A Comparison of Cognitive Therapy, Applied Relaxation and Imipramine in the Treatment of Panic Disorder

1994 ◽  
Vol 164 (6) ◽  
pp. 759-769 ◽  
Author(s):  
David M. Clark ◽  
Paul M. Salkovskis ◽  
Ann Hackmann ◽  
Hugh Middleton ◽  
Pavlos Anastasiades ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Effective Treatment ◽  
Cognitive Therapy ◽  
Predictors Of Outcome ◽  
Pharmacological Treatments ◽  
Cognitive Measures ◽  
End Of Treatment ◽  
Booster Sessions ◽  
Applied Relaxation

Recent studies have shown that cognitive therapy is an effective treatment for panic disorder. However, little is known about how cognitive therapy compares with other psychological and pharmacological treatments. To investigate this question 64 panic disorder patients were initially assigned to cognitive therapy, applied relaxation, imipramine (mean 233 mg/day), or a 3-month wait followed by allocation to treatment. During treatment patients had up to 12 sessions in the first 3 months and up to three booster sessions in the next 3 months. Imipramine was gradually withdrawn after 6 months. Each treatment included self-exposure homework assignments. Cognitive therapy and applied relaxation sessions lasted one hour. Imipramine sessions lasted 25 minutes. Assessments were before treatment/wait and at 3, 6, and 15 months. Comparisons with waiting-list showed all three treatments were effective. Comparisons between treatments showed that at 3 months cognitive therapy was superior to both applied relaxation and imipramine on most measures. At 6 months cognitive therapy did not differ from imipramine and both were superior to applied relaxation on several measures. Between 6 and 15 months a number of imipramine patients relapsed. At 15 months cognitive therapy was again superior to both applied relaxation and imipramine but on fewer measures than at 3 months. Cognitive measures taken at the end of treatment were significant predictors of outcome at follow-up.

Alprazolam and Exposure for Panic Disorder with Agoraphobia

1994 ◽  
Vol 164 (5) ◽  
pp. 652-659 ◽  
Author(s):  
Metin Başoglu ◽  
Isaac M. Marks ◽  
Cengiz Kiliç ◽  
Richard P. Swinson ◽  
Homa Noshirvani ◽  
...  
Keyword(s):  
Side Effects ◽  
Panic Disorder ◽  
Drug Treatment ◽  
Psychological Treatment ◽  
Illness Severity ◽  
Withdrawal Symptoms ◽  
Severe Withdrawal ◽  
End Of Treatment

Patients with panic disorder plus agoraphobia had 8 weeks of drug treatment (alprazolam or placebo) plus psychological treatment (exposure or relaxation). At the end of treatment at week 8, 40 patients who had become much/very much improved rated how much their gains were attributable to medication or to their own efforts. During the tapering-off to week 16, and treatment-free follow-up to week 43, patients who at week 8 had attributed their gains to medication and felt less confident in coping without tablets had more severe withdrawal symptoms and greater loss of gains than did patients who at week 8 had attributed their gains to their own efforts during treatment. Baseline illness severity, greater age, higher expectations from drug treatment, and more side-effects of drugs during treatment all predicted more external attributions (i.e. to the effect of drugs) but did not independently predict relapse. Patients on alprazolam compared with placebo had more drug attributions. Though drug attributions predicted relapse in both alprazolam and placebo groups, predictions were stronger in the alprazolam group.

COGNITIVE RESTRUCTURING AND INTEROCEPTIVE EXPOSURE IN THE TREATMENT OF PANIC DISORDER: A CROSSOVER STUDY

1998 ◽  
Vol 26 (2) ◽  
pp. 115-131 ◽  
Author(s):  
Jeffrey E. Hecker ◽  
Christine M. Fink ◽  
Nancy D. Vogeltanz ◽  
Geoffrey L. Thorpe ◽  
Sandra T. Sigmon
Keyword(s):  
Panic Disorder ◽  
Cognitive Therapy ◽  
Exposure Therapy ◽  
Cognitive Restructuring ◽  
Crossover Design ◽  
Similar Degree ◽  
Relative Efficacy ◽  
Interoceptive Exposure ◽  
Subsequent Intervention

The relative efficacy of cognitive restructuring and interoceptive exposure procedures for the treatment of panic disorder, as well as the differential effects of the order of these interventions, was studied. Eighteen clients with panic disorder were seen for four sessions of exposure therapy and four sessions of cognitive therapy in a crossover design study. Half of the participants received exposure therapy followed by cognitive therapy and for half the order was reversed. There was a 1-month follow-up period between the two interventions and after the second intervention. Questionnaire measures and independent clinician ratings were used to assess outcome. Participants expected greater benefit from cognitive therapy, but tended to improve to a similar degree with either intervention. The order in which treatments were presented did not influence outcome. Participants tended to improve with the first intervention and maintain improvement across the follow-up periods and subsequent intervention. Several methodological limitations qualify the conclusions that can be drawn from this study. These limitations, as well as some conceptual and methodological challenges of conducting this type of research, are discussed.

