males. To our knowledge, this is the first study to find that the relationship between resting heart rate and aggression is racially variant, suggesting that resting heart rate may not be a generalizable biomarker for conduct problems. At an intervention-level, findings could contribute to the development of more accurate risk assessment tools that take into account racial variance in risk factors.     

Feminism and Health in the Decade of Behavior

National health data are presented to demonstrate that important issues of women's health are linked to inequality and to the generalized oppression of women. Health issues of violence, reproductive health, coronary health, and mental health are reviewed as they relate to women of color and diverse ethnicity as well as to women in general. Feminist principles are applied to these issues, pointing out inequalities in assessment, treatment and access to care, bias in research and lack of research on topics particularly relevant to women and minorities, and limitations in the education and training of health care providers. It is imperative that these problems, which are not solely biological, be addressed in light of systems-level analysis that includes a feminist lens. Guided by feminist principles and sensibilities, the relevance of behavioral and social science is outlined for research, training, assessment, intervention, evaluation, and overall social change.