A randomized clinical trial of cognitive behavioral therapy and interpersonal psychotherapy for panic disorder with agoraphobia

BackgroundInterpersonal psychotherapy (IPT) seems to be as effective as cognitive behavioral therapy (CBT) in the treatment of major depression. Because the onset of panic attacks is often related to increased interpersonal life stress, IPT has the potential to also treat panic disorder. To date, a preliminary open trial yielded promising results but there have been no randomized controlled trials directly comparing CBT and IPT for panic disorder.MethodThis study aimed to directly compare the effects of CBT versus IPT for the treatment of panic disorder with agoraphobia. Ninety-one adult patients with a primary diagnosis of DSM-III or DSM-IV panic disorder with agoraphobia were randomized. Primary outcomes were panic attack frequency and an idiosyncratic behavioral test. Secondary outcomes were panic and agoraphobia severity, panic-related cognitions, interpersonal functioning and general psychopathology. Measures were taken at 0, 3 and 4 months (baseline, end of treatment and follow-up).ResultsIntention-to-treat (ITT) analyses on the primary outcomes indicated superior effects for CBT in treating panic disorder with agoraphobia. Per-protocol analyses emphasized the differences between treatments and yielded larger effect sizes. Reductions in the secondary outcomes were equal for both treatments, except for agoraphobic complaints and behavior and the credibility ratings of negative interpretations of bodily sensations, all of which decreased more in CBT.ConclusionsCBT is the preferred treatment for panic disorder with agoraphobia compared to IPT. Mechanisms of change should be investigated further, along with long-term outcomes.

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Efficacy of a specific model for cognitive-behavioral therapy among panic disorder patients with agoraphobia: a randomized clinical trial

Sao Paulo Medical Journal ◽

10.1590/s1516-31802011000500008 ◽

2011 ◽

Vol 129 (5) ◽

pp. 325-334 ◽

Cited By ~ 3

Author(s):

Anna Lucia Spear King ◽

Alexandre Martins Valença ◽

Valfrido Leão de Melo-Neto ◽

Rafael Christophe Freire ◽

Marco André Mezzasalma ◽

...

Keyword(s):

Clinical Trial ◽

Panic Disorder ◽

Cognitive Behavioral Therapy ◽

Randomized Clinical Trial ◽

Pharmacological Treatment ◽

Selective Serotonin Reuptake Inhibitors ◽

Behavioral Therapy ◽

Specific Model ◽

Panic Attacks ◽

Cognitive Behavioral

CONTEXT AND OBJECTIVE: Cognitive-behavioral therapy is frequently indicated for panic disorder. The aim here was to evaluate the efficacy of a model for cognitive-behavioral therapy for treating panic disorder with agoraphobia. DESIGN AND SETTING: Randomized clinical trial at Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. METHODS: A group of 50 patients with a diagnosis of panic disorder with agoraphobia was randomized into two groups to receive: a) cognitive-behavioral therapy with medication; or b) medication (tricyclic antidepressants or selective serotonin reuptake inhibitors). RESULTS: Although there was no difference between the groups after the treatment in relation to almost all variables with the exception of some items of the Sheehan disability scale and the psychosocial and environmental problems scale, the patients who received the specific therapy presented significant reductions in panic attacks, anticipatory anxiety, agoraphobia avoidance and fear of body sensations at the end of the study, in relation to the group without the therapy. On the overall functioning assessment scale, overall wellbeing increased from 60.8% to 72.5% among the patients in the group with therapy, thus differing from the group without therapy. CONCLUSION: Although both groups responded to the treatment and improved, we only observed significant differences between the interventions on some scales. The association between specific cognitive-behavioral therapy focusing on somatic complaints and pharmacological treatment was effective among this sample of patients with panic disorder and the response was similar in the group with pharmacological treatment alone.

