Behavioral Treatment Of Panic Disorder Research Articles

Anxious attachment improves and is predicted by anxiety sensitivity in internet-based, guided self-help cognitive behavioral treatment for panic disorder.

The purpose of this study was to examine whether anxious and avoidant attachment styles improve during guided internet-based cognitive behavioral treatment (ICBT) for panic disorder, and if so, to identify potential theoretically driven mechanisms related to the change. We examined changes in anxious and avoidant attachment and their time-lagged (1 week), longitudinal relationship with panic-related constructs in patients participating in ICBT (n = 79) in an open trial. Anxious attachment scores improved significantly with a medium effect during ICBT, d = 0.76 [0.45, 1.08]. According to benchmark analyses, changes were similar to the magnitude of change in face-to-face CBT and final scores to values of a nonclinical sample. Additionally, similar to findings in face-to-face CBT for panic disorder, longitudinal time analyses revealed that anxiety sensitivity scores predicted later improvement in anxious attachment scores, but not vice versa. Counter to our hypothesis, avoidant attachment did not significantly change during treatment, d = 0.15 [0.02, 0.46]; however, pretreatment level of avoidant attachment in ICBT was similar to the nonclinical sample. Also counter to our hypotheses, agoraphobic avoidant behaviors when alone did not predict changes in anxious attachment. These results suggest that anxious attachment can improve in ICBT for panic disorder even though the focus of the treatment is not on interpersonal relationships. These changes appear to follow changes in anxiety sensitivity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Supplemental Material for Anxious Attachment Improves and Is Predicted by Anxiety Sensitivity in Internet-Based, Guided Self-Help Cognitive Behavioral Treatment for Panic Disorder

Supplemental Material for Anxious Attachment Improves and Is Predicted by Anxiety Sensitivity in Internet-Based, Guided Self-Help Cognitive Behavioral Treatment for Panic Disorder

Intensive Treatments for Adolescents with Panic Disorder and Agoraphobia: Helping Youth Move beyond Avoidance

Panic disorder with agoraphobia (PDA) contributes to significant impairment and distress in adolescence, particularly when left untreated. Cognitive behavioral treatment of panic disorder in adolescents has now been developed and delivered in a traditional once per week format, and has also recently been adapted for delivery in an intensive format delivered over eight consecutive days. We provide a brief review of research efforts to date on the development and evaluation of intensive treatments for panic disorder in adolescence. Recent studies suggest that the intensive, eight-day treatment approach is associated with comparable reductions in PDA symptoms as compared to the once-weekly treatment and shows promise for reducing the impairing symptoms of PDA and its comorbid conditions. Ongoing research and future directions to further this body of work will be discussed.

The effects of comorbid personality disorders on cognitive behavioral treatment for panic disorder

The present study investigated the influence of personality pathology assessed both dimensionally and categorically on acute clinical response to group cognitive-behavioral treatment in a large sample of panic disorder patients ( N = 173) meeting DSMIII-R criteria for panic disorder with or without agoraphobia. Nearly one-third of the sample met for one or more personality disorders, with the majority meeting for a Cluster C diagnosis. Patients with one or more comorbid personality disorders displayed higher baseline and higher post treatment scores across multiple indices of panic disorder severity compared to those without personality disorders. After controlling for panic disorder severity at baseline, the presence of both Cluster C and Cluster A Pers-Ds predicted a poorer outcome, whereas when assessed dimensionally, only Cluster C symptoms predicted a poorer treatment response. However, the influence of personality pathology was modest relative to that of baseline panic disorder severity.

A Pilot Study of Sensation-Focused Intensive Treatment for Panic Disorder With Moderate to Severe Agoraphobia: Preliminary Outcome and Benchmarking Data

This report presents results of a treatment for panic disorder with moderate to severe agoraphobia (PDA-MS) called sensation-focused intensive treatment (SFIT). SFIT is an 8-day intensive treatment that combines features of cognitive- behavioral treatment for panic disorder, such as interoceptive exposure and cognitive restructuring with ungraded situational exposure. SFIT focuses on feared physical sensations as well as agoraphobic avoidance. Preliminary data support the utility of SFIT in improving PDA-MS. The goal of this exploratory study was to further investigate the effectiveness of SFIT and evaluate factors related to treatment outcome, including severity of panic symptoms, gender, comorbidity, self-efficacy, and place of residence (local vs. remote). SFIT was found to be effective in decreasing panic symptoms from pre- to posttreatment, with treatment gains maintained at follow-up. The implications of these findings for the treatment of PDA are discussed.