Alprazolam and Exposure Alone and Combined in Panic Disorder with Agoraphobia

1993 ◽  
Vol 162 (6) ◽  
pp. 776-787 ◽  
Author(s):  
Isaac M. Marks ◽  
Richard P. Swinson ◽  
Metin Başoǧlu ◽  
Klaus Kuch ◽  
Homa Noshirvani ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Combined Treatment ◽  
Randomised Trial ◽  
Treatment Groups ◽  
End Of Treatment ◽  
Group A ◽  
Contrast Group ◽  
Drop Outs ◽  
Cross National

A cross-national randomised trial of alprazolam for chronic panic disorder with agoraphobia was run. Compared with previous trials it had three new features: an exposure therapy contrast group, a six-month treatment-free follow-up, and a low rate of early placebo drop-outs (‘non-evaluables’). The dose of alprazolam was high (5 mg/day). The 154 patients had eight weeks of: alprazolam and exposure (combined treatment); or alprazolam and relaxation (a psychological placebo); or placebo and exposure; or placebo and relaxation (double placebo). Drug taper was from weeks 8 to 16. Follow-up was to week 43. Results were similar at both sites. Treatment integrity was good. All four treatment groups, including double placebo, improved well on panic throughout. On non-panic measures, by the end of treatment, both alprazolam and exposure were effective, but exposure had twice the effect size of alprazolam. During taper and follow-up, gains after alprazolam were lost, while gains after exposure were maintained. Combining alprazolam with exposure marginally enhanced gains during treatment, but impaired improvement thereafter. The new features put previous trials in a fresh light. By the end of treatment, though gains on alprazolam were largely as in previous studies, on phobias and disability they were half those with exposure. Relapse was usual after alprazolam was stopped, whereas gains persisted to six-month follow-up after exposure ceased. Panic improved as much with placebo as with alprazolam or exposure.

scholarly journals Cognitive therapy for people with a schizophrenia spectrum diagnosis not taking antipsychotic medication: an exploratory trial

2011 ◽  
Vol 42 (5) ◽  
pp. 1049-1056 ◽  
Author(s):  
A. P. Morrison ◽  
P. Hutton ◽  
M. Wardle ◽  
H. Spencer ◽  
S. Barratt ◽  
...  
Keyword(s):  
Cognitive Therapy ◽  
Antipsychotic Medication ◽  
Psychotic Disorders ◽  
Psychiatric Symptoms ◽  
Controlled Trial ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
End Of Treatment ◽  
Secondary Outcomes

BackgroundAlthough antipsychotic medication is the first line of treatment for schizophrenia, many service users choose to refuse or discontinue their pharmacological treatment. Cognitive therapy (CT) has been shown to be effective when delivered in combination with antipsychotic medication, but has yet to be formally evaluated in its absence. This study evaluates CT for people with psychotic disorders who have not been taking antipsychotic medication for at least 6 months.MethodTwenty participants with schizophrenia spectrum disorders received CT in an open trial. Our primary outcome was psychiatric symptoms measured using the Positive and Negative Syndromes Scale (PANSS), which was administered at baseline, 9 months (end of treatment) and 15 months (follow-up). Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning.ResultsT tests and Wilcoxon's signed ranks tests revealed significant beneficial effects on all primary and secondary outcomes at end of treatment and follow-up, with the exception of self-rated recovery at end of treatment. Cohen's d effect sizes were moderate to large [for PANSS total, d=0.85, 95% confidence interval (CI) 0.32–1.35 at end of treatment; d=1.26, 95% CI 0.66–1.84 at follow-up]. A response rate analysis found that 35% and 50% of participants achieved at least a 50% reduction in PANSS total scores by end of therapy and follow-up respectively. No patients deteriorated significantly.ConclusionsThis study provides preliminary evidence that CT is an acceptable and effective treatment for people with psychosis who choose not to take antipsychotic medication. An adequately powered randomized controlled trial is warranted.

