1. FearFighter (FF) is the most fully-realised evidence-based form of CCBT for phobic/panic/anxiety disorders. FF is based on over 20 years of clinical RCTs and open studies at the Institute of Psychiatry, and was further modified as a result of extensive clinical testing. It is used in standalone computers (standaloneFF) and now on the internet too (netFF). NetFF is essentially standaloneFF at a distance. Both versions have the same tested algorithms based on over 20 years of clinical RCTs and open studies at the Institute of Psychiatry. Over another 10 years these algorithms were further modified as a result of extensive clinical testing. After a positive evaluation of netFF’s technical aspects by the University of Warwick’s National B2B Centre and much investment netFF is ready for national distribution.

2. FF assumes a reading age of 11. It is individually-tailored to patient needs. Being data-driven it gives patients feedback on how they are progressing and can give clinicians similar feedback on progress of individual and aggregated users. Users are encouraged to complete FF’s 9 steps over 1 to 3 months.

3. Patients are empowered and given autonomy by working with FF which gives consistently good advice without tiring, widens choice, reduces disruption of work and home activities, incurs no drug side effects, and can print out advice and homework sheets, progress graphs, and results. Many users say they value FF’s confidentiality, which is assured by password and personal-ID access - only the user’s local referrer can link that ID to personal identifiers. FF also reduces stigma.

4. In RCTs and in naturalistic studies in diverse settings, standaloneFF and netFF were each clinically effective as well as efficacious in sufferers who were chronic, severely distressed and disabled and had failed with previous treatments. FF improved symptoms and interpersonal and social functioning significantly as much as did TCBT and more than did computer-guided relaxation or minimal CBT. FF’s acceptability was attested by patient satisfaction being as great with FF as with TCBT. Effect size remained large even if dropouts were counted as unimproved despite some saying they were better.

5. Gains with FF are clinically meaningful, enabling patients to resume normal lives.  

6. Therapists’ per-patient time doing CBT for panic/phobia/anxiety is cut dramatically by delegating routine therapy tasks to FF, allowing a marked rise in the number of patients each therapist can treat effectively, or freeing therapists to treat other patients.

7. Even patients who were computer-naïve with low literacy and low socio-economic status used FF successfully and non-English speakers used it with an interpreter. FF thus raises the equity of service provision.

8. NetFF used at home, a friend’s home, library, internet café, surgery or elsewhere is now the most convenient form of FF access as it

a) meets sufferers’ expressed preference for CCBT at home; 

b) eases patient access because assessment, password assignment and brief live support work equally well on a phone helpline or face to face for an hour in all over 3 months; 

c) gives users unlimited 24/7 access to FF with no need to physically attend a clinic, so saving travel time, expense, fear if agoraphobic, and child care and other problems ensuing from being away from home and work, and giving flexible timing of self-help guidance; 

d) allows simpler central rather than peripheral provision and updating of FF; 

e) permits efficient central audit of the non-personally-identifiable outcome of every user.

9. NetFF’s efficient central audit capability can provide ongoing automatic outcome-monitoring for audit of individual and aggregated patients. This speeds the meeting of clinical governance and performance criteria of the National Service Framework and makes feasible for the first time the creation of a national clearinghouse of clinical outcome of phobia/panic/anxiety collecting progress data automatically from users round the UK.

13. By its speeding of access to acceptable and effective CBT the wide provision of netFF as an early step in care could eventually reduce:

a) waiting lists for CBT of panic/phobia/anxiety; 

b) post-code and other inequity of treatment provision;

c) prevalence and chronicity of, and disability and family burden from phobia/panic/anxiety;

d) long-term medication use. Allowing GPs to refer phobic/anxious/depressed patients to a primary-care CCBT clinic reduced their referrals for secondary-care CBT by 80%.