title: Does maintenance CBT contribute to long-term treatment response of panic disorder with or without agoraphobia? A randomized controlled clinical trial.
abstract: OBJECTIVE
  We examined the possibility that maintenance cognitive behavior therapy (M-CBT) may improve the likelihood of sustained improvement and reduced relapse in a multi-site randomized controlled clinical trial of patients who met criteria for panic disorder with or without agoraphobia.
  
  
  METHODS
  Participants were all patients (N = 379) who first began an open trial of acute-phase CBT. Patients completing and responding to acute-phase treatment were randomized to receive either 9 monthly sessions of M-CBT (n = 79) or assessment only (n = 78) and were then followed for an additional 12 months without treatment.
  
  
  RESULTS
  M-CBT produced significantly lower relapse rates (5.2%) and reduced work and social impairment compared to the assessment only condition (18.4%) at a 21-month follow-up. Multivariate Cox proportional hazards models showed that residual symptoms of agoraphobia at the end of acute-phase treatment were independently predictive of time to relapse during 21-month follow-up (hazards ratio = 1.15, p < .01).
  
  
  CONCLUSIONS
  M-CBT aimed at reinforcing acute treatment gains to prevent relapse and offset disorder recurrence may improve long-term outcome for panic disorder with and without agoraphobia.
authors.affiliation: Department of Psychology, University of Missouri, St. Louis, MO 63121, USA. whiteks@umsl.edu
authors.forename: Kamila S
authors.initials: KS
authors.lastname: White
authors.forename: Laura A
authors.initials: LA
authors.lastname: Payne
authors.forename: Jack M
authors.initials: JM
authors.lastname: Gorman
authors.forename: M Katherine
authors.initials: MK
authors.lastname: Shear
authors.forename: Scott W
authors.initials: SW
authors.lastname: Woods
authors.forename: John R
authors.initials: JR
authors.lastname: Saksa
authors.forename: David H
authors.initials: DH
authors.lastname: Barlow
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000150:complications / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D010349:Patient Compliance; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention; D012917:Social Adjustment; D016896:Treatment Outcome