For many years, people with anxiety and depressive disorders have often had difficulty gaining access to effective treatment and psychiatrists in many parts of Australia. Where psychiatrists are available, they often have waiting lists or fees that some patients cannot afford. The same can also be said for psychologists and other mental health professionals.

Even if patients can get an appointment with these professionals, there is no guarantee they will be offered the types of therapy most likely to be effective. At St Vincent’s Clinical Research Unit for Anxiety Disorders, we have developed a sophisticated computerised cognitive behaviour therapy program that is effective in the short and long term.

Therapy over the web, when supervised by an expert clinician, is surprisingly effective, certainly as effective as the best face to face therapy.

We have now treated some 500 people, and have completed four studies with people with social phobia, two studies with people with depression and two studies with people with panic disorder and agoraphobia.

Therapy is efficient. Treatment of each person takes them less than four hours a week for eight to 10 weeks, can be done whenever the person has time, but requires less than three hours of expert clinician time overall — less than 20% of that required by the most efficient face to face treatment.

Patients say that their life is beginning to change. About 80% complete all sessions in the courses, which is very good. The computerised course must be doing something right.

What are the implications for service delivery? Provided they have an Internet connection, people anywhere in Australia can get treatment, and do it when it is convenient — 8pm to 10pm is the busy period.

Our findings are important for both clinicians and governments. This resource could give clinicians more time to deal with the difficulties that are specific to the individual. New Zealand is currently negotiating to roll the Climate programs out across primary care.

Peter Fray

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