Panic Disorder and Suicidal Behavior

Crisis ◽  
2011 ◽  
Vol 32 (3) ◽  
pp. 169-172 ◽  
Author(s):  
Tamas Zonda ◽  
Gabriella Nagy ◽  
David Lester
Keyword(s):  
Suicidal Ideation ◽  
Panic Disorder ◽  
Cognitive Therapy ◽  
Suicidal Behavior ◽  
Attempted Suicide ◽  
Suicidal Risk ◽  
Comorbid Disorder ◽  
Panic Disorders ◽  
Hungarian Population

Background: Previous research has suggested that patients with panic disorder but no comorbid disorder are not at greater risk for suicidal behavior. Aims: The present study followed up patients with panic disorder in order to assess the frequency of their suicidal behavior. Methods: A sample of 281 outpatients with panic disorder, but without a comorbid psychiatric disorder, was followed up for an average of 5 years. The patients were given 6–8 weeks of cognitive therapy, and 65% were prescribed SSRIs. Results: At the time of first admission, 5 patients (1.7%) reported a previous (lifetime) suicide attempt, and 53 patients (18.2%) reported previous (lifetime) suicidal ideation (both thoughts and plans), not greatly different from the Hungarian population in general. During the follow-up period, no patient committed suicide, 2 patients attempted suicide (0.7%), and 4 patients (1.4%) reported suicidal ideation. Conclusions: This study indicates that people with panic disorders without comorbid disorders have no higher suicidal risk than the general population in Hungary. After treatment with cognitive therapy and SSRIs, 38.5% were symptom-free, and only 7.8% required continued close therapeutic contact after the follow-up period.

Follow-up of Agoraphobic Patients Treated with Exposure in Vivo or Applied Relaxation

1986 ◽  
Vol 149 (4) ◽  
pp. 486-490 ◽  
Author(s):  
L. Jansson ◽  
A Jerremalm ◽  
L. G. Öst
Keyword(s):  
Treatment Results ◽  
Cognitive Behavioural ◽  
End Of Treatment ◽  
Applied Relaxation ◽  
Response Systems ◽  
Exposure In Vivo ◽  
Clinically Significant ◽  
Made In

The present study describes the results of a 7-month and a 15-month follow-up of 32 agoraphobic patients treated with exposure in vivo or applied relaxation. During the followup period, all patients were given self-exposure instructions. Assessments were made in three response systems-subjective-cognitive, behavioural, and physiological-at the follow-up points. The study showed overall maintenance of treatment results in all three response systems for exposure-treated patients. For applied relaxation/self-exposure, there was a relapse on Δ heart-rate at 7 months for physiologically reactive patients, but the improvement was regained at the 15 month follow-up. Furthermore, a large proportion of the total improvement occurred during the follow-up period: 36% and 22% for exposure and applied relaxation/self-exposure respectively. The proportion of patients reaching a clinically significant improvement was 50% at the end of treatment and 66% at the 15 month follow-up.

Cognitive Therapy of Depression and Counterdemand Effects: A Pilot Study

1987 ◽  
Vol 60 (2) ◽  
pp. 555-560 ◽  
Author(s):  
Lionel Collet ◽  
Jean Cottraux ◽  
Robert Ladouceur
Keyword(s):  
Pilot Study ◽  
Cognitive Therapy ◽  
Beck Depression Inventory ◽  
Multiple Baseline ◽  
Baseline Design ◽  
Beneficial Effects ◽  
Therapeutic Benefits ◽  
End Of Treatment ◽  
Depressive Patients

A multiple-baseline design with counterdemands instructions was used to evaluate the efficacy of cognitive therapy in five depressed patients. Depression measures (MMPI, Hamilton, and Beck Depression Inventory) showed that all the patients were improved at the end of treatment and therapeutic benefits were maintained at a 1-yr. follow-up. These results confirmed the beneficial effects for depressive patients of cognitive therapy with stringent methodological controls.

BRIEF PSYCHOLOGICAL TREATMENT FOR THE RELIEF OF PANIC DISORDER

2002 ◽  
Vol 30 (4) ◽  
pp. 423-430 ◽  
Author(s):  
Karin Elsesser ◽  
Angelika Mosch ◽  
Gudrun Sartory
Keyword(s):  
Treatment Outcome ◽  
Panic Disorder ◽  
Cognitive Therapy ◽  
Psychological Treatment ◽  
Management Training ◽  
Clinical Change ◽  
Treatment Groups ◽  
Cognitive Behavioural ◽  
Before And After

This study compared complaints management training and cognitive therapy (reattribution) in treating panic disorder. Both treatment groups received three sessions with initial psychoeducation. Thirty patients with panic disorder took part in the study. Assessments were carried out before and after treatment and again at a 4-week follow-up. Both groups showed similarly significant improvements and maintenance of the clinical change over the follow-up period. It is concluded that the initial psychoeducation, which conveyed to patients the cognitive-behavioural model of panic disorder, contributed to the treatment outcome.

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