Efficacy of a specific model for cognitive-behavioral therapy among panic disorder patients with agoraphobia
a randomized clinical trial
Keywords:
Anxiety, Respiration, Exercise, Panic, CognitionAbstract
CONTEXT AND OBJECTIVE: Cognitive-behavioral therapy is frequently indicated for panic disorder. The aim here was to evaluate the efficacy of a model for cognitive-behavioral therapy for treating panic disorder with agoraphobia. DESIGN AND SETTING: Randomized clinical trial at Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. METHODS: A group of 50 patients with a diagnosis of panic disorder with agoraphobia was randomized into two groups to receive: a) cognitive-behavioral therapy with medication; or b) medication (tricyclic antidepressants or selective serotonin reuptake inhibitors). RESULTS: Although there was no difference between the groups after the treatment in relation to almost all variables with the exception of some items of the Sheehan disability scale and the psychosocial and environmental problems scale, the patients who received the specific therapy presented significant reductions in panic attacks, anticipatory anxiety, agoraphobia avoidance and fear of body sensations at the end of the study, in relation to the group without the therapy. On the overall functioning assessment scale, overall wellbeing increased from 60.8% to 72.5% among the patients in the group with therapy, thus differing from the group without therapy. CONCLUSION: Although both groups responded to the treatment and improved, we only observed significant differences between the interventions on some scales. The association between specific cognitive-behavioral therapy focusing on somatic complaints and pharmacological treatment was effective among this sample of patients with panic disorder and the response was similar in the group with pharmacological treatment alone. CLINICAL TRIAL REGISTRATION NUMBER: NCT 01025908
Downloads
References
Associação Americana de Psiquiatria. Manual diagnóstico e estatístico de transtornos mentais. DSM-IV-TR. 4a ed. Porto Alegre: Artmed; 2002.
Lang AJ, Craske MG. Pânico e fobia. In: White JR, Freeman AS, editors. Terapia cognitivo-comportamental em grupo para populações e problemas específicos. São Paulo: Roca; 2003. p. 71-107.
Ehlers A, Margraf J. The psychophysiological model of panic attacks. In: Emmelkamp PMG, Everaed WT, Kraaimaat FW, Van Son MJ, editors. Fresh perspectives on anxiety disorders. Netherlands: Sweets & Zeitlinger; 1989. p. 1-29.
Barlow DH. Anxiety and its disorders: the treatment of anxiety and panic. New York: Guilford Press; 1988.
Araújo SRC, Mello MT, Leite JR. Transtornos de ansiedade e exercício físico [Anxiety disorders and physical exercise]. Rev Bras Psiquiatr. 2007;29(2):164-71.
King ALS, Valença AM, Mello-Neto VL, Nardi AE. A importância do foco da terapia cognitivo-comportamental direcionado às sensações corporais no transtorno de pânico: relato de caso [The importance of the focus of the cognitive-behavior therapy related to the body sensation in the panic disorder: case report]. Rev Psiquiatr Clín (São Paulo). 2007;34(4):191-5.
Crowe RR, Noyes R Jr. Panic disorder and agoraphobia. Dis Mon. 1986;32(7):389-444.
Beck AT, Emery G. Anxiety disorders and phobias: a cognitive perspective. New York: Basic Books; 1985.
First MB, Spitzer RL, Gibbon M, Williams JBM. Structured Clinical Interview Diagnostic (SCID) for DSM-IV Axis I Disorders-Clinician Version (SCID-CV). Washington: American Psychiatric Press; 1997.
Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893-7.
Spielberg CD, Gorusch RL, Lushene RE. Manual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologists Press; 1970.
Sheehan DV. The Anxiety Disease. Sheehan Disability Scale. New York, NY: Charles Scribner’s Sons; 1983.
Marks IM, Mathews AM. Brief standard self-rating for phobic patients. Behav Res Ther. 1979;17(3):263-7.
Chambless DL, Caputo GC, Bright P, Gallagher R. Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. J Consult Clin Psychol. 1984;52(6):1090-7.
Bandelow B. Panic and agoraphobia scale (PAS). Seattle: Hogrefe & Huber Publishers; 1999.
Chambless DL, Caputo GC, Jasin SE, Gracely EJ, Williams C. The Mobility Inventory for Agoraphobia. Behav Res Ther. 1985;23(1): 35-44.
Briggs AC, Stretch DD, Brandon S. Subtyping of panic disorder by symptom profile. Br J Psychiatry. 1993;163:201-9.
King ALS, Nardi AE, Cruz MS. Risco de suicídio em paciente alcoolista com depressão [Suicide risk in alcohol-dependent patient with depression]. J Bras Psiquiatr. 2006;55(1):70-3.
Barsky AJ, Fama JM, Bailey ED, Ahern DK. A prospective 4- to 5-year study of DSM-III-R hypochondriasis. Arch Gen Psychiatry. 1998;55(8):737-44.
Fava M, Rush AJ. Current status of augmentation and combination treatments for major depressive disorder: a literature review and a proposal for a novel approach to improve practice. Psychother Psychosom. 2006;75(3):139-53.
Clark DM, Salkovskis P, Gelder M, et al. A. tests of a cognitive theory of panic. In: Hand I, Wittchen H, editors. Pomic and phobias: treatments and variables affecting course and outcome. Berlin: Springer-Verlag; 1988. p. 71-90.
