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.