Group Therapy For Panic Disorder Research Articles

Cognitive behavioral group therapy for panic disorder in a general clinical setting: a prospective cohort study with 12 to 31-years follow-up

BackgroundThe long-term prognosis after cognitive behavioral therapy (CBT) in outpatient groups for panic disorder and agoraphobia is not well known. The purpose of this study was to assess long-term outcomes in terms of psychological health, health-related quality of life (HRQoL), quality of life (QoL) and treatment satisfaction after CBT for panic disorder and agoraphobia.MethodsThe sample consisted of 68 patients (61% response rate), who were assessed at pretreatment; at the start and end of treatment; and after 3 months, after 1 year, and over the long term (M = 24 years; SD = 5.3; range: 12 to 31 years). The main outcome was the total score on the Phobic Avoidance Rating Scale (PARS-total). At long-term follow-up, HRQoL was measured with the RAND-12 questionnaire, and QoL was measured with two questions from the “Study on European Union Statistics on Income and Living Conditions”. Patient experiences and treatment satisfaction were assessed by the Generic Short Patient Experiences Questionnaire. A marginal longitudinal model was applied to study the main outcome.ResultsThe effect size of the long-term change (mean change/ pooled SD) in the PARS-total score was (− 1.6, p < 0.001) and was stable over time. A PARS-total score reduction of 50% was found in 98% of patients at the long-term follow-up. The patients’ HRQoL and QoL were similar to the expected scores for the general Norwegian population. Of the patients, 95% reported high to very high satisfaction with the CBT, and 93% reported large treatment benefits.ConclusionsTo the best of our knowledge, this study has the longest follow-up after group CBT for panic disorder and agoraphobia, showing a good prognosis in ≥93% of the participating patients.

P.4.d.007 - The effect of early maladaptive schema on the treatment outcomes of cognitive-behavioural group therapy for panic disorder

P.4.d.007 - The effect of early maladaptive schema on the treatment outcomes of cognitive-behavioural group therapy for panic disorder

Sudden gains in exposure-focused cognitive-behavioral group therapy for panic disorder.

Sudden gains are common in panic disorder patients undergoing exposure-based cognitive-behavioral group therapy. Sudden gains during exposure-focused therapy are linked to greater improvement in panic disorder severity and functional impairment. The positive impact of sudden gains on panic disorder severity and functional impairment is maintained in the long term.

마음챙김 명상과 이정변기요법을 이용한 공황장애 그룹치료 효과에 대한 임상적 고찰

Objectives: This study was conducted to evaluate the clinical effects of group therapy for Panic dis-order patients based on Mindfulness & Li-Gyeung-Byun-Qi therapy.Methods: The FFMQ, BDI, STAI, STAXI, Panic attack, Anticipatory anxiety and subjective improvement of three Panic disorder patients were compared pre- and post-treatment when given Mindfulness & Li-Gyeung-Byun-Qi therapy.Results: 1) After the patient in case 1 underwent 5 weeks of group therapy for Panic disorder, the Mindfulness meditation score was slightly improved, anxiety and depression were significantly de-creased, and expression of anger was also improved. In addition, the Panic attack and Anticipatory anxiety became more stable in the objective evaluation, while 'Extreme improvement' was shown in the subjective evaluation. 2) After the patients in case 2 and 3 underwent 5 weeks of group therapy for Panic disorder, Mindfulness meditation scores were slightly improved, anxiety and depression were significantly decreased, and expression of anger was also improved. In addition, the Panic attack and Anticipatory anxiety became more stable in the objective evaluation, while 'Moderate improvements' were shown in the subjective evaluation.Conclusions: As per the results in these cases, it was shown that group therapy for Panic disorder utiliz-ing Mindfulness & Li-Gyeung-Byun-Qi therapy was effective to maintain meditation and control the emotions of anxiety, depression, anger and so on. Therefore, it was considered that expansion of clin-ical utilization through the standardization of a group therapy program for Panic disorder is needed. Furthermore, it was also considered that a comparat ive study of the effects of previous cognitive pro-grams for Panic disorder according to the objectified and standardized manual is needed in the future.Key Words: Panic disorder, Mindfulness, Li-Gyeung-Byun-Qi, Panic attack, Anticipatory anxiety. Group therapy.

Booster Sessions after Cognitive-Behavioural Group Therapy for Panic Disorder: Impact on Resilience, Coping, and Quality of Life.

