Study 1

Study 2

Study 3

Study 4

The following are summaries of some of those studies. Full citations are also given for those of you who wish to read these studies in their entirety.

Research Study 1

Gould, R. A. and Clum, G. A. Self-Help plus minimal therapist contact in the treatment of panic disorder: A replication and extension. Behavior Therapy, 1995, vol. 26, 533-546.

The study compared two groups:

1. Individuals in Group 1 received a self-help intervention based on the book Coping With Panic which was combined with
• a 15-minute videotape providing information regarding panic attacks and
• instruction in diaphragmatic breathing (a breathing approach found effective in reducing panic attacks)
2. Individuals in Group 2 were placed in a wait-list condition. They agreed to wait for treatment until the evaluation phase for the first group had been completed.

Participants in Group 1 were also contacted at the middle and end of the intervention to check on whether they were reading the material provided to them and to answer any questions.

The "treatment" period was four weeks long during which panic sufferers were to watch the videotape, read the book Coping With Panic and practice the techniques described in the book.

Individuals in both groups were evaluated on a variety of measures to determine the extent to which they had improved. These individuals were contacted again at the end of an additional 8-week period to determine whether any gains that were made were maintained.

The results showed that individuals in Group 1 -- those who read the book and watched the brief videotape -- had improved more than individuals in Group 2 on a number of different problems.

Specifically, panic sufferers in Group 1 were experiencing

• fewer panic attacks,
• less severe symptoms and panicky thoughts during an attack, and
• a lower level of agoraphobic avoidance.

Furthermore, panic sufferers in Group 1 utilized more coping skills and had less expectation that they would have a panic attack in the future than did individuals in Group 2.

When individuals in both groups were again compared 8-weeks after the treatment phase had ended, the improvements continued in Group 1 but were not found in Group 2.

All participants in both groups were then compared on the most important determinant of success to determine if they were panic free at the end of the 4-week treatment period.

In Group 1 46 percent were panic free at the end of the treatment period while 69 percent were panic free after the 8-week follow-up period.

In Group 2, on the other hand, only 25% were panic free at the end of the 4-week period and only 25% were panic free at the end of the 8-week follow-up period.

The results of this study were interpreted as supportive of the conclusion that self-help treatments, based on bibliotherapy -- in this case the book Coping With Panic -- work.

Research Study 2

Gould, R. A., Clum, G. A. and Shapiro, D. The Use of Bibliotherapy in the Treatment of Panic: A Preliminary Investigation. Behavior Therapy, 1993, vol. 24, 241-252.

This study compared three different groups:

1. Individuals in Group 1 received a self-help, bibliotherapy intervention based on the book Coping With Panic
2. Individuals in Group 2 received an individual treatment program in which a therapist met with panic sufferers twice weekly for four weeks (8 sessions) with each session being one-hour in duration. The treatment provided was a standard cognitive behavioral program for panic sufferers
3. Individuals in Group 3 agreed to be placed in a wait-list control group where they received neither bibliotherapy nor the individual treatment.

The "treatment "lasted for four weeks. During this time individuals in Group 1 were to read the book Coping With Panic. No other treatment was made available to individuals in this group. Individuals in this group were contacted at weeks two and four to make sure they were reading the book and to answer any questions. Individuals in Group 2 were assigned a therapist skilled in the administration of panic treatment based on a cognitive-behavioral approach. Individuals in Group 3 waited for seven weeks for their treatment to begin so that they could be compared to individuals receiving treatment in the two other groups. Individuals in this group were called only if they failed to mail back forms used to chart their progress.

Individuals in the three groups were compared one week after the end of the four week treatment period. Individuals in Groups 1 and 2 were essentially equal in their level of improvement, with any differences between the two groups favoring panic sufferers receiving the bibliotherapy intervention.

At the post-treatment evaluation session panic sufferers in Groups 1 and 2 were experiencing less severe panic symptoms and panic thoughts during a panic attack. They were also more confident in their ability to cope with panic attacks.

Panic sufferers who read Coping With Panic, however, were more confident they would not have a panic attack in the future than were individuals in Group 3. Individuals receiving the individual treatment by a therapist were not more confident than individuals in the wait-list condition.

In this study no differences were found among the three groups on the frequency of panic attacks or on the level of avoidance. When the three groups were compared at post-treatment on the proportion of individuals in each group who were panic free only panic sufferers reading the book Coping With Panic were more likely to be panic free than were individuals in Group 3.

The results of this study were interpreted by the authors as supportive of the idea that self-administered bibliotherapy interventions can be as effective as individually-administered treatments for individuals suffering from panic disorder. The fact that the treatment period was so brief and the time after the treatment completed so short may have explained the lack of difference between the three groups on avoidance and frequency of panic attacks.

