title: Does the addition of cognitive behavioral therapy improve panic disorder treatment outcome relative to medication alone in the primary-care setting?
abstract: BACKGROUND
  Randomized clinical trials indicate a benefit from combining medications with cognitive behavioral therapy (CBT) relative to medication alone for panic disorder. Using an as-treated analysis, we evaluated whether the addition of CBT enhanced outcomes for panic disorder relative to medications alone in the primary-care setting.
  
  
  METHODS
  Primary-care patients with panic disorder reported on their receipt of CBT and medications over the 3 months following baseline assessment. The degree to which outcomes for those who used anti-panic medications were enhanced by the receipt of at least one component of CBT was analyzed using a propensity score model that took into account observable baseline patient characteristics influencing both treatment selection and outcomes.
  
  
  RESULTS
  The addition of CBT resulted in statistically and clinically significant improvements at 3 months on anxiety sensitivity, social avoidance, and disability. Also, patients receiving CBT in the first 3 months of the study were more improved at 12 months than patients who took medications only during the first 3 months of the study.
  
  
  CONCLUSIONS
  The clinical utility of the findings are discussed in terms of the importance of primary-care physicians encouraging their panic disorder patients to receive CBT as well as medications.
authors.affiliation: Department of Psychology, University of California-Los Angeles, 405 Holgard Avenue, Los Angeles, CA 90095, USA. craske@psych.ucla.edu
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Craske
authors.forename: Daniela
authors.initials: D
authors.lastname: Golinelli
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
authors.forename: Alexander
authors.initials: A
authors.lastname: Bystritsky
authors.forename: Cathy
authors.initials: C
authors.lastname: Sherbourne
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016584:Panic Disorder / Q000523:psychology* / Q000628:therapy*; D011320:Primary Health Care; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents