Eficacia de un programa de tratamiento para la agorafobia vía internet con contacto mínimo con un terapeuta

  1. Wenceslao Peñate
  2. María José Roca Sánchez
  3. Carmen Teresa Pitti González
  4. María Luz Villaverde Ruiz
  5. Juan Manuel Bethencourt Pérez
  6. Yolanda Beatriz Álvarez Pérez
  7. Juan Antonio de la Fuente Portero
  8. Ramón Gracia Marco
Revista iberoamericana de psicología y salud

ISSN: 2171-2069

Year of publication: 2017

Volume: 8

Issue: 2

Pages: 85-95

Type: Article

DOI: 10.23923/J.RIPS.2017.08.008 DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Revista iberoamericana de psicología y salud


This study deals with the efficacy of an Internet-based computer therapy compared with an in-person cognitive-behavioral therapy, in the treatment of agoraphobia. Patients in the Internet group only had minimal initial contact with a therapist. The sample was composed of 44 adult patients with a diagnosis of agoraphobia. The Internet group and in-person groups underwent an 11-session intervention program. Agoraphobic cognitions, body sensations, social fear (as mobility test), and depression level were used as outcome measures. Results showed higher attrition rates in the Internet group. The in-person group exhibited improvements in all dependent measures, with moderate effect sizes (0.63 to 0.77 cohen’s d). The Internet group showed improvements in body sensations and depression level (moderate effect sizes). Intergroup comparisons showed a higher efficacy of in-person therapy, with moderate to large effect sizes (n2 = 0.15 to 0.40). After the intervention, the Internet group exhibited better results than the control group and comparable results to the in-person group in body sensations, social fears/mobility, and depression level. These results are discussed considering the limited extent of internet-based therapy.

