Videoconference-Based Cognitive Behavioral Therapy in Symptomatic Panic Disorder Following Primary Pharmacotherapy: Randomized, Assessor-Blinded, Controlled Trial (Preprint)

BACKGROUND Background: Given the difficulty in accessing cognitive behavioral therapy, pharmacotherapy remains the standard of care for panic disorder (PD). OBJECTIVE Objectives: This study aimed to determine the effectiveness of videoconference-based cognitive behavioral therapy (VCBT) for patients who remain symptomatic after primary pharmacotherapy as an adjunct to usual care (UC) when compared with UC alone. METHODS Methods: This prospective, randomized, open-label endpoint trial enrolled 30 patients with PD who did not respond to primary pharmacotherapy, including antidepressants and anxiolytics, after ≥8 weeks of therapy, who underwent VCBT (n=15) or UC (n=15) between November 2017 and March 2020 at Chiba University Hospital in Chiba, Japan. They were evaluated at screening, week 0 (baseline), week 8 (mid-intervention), and week 16 (post-intervention). The primary outcome was the change in the PD Severity Scale (PDSS) score at week 16 from baseline. RESULTS Results: After 16 weeks, the adjusted mean changes in the PDSS score from baseline were −7.92 and 0.75 in the VCBT and UC groups, respectively, with a between-group difference of −8.67 (95% CI: −11.80 to −5.54, P<.0001). A higher proportion of patients in the VCBT group responded to treatment (≥40% reduction in the PDSS score at week 16) and experienced remission (PDSS score <8 points at week 8) than those in the UC group (P<.0001). CONCLUSIONS Conclusions: Our results suggest that VCBT is an effective treatment adjunct to UC in patients with PD who remain symptomatic following primary pharmacotherapy and improves PD symptoms in these patients. CLINICALTRIAL Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000029987; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000034247.