Importance of knowledge in the behavioural treatment of panic disorder

2019 ◽  
Vol 47 (5) ◽  
pp. 611-615
Author(s):  
Kathleen M. Grubbs ◽  
James D. Broussard ◽  
Emily L. Hiatt ◽  
Melissa A. Beason-Smith ◽  
Ellen J. Teng
Keyword(s):  
Panic Disorder ◽  
Intensive Therapy ◽  
Behavioural Therapy ◽  
Behavioural Treatment ◽  
Knowledge Domains ◽  
Cognitive Behavioural ◽  
Severity Scores ◽  
Good Internal Consistency ◽  
Knowledge Scale

AbstractBackground:Cognitive behavioural therapy (CBT) for panic disorder encourages patients to learn about and make changes to thoughts and behaviour patterns that maintain symptoms of the disorder. Instruments to assess whether or not patients understand therapy content do not currently exist.Aims:The aim of this study was to examine if increases within specific knowledge domains of panic disorder were related to improvement in panic symptoms following an intensive 2-day panic treatment.Method:Thirty-nine Veterans enrolled in an intensive weekend panic disorder treatment completed knowledge measures immediately before the first session of therapy and at the end of the last day of therapy. Four panic disorder experts evaluated items and reached consensus on subscales. Subscales were reduced further to create psychometrically sound subscales of catastrophic misinterpretation (CM), behaviours (BE), and self-efficacy (SE). A simple regression analysis was conducted to determine whether increased knowledge predicted symptom change at a 3-month follow-up assessment.Results:The overall knowledge scale was reduced to three subscales BE (n = 7), CM (n = 13) and SE (n = 8) with good internal consistency. Veterans’ knowledge of panic disorder improved from pre- to post-treatment. Greater increase in scores on the knowledge assessment predicted lower panic severity scores at a 3-month follow-up. A follow-up analysis using the three subscales as predictors showed that only changes in CM significantly contributed to the prediction.Conclusions:In an intensive therapy format, reduction in panic severity was related to improved knowledge overall, but particularly as a result of fewer catastrophic misinterpretations.

scholarly journals Are claims of non-inferiority of Internet and computer-based cognitive-behavioural therapy compared with in-person cognitive-behavioural therapy for adults with anxiety disorders supported by the evidence from head-to-head randomised controlled trials? A systematic review

2019 ◽  
Vol 53 (9) ◽  
pp. 851-865 ◽  
Author(s):  
Richard O’Kearney ◽  
Sheri Kim ◽  
Rachelle L Dawson ◽  
Alison L Calear
Keyword(s):  
Panic Disorder ◽  
Cognitive Behavioural Therapy ◽  
Randomised Controlled Trials ◽  
Behavioural Therapy ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Cognitive Behavioural ◽  
Randomised Controlled ◽  
Internet Cognitive Behavioural Therapy

