title: Implications of naturalistic use of pharmacotherapy in CBT treatment for panic disorder.
abstract: This study examined naturalistic medication use and cognitive behavioral therapy (CBT) treatment outcomes in 105 patients meeting DSM-IV criteria for panic disorder (PD), assessed by structured clinical interview. The association between pre- and post-treatment use of SSRIs, benzodiazepines (BZs), and any anti-anxiety or anti-depressant (A/D) medication were investigated for three indicators of treatment outcome (PD severity, presence of agoraphobia (AG), anxiety sensitivity) at post-treatment and 6-month follow-up. Controlling for pre-treatment severity, pre-treatment SSRI use was associated with worse outcomes for AG (p=.04) and anxiety sensitivity (p=.047); post-treatment SSRI use was associated with delayed improvements in PD severity (p=.05). Pre-treatment use of A/D was associated with poorer PD severity outcomes (p=.04). Post-treatment use of A/D was associated with higher anxiety sensitivity scores across post-treatment and 6-month follow-up (p=.03). BZ use was not associated with significantly worse outcomes. However, there was a decrease in the number of patients using BZs from pre-treatment to post-treatment (p=.06) and follow-up (p=.006). In conclusion, controlling for pre-treatment severity, pre- and post-treatment use of SSRIs and A/D was associated with poorer outcomes, particularly for PD severity and anxiety sensitivity.
authors.affiliation: Department of Psychology, Franz Hall, University of California, Los Angeles, CA 90095-1563, USA. jarch@ucla.edu
authors.forename: Joanna J
authors.initials: JJ
authors.lastname: Arch
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Craske
mesh_terms: D000328:Adult; D000367:Age Factors; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D016584:Panic Disorder / Q000188:drug therapy / Q000628:therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents; D000929:Antidepressive Agents, Tricyclic; D001569:Benzodiazepines; D017367:Selective Serotonin Reuptake Inhibitors