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An effectiveness trial of cognitive-behavioral therapy and medication for panic disorder

28 Mar
Researchers at Harborview Medical Center in Seattle conducted randomized, controlled, clinical trials to test the effectiveness of a combined pharmacotherapy and cognitive-behavioral intervention for panic disorder.

Two hundred thirty-two primary care patients meeting DSM-IV criteria for panic disorder were culled from 6 primary care clinics associated with 3 university medical schools, all serving an ethnically and socioeconomically diverse patient population. Patients were randomized to receive either treatment as usual or an intervention consisting of a combination of up to 6 sessions (across 12 weeks) of cognitive-behavioral therapy (CBT) modified for the primary care setting, with up to 6 follow-up telephone contacts during the next 9 months, and algorithm-based pharmacotherapy provided by the primary care physician with guidance from a psychiatrist.
Behavioral health specialists, the majority inexperienced in CBT for panic disorder, were trained to deliver the CBT and coordinated overall care, including pharmacotherapy. Outcome measures were the proportion of patients in remission (no panic attacks in the past month, minimal anticipatory anxiety, and an agoraphobia subscale score of less than 10 on the Fear Questionnaire), an Anxiety Sensitivity score of under 20; and change over time in the World Health Organization Disability Scale. The study found that the combined cognitive-behavioral and pharmacotherapeutic intervention resulted in sustained and gradually increasing improvement relative to treatment as usual, with significantly higher rates at all points of both the proportion of subjects remitted (3 months, 20% vs 12%; 12 months, 29% vs 16%) and responding (3 months, 46% vs 27%; 12 months, 63% vs 38%) and significantly greater improvements in World Health Organization Disability Scale (all points) and short form 12 mental health functioning (3 and 6 months) scores.

The study concludes that the combination of CBT and medication in this collaborative care model is not only feasible, but significantly more effective than usual care for primary care panic disorder.

Citation: Roy-Byrne PP, Craske MG, Stein MB, Sullivan G, Bystritsky A, Katon W, Golinelli D, Sherbourne CD.A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Archives of General Psychiatry. 2005 Mar; 62 (3): pages 290-8.

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award