Objective: This review examines the evidence from head-to-head randomised controlled trials addressing whether the efficacy of cognitive-behavioural therapy for anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorders in adults delivered by computer or online (computer- and Internet-delivered cognitive-behavioural therapy) is not inferior to in-person cognitive-behavioural therapy for reducing levels of symptoms and producing clinically significant gains at post-treatment and at follow-up. A supplementary aim is to examine the evidence for severity as a moderator of the relative efficacy of computer- and Internet-delivered cognitive-behavioural therapy and in-person cognitive-behavioural therapy. Method: PubMed, PsycINFO, Embase and Cochrane database of randomised trials were searched for randomised controlled trials of cognitive-behavioural therapy for these disorders with at least an in-person cognitive-behavioural therapy and Internet or computer cognitive-behavioural therapy arm. Results: A total of 14 randomised controlled trials (9 Internet, 5 computer) of cognitive-behavioural therapy for social anxiety disorder, panic disorder and specific phobia and 3 reports of effect moderators were included. One study showed a low risk of bias when assessed against risk of bias criteria for non-inferiority trials. The remaining studies were assessed as high or unclear risk of bias. One study found that Internet-delivered cognitive-behavioural therapy was superior and non-inferior at post-treatment and follow-up to group in-person cognitive-behavioural therapy for social anxiety disorder. One study of Internet-delivered cognitive-behavioural therapy for panic disorder showed non-inferiority to individual in-person cognitive-behavioural therapy for responder status at post-treatment and one of Internet cognitive-behavioural therapy for panic disorder for symptom severity at follow-up. Other comparisons (22 Internet, 13 computer) and for estimates pooled for Internet cognitive-behavioural therapy for social anxiety disorder, Internet cognitive-behavioural therapy for panic disorder and computer-delivered cognitive-behavioural therapy studies did not support non-inferiority. Evidence of effect moderation by severity and co-morbidity was mixed. Conclusion: There is limited evidence from randomised controlled trials which supports claims that computer- or Internet-delivered cognitive-behavioural therapy for anxiety disorders is not inferior to in-person delivery. Randomised controlled trials properly designed to test non-inferiority are needed before conclusions about the relative benefits of in-person and Internet- and computer-delivered cognitive-behavioural therapy can be made. Prospero: CRD420180961655-6

THE POSSIBILITY OF REDUCING THERAPIST CONTACT AND TOTAL LENGTH OF THERAPY IN THE TREATMENT OF PANIC DISORDER

1999 ◽  
Vol 27 (3) ◽  
pp. 231-247 ◽  
Author(s):  
Cristina Botella ◽  
Azucena García-Palacios
Keyword(s):  
Panic Disorder ◽  
Public Mental Health ◽  
Cost Benefit ◽  
Treatment Programs ◽  
Behavioural Treatment ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Post Test ◽  
The Cost

This study compares the effectiveness of a standard cognitive-behavioural treatment for panic disorder with a reduced therapist contact program supported by self-help materials. This program shortens the total therapy length (from 10 to 5 weeks) and the contact time with the therapist (from 10 to 5 sessions). The sample was mostly referred from a public mental health unit, and it had a low level of education (average of 9.7 years). The subjects were assessed according to several variables related with panic disorder at pre- and post-test, and at 12-month follow-up. The results demonstrated that both programs produced significant improvements for all variables at post-test, the benefits were maintained at follow-up assessment, and even heightened for some of the measures. Also, both treatment programs obtained comparable improvements for most measures. These results suggest that the programs that reduce the contact with the therapist, supported by self-help materials, and shorten the time that the patient suffers from this problem (Margraf, Barlow, Clark, & Telch, 1993) may be a good intervention for the treatment of panic disorder. These programs can help to overcome some of the cost-benefit therapeutic limitations of standard cognitive-behavioural programs.

Parent-Assisted Cognitive-Behavioural Therapy for Children's Nighttime Fear

2014 ◽  
Vol 31 (4) ◽  
pp. 243-257 ◽  
Author(s):  
Sandra E. Stewart ◽  
Jocelynne E. Gordon
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Muscle Relaxation ◽  
Behavioural Therapy ◽  
Current Evidence ◽  
Behavioural Treatment ◽  
General Behaviour ◽  
Recommended Treatment ◽  
Cognitive Behavioural ◽  
Treatment Package

Nighttime fear, including fear of monsters and the dark, is common. For most children and adolescents, nighttime fears are transient. However, approximately 10% experience severe nighttime fear that negatively impacts sleep, adjustment, and family life. Research conducted in the 1980s indicates that cognitive-behavioural therapy can reduce nighttime fear in as few as three sessions. The aims of the present study were to replicate and extend earlier research by evaluating a cognitive-behavioural treatment package for children's severe nighttime fear, and address methodological issues in previous studies. A manualised, multi-component treatment package was developed, based on current evidence-based practice for the treatment of children's anxiety. Interventions included graded exposure, muscle relaxation, cognitive restructuring, and social and material reinforcement. Treatment was individually tailored and delivered via weekly modules. A multiple baseline across-subjects design was utilised. Four ‘families’ — one parent and one child — participated; children's ages ranged from 6 to 10 years. Families attended five weekly intervention sessions and a 1-month follow-up. Multiple outcome measures were administered pre- and post-treatment. All children displayed changes consistent with reduced nighttime fear following treatment, including fewer phobic symptoms, reduced general fear, and improved nighttime and general behaviour. These changes were maintained at follow-up. Parents reported a high degree of satisfaction with the program and would recommend it to other families. The results support the effectiveness of manualised, parent-assisted treatment for nighttime fear in as few as three sessions. In cases of severe nighttime fear, therapist support is recommended. Treatment implications for children with complex presentations are discussed.