Bibliographic References

  • Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., … Vollebergh, W. A. M. (2004). Disability and quality of life impact of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica, 109 (s420), 38-46. http://doi.org/10.1111/j.1600-0047.2004.00329.x
  • Andersson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014). Guided Internet-based vs. faceto-face cognitive behavior therapy for psychiatric and somatic disorders: A systematic review and meta-analysis. World Psychiatry, 13, 288-295. http://doi.org/10.1002/wps.20151
  • Andersson, G., & Titov, N. (2014). Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry, 13, 4-11. http:// doi.org/10.1002/wps.20083
  • Arnau, R. C., Meagher, M. W., Norris, M. P., & Bramson, R. (2001). Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. Health Psychology, 20, 112-119. http://doi.org/10.1037//0278-6133.20.2.112
  • Baumeister, H., Reichler, L., Munzinger, M., & Lin, J. (2014). The impact of guidance on Internetbased mental health interventions — A systematic review. Internet Interventions, 1, 205-215. http://doi.org/10.1016/j.invent.2014.08.003
  • Beck, A., Steer, R., & Brown, G. (1996). Manual for the Beck Depression Inventory-II. San Antonio, Texas: Psychological Corporation.
  • Bergström, J., Andersson, G., Ljótsson, B., Rück, C., Andréewitch, S., Karlsson, A., … Lindefors, N. (2010). Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: A randomised trial. BMC Psychiatry, 10, 54. http://doi.org/10.1186/1471-244X-10-54
  • Carlbring, P., Nilsson-Ihrfelt, E., Waara, J., Kollenstam, C., Buhrman, M., Kaldo, V., … Andersson, G. (2005). Treatment of panic disorder: Live therapy vs. self-help via the Internet. Behaviour Research and Therapy, 43, 1321-1333. http://doi.org/10.1016/j.brat.2004.10.002
  • Chambless, D. L., Caputo, G. C., Bright, P., & Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: The Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090-1097. http://doi.org/10.1037/0022-006X.52.6.1090
  • Davies, E. B., Morriss, R., & Glazebrook, C. (2014). Computer-delivered and web-based interventions to improve depression, anxiety, and psychological wellbeing of university students: A systematic review and meta-analysis. Journal of Medical Internet Research, 16 (5), e130. http://doi.org/10.2196/jmir.3142
  • Foroushani, P. S., Schneider, J., & Assareh, N. (2011). Meta-review of the effectiveness of computerised CBT in treating depression. BMC Psychiatry, 11, 131. http:// doi.org/10.1186/1471-244X-11-131
  • Heimberg, R. G., Horner, K. J., Juster, H. R., Safren, S. A., Brown, E. J., Schneier, F. R., & Liebowitz, M. R. (1999). Psychometric properties of the Liebowitz Social Anxiety Scale. Psychological Medicine, 29, S0033291798007879. http://doi.org/10.1017/S0033291798007879
  • Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H.-U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21, 169-184. http://doi.org/10.1002/mpr.1359
  • Kessler, R. C., & Ustün, T. B. (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93-121. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15297906
  • Kiropoulos, L. A., Klein, B., Austin, D. W., Gilson, K., Pier, C., Mitchell, J., & Ciechomski, L. (2008). Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? Journal of Anxiety Disorders, 22, 1273-1284. http://doi.org/10.1016/j.janxdis.2008.01.008
  • Klein, B., Richards, J. C., & Austin, D. W. (2006). Efficacy of internet therapy for panic disorder. Journal of Behavior Therapy and Experimental Psychiatry, 37, 213-238. http://doi.org/10.1016/j.jbtep.2005.07.001
  • Krupinski, E., & Weinstein, R. (2014). Telemedicine, Telehealth and m-Health: New Frontiers in Medical Practice. Healthcare, 2, 250-252. http://doi.org/10.3390/healthcare2020250
  • Kyrios, M., & Thomas, N. (2014). Psychology and the Internet: Where are we and where to from here? InPsych, 36 (3), 8–11.
  • Liebowitz, M. R. (1987). Social phobia. In D. F. Klein (Ed.), Anxiety: Modern problems in pharmacopsychiatry (pp. 141-173). New York: Karger.
  • Moral, M. V., & Suárez, C. (2016). Factores de riesgo en el uso problemático de Internet y del teléfono móvil en adolescentes españoles [Risk factors in the problematic use of Internet and phone in Spanish adolescents]. Revista Iberoamericana de Psicología y Salud, 7, 69-78. http://doi.org/10.1016/j. rips.2016.03.001
  • Newman, M. G., Szkodny, L. E., Llera, S. J., & Przeworski, A. (2011). A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: Is human contact necessary for therapeutic efficacy? Clinical Psychology Review, 31, 89-103. http://doi.org/10.1016/j.cpr.2010.09.008
  • Peñate, W. (2012). About the effectiveness of telehealth procedures in psychological treatments. International Journal of Clinical and Health Psychology, 12, 475-487.
  • Peñate, W., & Fumero, A. (2016). A meta-review of Internet computer-based psychological treatments for anxiety disorders. Journal of Telemedicine and Telecare, 22 (1), 3–11. http://doi.org/10.1177/1357633X15586491
  • Peñate, W., Roca-Sánchez, M. J., & Pino-Sedeño, T. (2014). Los nuevos desarrollos tecnológicos aplicados al tratamiento psicológico. [New technological developments applied to psychological treatment]. Acta Colombiana de Psicología, 17, 91-101.
  • Peñate, W., Roca-Sánchez, M. J., Pitti-González, C. T., Bethencourt, J. M., de la Fuente Portero, J. A., & Gracia, R. (2014). Cognitive-behavioral treatment and antidepressants combined with virtual reality exposure for patients with chronic agoraphobia. International Journal of Clinical and Health Psychology, 14, 9-17. http://doi.org/10.1016/S1697-2600(14)70032-8
  • Richards, D., & Richardson, T. (2012). Computer-based psychological treatments for depression: A systematic review and meta-analysis. Clinical Psychology Review, 32, 329-342. http://doi.org/10.1016/j. cpr.2012.02.004
  • Roca-Sánchez, M. J., Álvarez-Pérez, Y., & Peñate, W. (2014). Aceptabilidad de un tratamiento vía internet para la agorafobia por pacientes y terapeutas. Análisis y Modificación de Conducta, 40 (161-162), 29-41.
  • Van Ballegooijen, W., Cuijpers, P., van Straten, A., Karyotaki, E., Andersson, G., Smit, J. H., & Riper, H. (2014). Adherence to internet-based and face-toface cognitive behavioural therapy for depression: A meta-analysis. PLoS ONE, 9, e100674. http://doi.org/10.1371/journal.pone.0100674
  • Vázquez, F. L., Torres, Á., Blanco, V., Otero, P., & Hermida, E. (2015). Intervenciones psicológicas administradas por teléfono para la depresión: Una revisión sistemática y meta-análisis [Telephone-administered psychological interventions for depression: A systematic review and meta-analysis]. Revista Iberoamericana de Psicología y Salud, 6, 39-52. http://doi.org/10.1016/S2171-2069(15)70005-0
  • Wittchen, H.-U., Gloster, A. T., Beesdo-Baum, K., Fava, G. A., & Craske, M. G. (2010). Agoraphobia: A review of the diagnostic classificatory position and criteria. Depression and Anxiety, 27, 113-133. http:// doi.org/10.1002/da.20646
  • World Health Organization. (1992). ICD-10: International Statistical Classification of Diseases and Related Health Problems. Geneve, Switzerland: World Health Organization.