Steven Friedman, Jeffrey W. Braunstein, & Beth Halpern (2006). Cognitive behavioral treatment of panic disorder and agoraphobia in a multi-ethnic urban outpatient clinic: Initial presentation and treatment outcome. Cognitive and Behavioral Practice, 13, 282–292

Steven Friedman, Jeffrey W. Braunstein, & Beth Halpern (2006). Cognitive behavioral treatment of panic disorder and agoraphobia in a multi-ethnic urban outpatient clinic: Initial presentation and treatment outcome. Cognitive and Behavioral Practice, 13, 282–292

Cognitive Behavioral Treatment of Panic Disorder and Agoraphobia in a Multiethnic Urban Outpatient Clinic: Initial Presentation and Treatment Outcome

Few studies examine the effectiveness of panic control treatment across diverse ethnic groups. In this paper we present data on 40 patients (African American, n = 24; Caucasian, n = 16) with panic disorder and comorbid agoraphobia who presented at an anxiety disorder clinic in an inner-city area. On initial assessment both groups were similar on psychometric measures, and both groups moderately improved with treatment though significant residual symptoms remained. We illustrate, through case examples, a variety of clinical issues that need to be addressed when providing treatment to multiethnic African American clients with panic disorder and agoraphobia.

Therapists’ and clients’ perception of each other and working alliance in the behavioral treatment of panic disorder and agoraphobia

Fifty-nine patients who fulfilled criteria for a primary diagnosis of panic disorder with moderate to severe agoraphobia were treated with 16 sessions of behavioral therapy. The study investigated the relationship between therapists’ and clients’ perception of each other, working alliance, and outcome. There was initially a low correspondence between therapist and client perceptions but a growing consensus during treatment. This was most pronounced regarding high ratings of therapist qualities and the perception of the client as attractive. Clients’ perceptions showed virtually zero correlation with outcome regardless of time. Therapist perception of client as showing active participation and goal direction yielded positive correlations with outcome at posttreatment and follow-up from Session 4 and throughout treatment. No significant relation between working alliance and outcome was found apart from the fact that those who improved during follow-up rated the alliance significantly higher than those who did not improve.

Personality disorder and social anxiety predict delayed response in drug and behavioral treatment of panic disorder

Background: The aim of this study was to analyze the impact of pretreatment characteristics and personality disorders on the onset of response in the treatment of panic disorder. Methods: The data of 73 out-patients with panic disorder who had completed at least 6 weeks of a randomized trial of 24 weeks of either paroxetine only or paroxetine combined with cognitive group-therapy were analyzed in a Cox proportional hazards model. Results: The likelihood of having responded to treatment (defined by a CGI rating of improvement) was more than twice as high for patients without a personality disorder or social phobia than for Patients with a personality disorder or social phobia. Conclusions: We suggest that patients with these characteristics do benefit from prolonged treatment, and they may profit from an additional treatment focused on social anxiety.

Antidepressant discontinuation in the context of cognitive behavioral treatment for panic disorder

Cognitive behavioral treatment (CBT) has been shown to reduce risk for adverse reactions (e.g., rebound panic) following benzodiazepine taper for patients with panic disorder (PD). This study evaluated the effects of antidepressant discontinuation for patients with PD in the context of CBT. Patients with PD ( n=21) on a stable dose of antidepressants completed a 12-week group CBT treatment and were randomly assigned to discontinue antidepressants during week 8 of the treatment. There were no statistically significant differences between groups at posttreatment or 6-month follow-up. Data indicate no apparent immediate or long-term adverse effects for antidepressant discontinuation for patients with PD receiving CBT.

The value of psychophysiological data for cognitive behavioral treatment of panic disorder

Recurring episodes of intense physical sensations are characteristic features of panic disorder. During cognitive behavioral treatment (CBT) of the disorder, the therapist frequently challenges the patient's misinterpretations of certain physiological symptoms. When discussing these issues, the therapist typically has to rely on the patient's subjective report, which is often subject to distortion. Although recent technological advances make it possible to monitor patients' ambulatory psychophysiological responses, such data have rarely been used in treatment. This article will provide some arguments for using psychophysiological data in CBT for panic disorder.

