# Does remote match reality? Comparing the effectiveness of a self‐help app for panic disorder and agoraphobia to face‐to‐face CBT

## TL;DR

A self-help app for panic disorder and agoraphobia was less effective than face-to-face therapy, though both showed symptom improvement.

## Contribution

This study directly compares a digital CBT app to face-to-face CBT for panic and agoraphobia using RCT data.

## Key findings

- Face-to-face CBT was more effective in reducing panic and agoraphobia symptoms than the app.
- Both interventions had similar dropout rates but differing efficacy levels.
- Digital CBT may serve as a bridge or alternative when in-person therapy is unavailable.

## Abstract

Exposure‐based CBT is highly effective in treating patients with panic disorder and agoraphobia; however, access to such treatments is often limited. Smartphone‐based self‐management apps offer a promising low‐threshold treatment alternative to face‐to‐face therapy. Although such health apps have shown to be effective in reducing anxiety symptoms, comparisons to active treatments are still scarce. Therefore, this study compared the effectiveness of a self‐help app to an established face‐to‐face CBT intervention for panic and agoraphobia.

The present study conducts a post hoc comparison of two independent RCTs examining participants with panic disorder and/or agoraphobia. Interventions in both studies were based on the same CBT manual. Study 1 (n = 138) included face‐to‐face CBT; Study 2 addressed the effects of a digital self‐help intervention (n = 57). Main outcomes comprised symptoms of both panic disorder and agoraphobia, depressive symptoms and agoraphobic avoidance. Data were analysed using linear mixed models in intent‐to‐treat and completer data sets.

Linear mixed models showed that face‐to‐face treatment was superior to app treatment in reducing panic and agoraphobic symptoms (R
2 = 0.32), depressive symptoms (R
2 = 0.24) and agoraphobic avoidance (R
2 = 0.12 and 0.15). Dropout rates did not differ significantly, and both interventions demonstrated high levels of adherence.

Although a smartphone‐based CBT intervention was effective in reducing symptoms of panic and agoraphobia, its efficacy was significantly below the effects of the same intervention delivered in face‐to‐face format. Thus, digital interventions might be most suitable within a stepped‐care approach or to bridge waiting times for psychotherapy.