Research Study 3

Lidren, D. M., Watkins, P. L., etal. A Comparison of Bibliotherapy and Group Therapy in the Treatment of Panic Disorder. Journal of Consulting and Clinical Psychology, 1994, vol. 62, 865-869.

This study compared three groups:

1. Participants in Group 1 used a self-administered bibliotherapy intervention based on the book Coping With Panic. They had eight weeks to read, digest and practice the techniques described in the book. Group 1 participants were contacted by telephone during the second, fifth, and eighth weeks to determine if they were reading, comprehending and using the strategies described in the book.
2. Participants in Group 2 also read the book Coping With Panic. In addition they participated in weekly group meetings where they went over and practiced the techniques described in the book. These group sessions lasted for 90 minutes each week.
3. Participants in Group 3 were designated as the control group. They completed the Comprehensive Panic Profile on a weekly basis and were called only if they failed to return the questionnaires. During this time they received no other intervention.

All participants were diagnosed as having a Panic Disorder with 30 0f 36 individuals reporting that they also experienced symptoms of agoraphobia.

Individuals in the three groups were compared at three different points:

• Prior to beginning the intervention
• After the 8-week intervention period
• Six (6)-months after treatment termination (follow-up).

Individuals in Group 1 were equivalent in outcome to individuals in Group 2 on all measures, including frequency of panic attacks, severity of panic attacks, level of avoidance behavior, confidence in their ability to use interventions while experiencing panic symptoms, and level of depression. So, the addition of group therapy sessions did not add to the effectiveness of the bibliotherapy based on the book, Coping with Panic.

Both Groups 1 and 2 were superior in outcome to Group 3 which received no treatment. The level of effectiveness of the interventions received by individuals in Groups 1 and 2 was maintained after 6-months.

At the end of treatment 83% of all individuals in Groups 1 and 2 were panic free. This is in comparison to 25% of individuals in Group 3 that were panic free at this time. Seventy-five percent (75%) of the individuals in Group 1 were reporting no panic attacks during the follow-up period. Of those receiving group treatment in addition to reading the book Coping With Panic 92% were panic free 6-months after treatment had ended.

The results of this study were interpreted as meaning that bibliotherapy, consisting of reading the book Coping With Panic and monitoring your progress over time, is equally effective to receiving a group intervention plus reading the book and that both are superior to only monitoring your progress. The results were also interpreted as indicating that improvement made over an 8-week treatment period were sustained for at least 6-months after the end of treatment.

Research Study 4

Febbraro, G. A. R., Clum, G. A., Wright, J. A. and Roodman, A. The Limits of Bibliotherapy: A Study of the Differential Effectiveness of Self-Administered Interventions in Individuals with Panic Attacks. Behavior Therapy, 1999, vol. 30.

This research study was the first to investigate self-help interventions which relied solely on bibliotherapy, i.e., there was absolutely no contact between the researchers and any of the participants. All participants were individuals with panic problems.

Participants were randomly assigned to one of four groups:

Group 1: Participants in Group 1 simply read the book Coping With Panic. They did not monitor their progress and they did not return weekly evaluations to the study headquarters

Group 2: Participants in Group 2 read the book Coping With Panic and also monitored their progress. They did not return their monitoring results until the study was completed

Group 3: Participants in Group 3 did not read the book Coping With Panic. They only monitored their progress. The monitoring data was collected at the end of the treatment period

Group 4: Participants in Group 4 neither read the book nor monitored their progress. At the end of the treatment period they were sent both the book and the monitoring booklet.

All participants were compared at the start of treatment and at the end of treatment, 8-weeks later.

Unlike all other studies on the effectiveness of bibliotherapy on panic attacks and accompanying problems, there was no differential effect between treatment groups between pre- and post therapy. Participants in all four groups improved significantly on their frequency of panic attacks between pre- and post-treatment. When participants in the four groups were examined for whether or not they were panic free at At the conclusion of the study the following results were reported:

• Group 1 (read Coping with Panic only): 65% were free of panic symptoms
• Group 2 (read Coping with Panic AND monitored progress):53% were free of panic symptoms
• Group 3 (did NOT read Coping with Panic but monitored progress): 69% were free of panic symptoms
• Group 4 (did not read or monitor progress):39% were free of panic symptoms

The results of this study were not as positive as the results of other studies reported here on the effectiveness of the book Coping With Panic. The authors of the article interpreted the results as indicating the importance of having some contact with the participants, a factor that was a part of all other studies on the effectiveness of the book Coping With Panic. Contact with individuals trying to overcome their panic problem in which questions are answered and encouragement to continue in their program provided, may be essential in helping panic-sufferers learn to deal effectively with their panic problem.