Cognitive Therapy For Panic Disorder Research Articles

Factors Associated with Treatment Outcomes in Mindfulness-Based Cognitive Therapy for Panic Disorder

PurposeAlthough the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for panic disorder (PD) has been studied previously, data on the predictors of treatment outcomes in MBCT for PD are scarce.Materials and MethodsEighty patients with PD were screened to analyze treatment outcomes such as MBCT completion, treatment response, and remission after undergoing MBCT for PD. Sociodemographic characteristics, comorbid personality disorders, and baseline medication doses were examined. The study administered the Panic Disorder Severity Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale and Anxiety Sensitivity Inventory-Revised to patients at baseline and at eight weeks.ResultsSixty-five participants were enrolled in the present study. Comorbid personality disorder was significantly associated with MBCT non-completion. We found that anxiety sensitivity (AS) improvement after an eight week MBCT program was a statistically significant factor associated with treatment response. Using logistic regression analysis, AS improvement after MBCT showed significant association with PD remission after MBCT.ConclusionComorbid personality disorders of participants could be a potential predictor of MBCT non-completion. Furthermore, AS improvement after MBCT may predict treatment response and remission after MBCT for PD. However, better designed studies with a larger number of patients are needed to confirm our findings.

MEDICAL INFORMATION IN THE STRUCTURE OF COGNITIVE THERAPY FOR PANIC DISORDER

The paper describes the procedure of cognitive therapy for panic disorder, which is based on the explanation of the nature of physical and psychopathological symptoms of anxiety.

Dissemination of Cognitive Therapy for Panic Disorder in Primary Care.

This study investigated whether brief training in cognitive therapy for panic disorder (Clark et al., 1994) can improve the outcomes that primary care therapists obtain with their patients. Seven primary care therapists treated 36 patients meeting DSM-IV (APA, 1994) criteria for panic disorder with or without agoraphobia in general practice surgeries. Outcomes for the cohort of patients whom the therapists treated with their usual methods (treatment-as-usual) before the training (N = 12) were compared with those obtained with similar patients treated by the same therapists after brief training and ongoing supervision in cognitive therapy (CT) for panic disorder (N = 24). Treatment-as-usual led to significant improvements in panic severity, general anxiety, and depression. However, only a small proportion (17% of the intent-to-treat sample) became panic free and there was no improvement in agoraphobic avoidance. Patients treated with CT achieved significantly better outcomes on all measures of panic attacks, including panic-free rate (54%, intent-to-treat), and showed significantly greater improvements in agoraphobic avoidance and patient-rated general anxiety. In conclusion, cognitive therapy for panic disorder can be successfully disseminated in primary care with a brief therapist training and supervision programme that leads to significant improvements in patient outcomes.

Mechanisms of change in cognitive therapy for panic disorder with agoraphobia

The purpose of this study was to test the predictions of an integrated cognitive and behavioral model of agoraphobic avoidance in patients with chronic panic disorder and agoraphobia during the process of observed therapeutic change. Treatment was residential with the majority ( n=165, 88%) receiving cognitive therapy, while the remaining 23 (12%) received guided mastery therapy. The results of latent variable path modeling of the changes occurring over the course of this treatment suggested that the anxiety elicited by bodily sensations influenced catastrophic beliefs, which, in turn, increased avoidance. Avoidance increased the anxiety elicited by bodily sensations.

The Change Process in a Cognitive-Behavioral Therapy: Testing a Cognitive, a Behavioral, and an Integrated Model of Panic Disorder With Agoraphobia

The authors investigated the relationship among catastrophic cognitions, fear of bodily sensations, and avoidance in patients undergoing cognitive therapy for panic disorder with agoraphobia to determine which of three theoretical models was most consistent with their data, which were analyzed by structural modeling techniques. The final path model indicated a three-step change process. Beliefs about losing control predicted a fear of bodily sensations. A fear of bodily sensations, in turn, predicted both avoidance and a conviction of a looming physical catastrophe. The results, although preliminary, are consistent with an integrated behavioral and cognitive model for understanding the intratherapeutic relationship among these variables.

Cognitive therapy for panic disorder: The impact of medication discontinuation on symptoms

Little is known about the impact of withdrawal and discontinuation of medication during cognitive treatment for panic disorder. This naturalistic study was designed to gather initial evidence on this question. The sample for this study consisted of patients who had participated in a comparative outcome study on cognitive therapy for panic disorder. Of 21 patients who were taking medication while receiving cognitive therapy, 9 were able to withdraw from their medication by termination, and remained medication-free at 1-year follow-up. The results revealed a significant decrease in the frequency of panic attacks and improvement on other symptom measures at termination and at 1-year follow-up, regardless of medication status. Withdrawal and discontinuation of medication did not result in relapse and did not reduce the effectiveness of cognitive therapy. Implications for clinical decision making are described.

Brief cognitive therapy for panic disorder: A randomized controlled trial.

Brief cognitive therapy for panic disorder: A randomized controlled trial.

A Comparison of Focused and Standard Cognitive Therapy for Panic Disorder

The relative efficacy of two psychotherapeutic approaches to panic disorder, namely, focused cognitive therapy (FCT) and standard cognitive therapy (SCT) was examined. FCT focused specifically on the “catastrophic misinterpretation” of physical and psychological sensations experienced during panic attacks induced in the office or occurring spontaneously between sessions. SCT focused primarily on the cognitions and beliefs relevant to interpersonal concerns involved in generalized anxiety. We hypothesized that FCT would be more effective than SCT since the latter did not include an induced panic exercise (exposure condition) specific to the patient's panicogenic cognitions. Forty patients diagnosed with panic disorder were randomly assigned to the SCT and FCT groups for approximately 12 to 18 sessions of treatment. Both groups reported significant decreases in the severity of the clinical measures at termination. Moreover, 89.5% of the SCT group and 84.2% of the FCT group were free of panic attacks at 1-year follow-up. Contrary to the predictions, the results for measures of panic attack frequency, anxiety, and depression did not reveal any significant differences between the two groups. Results suggest that in-office “exposure” is not necessary for improvement and that a primary focus on cognitions associated with generalized anxiety may be an effective intervention. However, since improvement in panic was correlated with normalizing of panic-related beliefs in both conditions, it is suggested that cognitive change may be a crucial ingredient of improvement in panic episodes. © 1997 Elsevier Science Ltd