Randomised placebo-controlled trial of moclobemide, cognitive–behavioural therapy and their combination in panic disorder with agoraphobia

1999 ◽  
Vol 174 (3) ◽  
pp. 205-212 ◽  
Author(s):  
Bernd Loerch ◽  
Mechthild Graf-Morgenstern ◽  
Martin Hautzinger ◽  
Sabine Schlegel ◽  
Christoph Hain ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Cognitive Behavioural Therapy ◽  
Clinical Management ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Additional Treatment ◽  
Combined Treatments ◽  
Short Term ◽  
Cognitive Behavioural

BackgroundIn the treatment of panic disorder with agoraphobia, the efficacy of pharmacological, psychological and combined treatments has been established. Unanswered questions concern the relative efficacy of such treatments.AimsTo demonstrate that moclobemide and cognitive–behavioural therapy (CBT) are effective singly and more effective in combination.MethodFifty-five patients were randomly assigned to an eight-week treatment of: moclobemide plus CBT; moclobemide plus clinical management (‘psychological placebo’); placebo plus CBT; or placebo plus clinical management.ResultsComparisons between treatments revealed strong effects for CBT. Moclobemide with clinical management was not superior to placebo. The combination of moclobemide with CBT did not yield significantly better short-term results than CBT with placebo. The CBT results remained stable during a six-month follow-up, although a substantial proportion of patients treated with placebo plus CBT needed additional treatment.ConclusionsCBT was highly effective in the treatment of panic disorder with agoraphobia and reduced agoraphobia to levels that were comparable to those of non-clinical controls.

Cognitive-behavioural Treatment for Young People Who Have Been Sexually Abused: Developmental Considerations

2000 ◽  
Vol 17 (1) ◽  
pp. 37-47 ◽  
Author(s):  
Nicole N. Myerson ◽  
Neville J. King ◽  
Bruce J. Tonge ◽  
David A. Heyne ◽  
Dawn A. Young ◽  
...  
Keyword(s):  
Young People ◽  
Therapeutic Approach ◽  
Sexually Abused ◽  
Treatment Approach ◽  
Behavioural Therapy ◽  
Behavioural Treatment ◽  
Cognitive Behavioural Treatment ◽  
Positive Therapeutic Effect ◽  
Cognitive Behavioural

AbstractThis article describes the application of cognitive behavioural therapy to three sexually abused young people. We emphasise developmental influences and the nuances of the therapeutic approach. An exposure-based treatment approach was used with the youths. A multimodal assessment evaluation was conducted at pretreatment and posttreatment, and at a 3-month follow-up. Results on outcome measures indicated a positive therapeutic effect for the youths.

scholarly journals Internet cognitive–behavioural treatment for panic disorder: randomised controlled trial and evidence of effectiveness in primary care

BJPsych Open ◽  
2016 ◽  
Vol 2 (2) ◽  
pp. 154-162 ◽  
Author(s):  
Adrian R. Allen ◽  
Jill M. Newby ◽  
Anna Mackenzie ◽  
Jessica Smith ◽  
Matthew Boulton ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomised Controlled Trial ◽  
Panic Disorder ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Waiting List ◽  
Behavioural Treatment ◽  
Cognitive Behavioural ◽  
Primary Care Practitioners ◽  
Randomised Controlled