Cognitive–Behavioral Treatment of Panic Disorder With Agoraphobia Triggered by AICD Implant Activity

Received January 24, 1997; revised June 18, 1997; accepted July 8, 1997. From the Department of Psychiatry, State University of New York (SUNY) Health Science Center at Brooklyn. Address reprint requests to Dr. Smith, Box 1203, 450 Clarkson Avenue, SUNY Health Science Center at Brooklyn, Brooklyn, NY 11203. Copyright 1998 The Academy of Psychosomatic Medicine. The use of automatic implantable cardioverter defibrillators (AICDs) has been successful in reducing the incidence of sudden arrhythmic mortality in high-risk patients to less than 3% per year. However, in addition to the stress associated with chronic cardiac disease, AICD patients face unique problems, such as device dependency and fear of unpredictable shocks, which make them particularly vulnerable to anxiety, depression, and other psychological disturbances. As many as 50% of these patients have been shown to develop a psychiatric disorder: 30% adjustment disorder–mixed type, 15% major depression, and 5% panic disorder. Supportive treatment, often within a group setting,and the use of psychotropic medications (primarily benzodiazepines) are common treatment modalities. Cognitive–behavioral therapy (CBT) in particular can be helpful in managing anxiety and fatigue, maximizing physical and social activity, and reframing the meaning of the AICD from the center of one’s life to a neutral medical intervention designed to enhance and prolong life. Although CBT is mentioned in most articles addressing the psychiatric management of patients with AICDs, no detailed account of its specific application or effectiveness has been reported. We will describe the psychological reaction and comprehensive case management of a client with an AICD.

Self-directed versus therapist-directed cognitive behavioral treatment for panic disorder

This study investigated two approaches to providing cognitive behavioral therapy for panic disorder: self-directed and therapist-directed. Sixteen individuals with panic disorder were randomly assigned to the treatment conditions. All participants were provided with a workbook describing cognitive-behavioral treatment ( Mastery of Your Anxiety and Panic by Barlow & Craske). Therapist-directed participants worked through the material over 12 weekly therapy sessions. Therapists met with self-directed participants three times over 12 weeks to assign readings and answer questions. A fourth meeting was devoted to posttreatment assessment. Participants in both conditions improved with treatment and maintained their gains at 6-months follow-up. There were no differences between the treatment conditions on outcome measures. Forty percent and 28.6% of self-directed and therapist-directed participants, respectively, met conservative criteria for high end-state functioning at follow-up.

Ambulatory psychophysiological monitoring: A potentially useful tool when treating panic relapse

Following relapse after 11 sessions of cognitive behavioral treatment of panic disorder, a client wore an ambulatory physiological monitoring device for 1 day. The physiological data were used to test the client's hypothesis that panic attacks always occur from “out of the blue.” Results showed that hyperventilation and fearful thoughts preceded panic attacks, refuting the client's initial hypothesis. A comparison of the client's self-report data before and after wearing the device indicated that this therapeutic strategy had a beneficial treatment effect. The results are discussed in the context of the scientist-practitioner approach to treatment failure.

Cognitive Behavioral Treatment of Panic Disorder in Elderly Adults: Two Case Studies

Cognitive behavioral treatment (CBT) has been repeatedly proven efficacious in the treatment of panic disorder (PD); however, information about the efficacy of this treatment with geriatric patients is lacking. The current paper outlines treatment course and outcome for two elderly PD patients receiving CBT. J. B. was a 70-year-old White male with a 51-year history of PD; A. B. was a 69-year-old White female with a 25-year history of PD. Diagnoses were made on the basis of the Structured Clinical Interview for DSM-III-R patient version (SCID-P). Both subjects received manual-driven CBT. Four primary treatment components consisted of psychoeducation, cognitive restructuring, breathing retraining, and systematic exposure. Subjects completed symptom measures before and after treatment and at a follow-up evaluation. Results support the efficacy of the treatment for both patients, as panic attacks, fear and avoidance, and general symptomatology were substantially reduced at post- and follow-up assessments. Results are discussed in terms of the utility of CBT with elderly patients and the nuances of treating elderly patients with this treatment procedure.

Patient-therapist interaction in the behavioral treatment of panic disorder with agoraphobia.

