Cognitive behavior therapy for treatment-refractory panic disorder.
BACKGROUND
The purpose of this pilot study is to assess the efficacy of cognitive behavior therapy for the treatment of patients with panic disorder who experience an incomplete response to a trial of pharmacotherapy.


METHODS
Fifteen consecutive patients with a DSM-III-R diagnosis of panic disorder referred for further treatment because of an incomplete response to pharmacotherapy were treated with 12-weeks of group cognitive behavior therapy. Patients were evaluated at baseline, endpoint, and at a mean of 2-months' follow-up to assess changes in panic attack frequency and global outcome. Eight of the 15 patients were deemed to have received an inadequate prior trial of medication at baseline, mainly because of a desire to control their symptoms without medication or fear of withdrawal and/or addiction. Seven of the patients were symptomatic at baseline despite an adequate prior trial of medication.


RESULTS
Overall, patients experienced a significant improvement in global function at the end of the cognitive behavior therapy intervention, as well as a decrease in panic attack frequency. Improvement was maintained at follow-up.


CONCLUSIONS
This study is consistent with a growing body of evidence that many patients with panic disorder remain symptomatic over time and are receiving inadequate pharmacotherapeutic treatment. Further, we observed that patients with panic disorder who are incompletely responsive or resistant to pharmacotherapeutic management may benefit from the addition of cognitive behavior therapy.
Pollack
M H
MH
Clinical Psychopharmacology Unit, Harvard Medical School, Massachusetts General Hospital, Boston 02114.
Otto
M W
MW
Kaspi
S P
SP
Hammerness
P G
PG
Rosenbaum
J F
JF
D000328:Adult; D000525:Alprazolam / Q000627:therapeutic use; D002998:Clonazepam / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000188:drug therapy / Q000628:therapy*; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group; D016896:Treatment Outcome
D005473:Fluoxetine; D002998:Clonazepam; D007099:Imipramine; D000525:Alprazolam