Effektivität stationärer Verhaltenstherapie bei schwerer Panikstörung und Agoraphobie

Abstract

The efficacy of cognitive-behavioral therapy(CBT), of selective serotonin reuptake inhibitors (SSRI) andother antidepressants in panic disorder and agoraphobia(PDA) has been proven in many controlled trials. However,efficacy does not guarantee good effectiveness in certain subgroupsof patients. Only few studies have investigated the effectivenessof CBT with or without concomitant medication ininpatients with severe PDA. Methods: 80 inpatients weretreated with CBT comprising intense exposure in vivo. 41 ofthem received additional medication, mostly SSRI and otherantidepressants. Drug treatment was not randomized orblinded. Progress in therapy was measured weekly with Bandelow’sPanic and Agoraphobia Scale. Psychopathology, demographicand clinical features were assessed as well. Thetemporal course was analyzed using cox regression. Results:71 patients (89%) improved by at least 30%. At posttest12 patients (15%) were free of panic and avoidance, another49 patients (61,2%) experienced only mild residual anxietysymptoms. The main outcome measure yielded an effect sizeof 2,50. A reliable improvement by 30% took 7 weeks in median.Female sex and secondary school education, but not universitydegree, predicted better outcome. Depression andmultiple comorbidity influenced results adversely. Additionalpharmacotherapy did not enhance or accelerate treatmentoutcome in general, but the medication group had more severepsychopathology at pretest. Conclusions: CBT bringsabout a good reduction of anxiety and avoidance in inpatientswith serious PDA. Residual symptoms remain in manyof these patients. Combining SSRI or other antidepressantdrugs with CBT is not generally beneficial. Future studiesshould investigate the differential effectiveness of CBT/drugcombination.