For many people with phobias and panic disorder, reading about how to deal with their problem is a key to effective self-management of their disorder. Such self-help is achieved alongside varying amounts of professional advice given face-to-face, by phone, book or internet. This seems to be true for disorders like diabetes, hypertension, asthma and phobia/panic. In a randomised controlled trial (RCT) carried out two decades ago, people with phobia/panic improved to a similar extent regardless of whether self-exposure guidance was given by a book, a computer program, or face-to-face by a psychiatrist (Reference GHOSH, MARKS and CARRGhosh et al, 1988). All participants in this trial attended a clinic (outpatients) and were rated by a psychiatrist four times over 6 months, which may have aided them to achieve better results. Two of the participants in the book group had bought it in a shop before being enlisted for the trial, but had not read the book until the trial began. They were then asked by the psychiatrist to do so (i.e. read the book and follow its advice) and their condition improved.

Hundreds of people with phobia/panic around the UK now receive self-help computer/internet guidance from FearFighter, a treatment recommended by NICE (National Institute for Health and Clinical Excellence, 2006), perhaps the first such recommendation by any government regulatory agency given to such a self-help device for anxiety.

Different people need varying amounts of guidance with self-help. Some manage entirely alone, like the founder of a British network of 23 self-help groups Triumph Over Phobia (TOP) did. She went to Canada by boat because she feared flying. When in Toronto, she bought Living with Fear and followed its self-exposure advice unaided. She then flew for the first time ever to return to England, and founded TOP. Triumph Over Phobia groups around the UK use Living with Fear and are led by lay people, usually ex-sufferers who overcame their phobia/panic by self-exposure. Users of FearFighter on the internet get up to an hour in all of live support by phone and/or email over 3 months. A few people doing self-help need far more support before attaining independence. The more such contact, the less apt the term self-help. Fortunately just an ounce of contact can make a ton of difference to adherence to self-help – internet self-help via free, unscreened and non-moderated access tends to have huge dropout rates (Reference EYSENBACHEysenbach, 2005), far higher than with systems offering brief personal contact.

Phobia/panic sufferers can find a horde of self-help pamphlets, books, audiotapes, CD-ROMs and internet systems. Reliable self-help materials can lessen stigma and empower and motivate users by showing how others have successfully overcome similar problems. Their ultimate value, however, can be hard to gauge without evidence other than their popularity, which is not always a reliable guide.

Randomised controlled trials are often regarded as a gold standard, though there are limits to what they can test. Some people benefit from reading self-help books or websites even though they would not enter a trial of the same. Randomised controlled trial attendance and rating regimes may enhance compliance and so be an unreliable guide to the benefit obtained from finding the same self-help material outside the trial. Nor is compliance a reliable guide to efficacy. For instance, relaxation without exposure has high compliance rates but low efficacy for phobia/panic.

Criteria for inclusion

While acknowledging the limits of RCTs, this paper describes self-help materials in the form of books and computer systems which were tested in such trials. For books we searched Medline and Psychinfo databases for the terms ‘panic,’ ‘phobia,’ ‘self-help,’ and ‘bibliotherapy’ in English-language publications from 1980 onwards and currently available to the public, and checked their reference lists (the ones we examined were from the UK, the USA and Australia). For computer-aided self-help around the world we searched an extensive, recent review (Reference MARKS, CAVANAGH and GEGAMarks et al, 2007). We included only materials which had been tested in RCTs in patients (not analogue or student volunteers) who had panic and/or phobia and which are generally available. We excluded handheld devices as these were mostly aids to homework rather than self-help guides per se.

The foregoing criteria were met by four books and one computer system that we found – two further computer systems are noted but not yet widely available. All guided self-help by cognitive–behavioural therapy (CBT) including repeated practice of self-exposure and cognitive methods in varying combinations. We also describe five UK organisations promoting self-help for phobia/panic.

Self-help book guides

Self-help computer guides

Self-help guided by the UK phobia/panic charities and websites

Declaration of interest

I.M.M. is the author of Living with Fear and shares intellectual property rights in FearFighter.