BackgroundInternet cognitive–behavioural therapy (iCBT) for panic disorder of up to 10 lessons is well established. The utility of briefer programmes is unknown.AimsTo determine the efficacy and effectiveness of a five-lesson iCBT programme for panic disorder.MethodStudy 1 (efficacy): Randomised controlled trial comparing active iCBT (n=27) and waiting list control participants (n=36) on measures of panic severity and comorbid symptoms. Study 2 (effectiveness): 330 primary care patients completed the iCBT programme under the supervision of primary care practitioners.ResultsiCBT was significantly more effective than waiting list control in reducing panic (g=0.97, 95% CI 0.34 to 1.61), distress (g=0.92, 95% CI 0.28 to 1.55), disability (g=0.81, 95% CI 0.19 to 1.44) and depression (g=0.79, 95% CI 0.17 to 1.41), and gains were maintained at 3 months post-treatment (iCBT group). iCBT remained effective in primary care, but lower completion rates were found (56.1% in study 2 v. 63% in study 1). Adherence appeared to be related to therapist contact.ConclusionsThe five-lesson Panic Program has utility for treating panic disorder, which translates to primary care. Adherence may be enhanced with therapist contact.

scholarly journals Computerised cognitive–behavioural therapy for adults with intellectual disability: randomised controlled trial

2017 ◽  
Vol 211 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Patricia Cooney ◽  
Catherine Jackman ◽  
David Coyle ◽  
Gary O'Reilly
Keyword(s):  
Intellectual Disability ◽  
Randomised Controlled Trial ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Primary Outcome Measure ◽  
Cognitive Behavioural ◽  
Randomised Controlled

BackgroundDespite the evidence base for computer-assisted cognitive–behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.AimsTo evaluate the utility of a CBT computer game for adults who have an intellectual disability.MethodA 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.ResultsA significant group x time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.ConclusionsAs the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

scholarly journals Pain in Patients with Panic Disorder: Relation to Symptoms, Cognitive Characteristics and Treatment Outcome

2002 ◽  
Vol 7 (3) ◽  
pp. 134-141 ◽  
Author(s):  
Norman B Schmidt ◽  
Helen T Santiago ◽  
John H Trakowski ◽  
J Michael Kendren
Keyword(s):  
Treatment Outcome ◽  
Chest Pain ◽  
Panic Disorder ◽  
Joint Pain ◽  
Behavioural Therapy ◽  
Depression Symptoms ◽  
Diagnostic And Statistical Manual ◽  
Cognitive Behavioural ◽  
Stomach Pain ◽  
Pain Symptoms

OBJECTIVE:Although there has been a link between certain types of pain, notably chest pain, and panic disorder, the relation between pain and panic disorder has not been systematically evaluated. In the present study, the relation between pain symptoms (headache, chest pain, stomach pain, joint pain) and the clinical presentation of patients with panic disorder was evaluated.HYPOTHESES:Pain was generally hypothesized to be related to increased symptoms of anxiety, panic-relevant cognitive domains and treatment outcome. In terms of specific pain domains, headache and chest pain were expected to be more closely related to anxiety-related symptoms.PARTICIPANTS AND METHODS:Patients (n=139) meeting the criteria of theDiagnostic and Statistical Manual of Mental Disorders - Fourth Editionfor panic disorder completed a set of standardized clinician-rated and self-reported measures. Moderator analyses were used in a subset of these patients completing a treatment outcome study.RESULTS:Approximately two-thirds of the participants endorsed at least one current pain symptom. The hypotheses were partially supported, with pain being associated with higher levels of anxiety and depression symptoms, as well as panic frequency. Pain was also related to several cognitive features, including anxiety sensitivity and panic appraisals. Headache and chest pain were more highly associated with anxiety symptoms than was joint pain. Cognitive measures did not mediate the relation between anxiety and pain, and pain did not significantly moderate outcome in response to cognitive-behavioural therapy.CONCLUSIONS:Co-occurring pain symptoms appear to be more highly related to phenomenology than to treatment response in patients with panic disorder.

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