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Cognitive-Behavioral Therapy for Panic Disorder: A Review of Treatment Elements, Strategies, and Outcomes

CNS Spectrums ◽

10.1017/s1092852900018617 ◽

2003 ◽

Vol 8 (5) ◽

pp. 356-362 ◽

Cited By ~ 11

Author(s):

Nadine Recker Rayburn ◽

Michael W. Otto

Keyword(s):

Panic Disorder ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Panic Attacks ◽

Cognitive Behavioral ◽

Preventive Strategy ◽

Line Treatment ◽

First Line ◽

Term Outcome ◽

First Line Treatment

ABSTRACTThis article provides an overview of cognitive-behavioral therapy (CBT) for panic disorder. CBT is currently considered a first-line treatment for panic disorder. It offers benefit after short-term intervention, typically consisting of 12–15 sessions conducted in either an individual or a group format. The treatment focuses on the elimination of the patterns that underlie and perpetuate the disorder. Through CBT, patients learn about the nature of the disorder and acquire a set of strategies that counter the fears of panic attacks themselves, and break the recurring cycle of anticipatory anxiety, panic, and agoraphobic avoidance. The collaborative format of treatment, and a focus on elimination of core fears may be factors in enhancing longer-term outcome. In this article, we review the efficacy of CBT as a first-line treatment, a strategy for medication nonresponders, a replacement strategy for patients who wish to discontinue pharmacotherapy, and a potential preventive strategy for at-risk individuals. We also discuss some of the complex issues involved with combination-treatment strategies.

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WCA Recommendations for the Long-Term Treatment of Panic Disorder

CNS Spectrums ◽

10.1017/s109285290000691x ◽

2003 ◽

Vol 8 (S1) ◽

pp. 17-30 ◽

Cited By ~ 39

Author(s):

Mark H. Pollack ◽

Christer Allgulander ◽

Borwin Bandelow ◽

Giovanni B. Cassano ◽

John H. Greist ◽

...

Keyword(s):

Panic Disorder ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Term Treatment ◽

Integrated Treatment ◽

Panic Attacks ◽

Cognitive Behavioral ◽

Increased Risk ◽

Long Term Treatment

ABSTRACTWhat are the symptoms of panic disorder and how is the disorder most effectively treated? One of the most commonly encountered anxiety disorders in the primary care setting, panic disorder is a chronic and debilitating illness. The core symptoms are recurrent panic attacks coupled with anticipatory anxiety and phobic avoidance, which together impair the patient's professional, social, and familial functioning. Patients with panic disorder have medically unexplained symptoms that lead to overutilization of healthcare services. Panic disorder is often comorbid with agoraphobia and major depression, and patients may be at increased risk of cardiovascular disease and, possibly, suicide. Research into the optimal treatment of this disorder has been undertaken in the past 2 decades, and numerous randomized, controlled trials have been published. Selective serotonin reuptake inhibitors have emerged as the most favorable treatment, as they have a beneficial side-effect profile, are relatively safe (even if taken in overdose), and do not produce physical dependency. High-potency benzodiazepines, reversible monoamine oxidase inhibitors, and tricyclic antidepressants, have also shown antipardc efficacy. In addition, cognitive-behavioral therapy has demonstrated efficacy in the acute and long-term treatment of panic disorder. A n integrated treatment approach that combines pharmacotherapy with cognitive-behavioral therapy may provide the best treatment. Long-term efficacy and ease of use are important considerations in treatment selection, as maintenance treatment is recommended for at least 12–24 months, and in some cases, indefinitely.

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EMDR and Cognitive Behavioral Therapy in the Treatment of Panic Disorder: A Comparison

Journal of EMDR Practice and Research ◽

10.1891/1933-3196.7.3.121 ◽

2013 ◽

Vol 7 (3) ◽

pp. 121-133 ◽

Cited By ~ 8

Author(s):

Elisa Faretta

Keyword(s):

Panic Disorder ◽

Cognitive Behavioral Therapy ◽

Eye Movement ◽

Outcome Measures ◽

Private Practice ◽

Behavioral Therapy ◽

Treatment Fidelity ◽

Panic Attacks ◽

Cognitive Behavioral

A pilot comparison was made between two treatments for panic disorder, eye movement desensitization and reprocessing (EMDR) and cognitive behavioral therapy (CBT). Treatment was provided in the private practice settings of 7 credentialed therapists, whose treatment fidelity was monitored throughout the study. Five outcome measures were administered at pretreatment, posttreatment, and 1-year follow-up. There was significant improvement for participants in both groups (N = 19) after 12 sessions of treatment. No significant differences in outcome were seen between the 2 therapies, except for lower frequency of panic attacks reported by those in the EMDR group. The current study reanalyzed the data previously reported in Faretta (2012). Further research in this area is suggested.

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