Although effective behavioral techniques have been developed, what aspects of the patient-therapist interaction affect treatment outcome remain largely unknown. This study hypothesized that the interaction between patient and therapist develops over several phases. Further, the association between behavior modes and treatment outcome was expected to alter as that interaction developed. Thirty patients diagnosed with panic disorder with agoraphobia were treated with a standardized behavioral treatment program of 12 sessions. The interpersonal verbal therapist and patient behavior modes were studied at Sessions 1, 3, and 10, using an observational instrument. It was found that behavior modes change over the course of treatment, in line with predictions derived from social-psychological models. The hypothesis that establishing a therapeutic relationship requires an empathic and nondirective stance by the therapist in Session 1 was partly confirmed.

Outcomes of Group Cognitive Behavioral Training in the Treatment of Panic Disorder And Agoraphobia

BACKGROUND: Several investigators have demonstrated the efficacy of group cognitive behavioral treatment for panic disorder and agoraphobia. However, no information on nurse-facilitated, short-term, outpatient cognitive behavioral treatment training programs was found in the literature. OBJECTIVES: This study examined differences in the severity of symptoms before and after participation in a 6-week training program for clients with panic disorder and agoraphobia. This article describes the cognitive behavioral techniques used in the Comprehensive Anxiety Management Program. DESIGN: Forty consecutive treatment-seeking subjects completed the Symptom Check List-90-Revised and the Weekly Ratings Scale before and afler participation in the training program. Dependent variables included intensity of panic symptoms, phobic avoidance, generalized anxiety, and depression. RESULTS : Significant differences between baseline and endpoint means scores of the group participants were found. No significant differences in progress were noted between subjects who were taking medication and those who were not, nor did a concurrent diagnosis of depression or another anxiety disorder contribute to differ ent outcomes. CONCLUSIONS: The findings indicate that brief, nurse-facilitated group training in cog nitive behavioral treatment can significantly reduce symptoms of panic disorder and agoraphobia. Further research is needed to determine which components of the train ing program were primarily responsible for the observed outcomes. (J AM PSYCHIATR NURSES Assoc [1995], 1, 83-91)

Impact of Personality Functioning on Cognitive Behavioral Treatment of Panic Disorder: A Preliminary Report

Although research has demonstrated the efficacy of cognitive behavioral therapy (CBT) for the treatment of panic disorder (PD), some patients do not have an adequate response to this treatment. Several previous studies found that personality functioning was a prognostic indicator of treatment outcome. The present study examined the effects of personality characteristics on outcome of 18 PD patients treated with a 12-week trial of CBT. Results of this study indicated that although looking at the presence of significant scale elevations on the Millón Clinical Multiaxial Inventory-II (MCMI-II) yielded no outcome differences, treatment responders showed relative differences in specific personality characteristics (lower initial scores on borderline, histrionic, schizoid, schizotypal, antisocial, aggressive/sadistic, and self defeating scales, and higher initial scores on the compulsive scale). Additionally, the entire group of panic disorder patients showed global improvement in personality functioning with changes on each MCMI-II scale from pre- to post-treatment. Findings are discussed in terms of the utility of assessing personality characteristics in PD patients, dimensional versus categorical assessment of personality, and the impact of CBT on personality.

Cognitive behavioral treatment of panic disorder with agoraphobia in adolescents: A multiple baseline design analysis

In this study, four adolescents with Panic Disorder with Agoraphobia (PDAG) were treated using cognitive behavior therapy. A multiple baseline design across subjects was used to illustrate the controlling effects of treatment. Panic attacks were eliminated, agoraphobic avoidance was reduced, and self-efficacy for coping with future attacks was enhanced as a function of treatment. In addition, heightened levels of anxiety sensitivity, trait anxiety, fear, and depression were reduced to normative levels. Issues related to use of these procedures, and their extension to children, are addressed.

Cognitive Behavioral Treatment Compared With Nonprescriptive Treatment of Panic Disorder

The efficacy of cognitive behavioral treatment for panic disorder has been established in controlled studies. However, little is known about the efficacy of other psychological treatments. We report the results of a study comparing cognitive behavioral treatment with a focused nonprescriptive treatment for panic. Three sessions of panic-related information were provided in each treatment, followed by 12 sessions of either nonprescriptive, reflective listening (non-prescriptive treatment) or a treatment package that included breathing retraining, muscle relaxation, cognitive reframing, and exposure to interoceptive and agoraphobic stimuli (cognitive behavioral treatment). Posttreatment and 6-month follow-up assessments revealed a good response to both treatments. We observed a high rate of panic remission and significant improvement in associated symptoms in subjects in each treatment group. These findings raise questions about the specificity of cognitive behavioral treatment.