Panic disorder (PD) has a chronic nature, especially as a result of maladaptive coping strategies to deal with stressful events. To evaluate the impact of booster sessions with cognitive techniques on coping strategies, resilience, and quality of life (QoL) in patients previously submitted to standard cognitive-behavioural group therapy (CBGT) for PD. A controlled clinical trial with 44 patients with PD (intervention = 20; control = 24) who had previously completed a 12-week CBGT protocol. PD, anxiety, and depression severity symptoms were assessed at baseline and 1, 6, and 12 months after the booster sessions. Coping strategies, resilience, and QoL were assessed by Coping Strategies Inventory (CSI), Resilience Scale, and WHOQOL-BREF respectively. Over time, a significant improvement in PD and depression symptoms was observed in both groups. A significant increase in the QoL social relations domain was found in the booster group, considering a time/group interaction. Coping and other QoL domains did not change after the booster sessions. Changes in resilience were dependent on the intensity of symptoms, with negative but non-significant correlations. The improvement in PD and depression symptoms for both groups may be a result of the group format of the intervention. Group booster sessions after CBGT are useful to maintain the benefits obtained with CBGT.

Applying the Quadruple Process model to evaluate change in implicit attitudinal responses during therapy for panic disorder

ObjectiveThis study explored the automatic and controlled processes that may influence performance on an implicit measure across cognitive-behavioral group therapy for panic disorder. MethodThe Quadruple Process model was applied to error scores from an Implicit Association Test evaluating associations between the concepts Me (vs. Not Me) + Calm (vs. Panicked) to evaluate four distinct processes: Association Activation, Detection, Guessing, and Overcoming Bias. Parameter estimates were calculated in the panic group (n = 28) across each treatment session where the IAT was administered, and at matched times when the IAT was completed in the healthy control group (n = 31). ResultsAssociation Activation for Me + Calm became stronger over treatment for participants in the panic group, demonstrating that it is possible to change automatically activated associations in memory (vs. simply overriding those associations) in a clinical sample via therapy. As well, the Guessing bias toward the calm category increased over treatment for participants in the panic group. ConclusionsThis research evaluates key tenets about the role of automatic processing in cognitive models of anxiety, and emphasizes the viability of changing the actual activation of automatic associations in the context of treatment, versus only changing a person's ability to use reflective processing to overcome biased automatic processing.

2366 – Booster sessions after cognitive-behavioral group therapy for panic disorder: impact on resilience, coping and quality of life

Panic Disorder (PD) tends to chronicity and one of the risk factors is the use of maladaptive coping strategies to deal with stressful events. To evaluate the response to booster sessions with cognitive techniques of coping strategies on resilience and on quality of life (QoL) of patients who received standard cognitive-behavioral group therapy (CBGT) for PD. A controlled clinical trial with 44 patients with PD (intervention= 20 and control= 24) who previously completed the 12-week CBGT protocol. PD, anxiety, and depression severity symptoms were assessed at baseline and 1, 6 and 12 months after the booster sessions. Coping strategies, resilience and QoL were assessed by Coping Strategies Inventory (CSI), Resilience Scale and WHOQOL-BREF, respectively. Considering the outcome ‘time,’ a significant improvement of PD and depression symptoms was observed in both groups. A significant increase in QoL domain of social relations for the intervention group was found, considering a time*group interaction. There was no significant difference on coping and other QoL domains. Changes on resilience were dependent on the symptoms intensity, and the correlations were negative. The improvement of PD and depression symptoms for both groups may be related to the therapeutic factors of the group sessions format. Therefore, booster sessions with groups after CBGT may benefit patients with PD regardless the use of specific cognitive techniques.

Do patterns of change during treatment for panic disorder predict future panic symptoms?

Background and objectivesCognitive-behavioral therapies are currently the gold standard for panic disorder treatment, with well-documented treatment response. However, following interventions, some individuals continue to improve, while others experience a return of symptoms. The field lacks reliable ways to predict follow-up symptomatology. In the current study, a cluster analysis with a repeated measures design was conducted to examine change patterns over 12 weeks of cognitive behavioral group therapy for panic disorder. The central aim of the study was to evaluate if change patterns predict level of panic symptom severity at a six month follow-up in this sample. MethodsIndividuals with panic disorder (N = 36) completed a measure of panic symptoms (Panic Disorder Severity Scale) at the outset of every therapy session and at a six month follow-up. ResultsResults revealed three patterns of change in this specific trial, which significantly predicted level of panic symptoms six months post-treatment, beyond initial or final level of panic symptoms, and beyond total symptom change. LimitationsGiven the relatively small, lab-based sample, replications in other settings and samples will be important. ConclusionsOverall, results provide initial evidence that change patterns are meaningful predictors of panic symptom severity well after the final session of treatment.

Impact of Alexithymia on Treatment Outcome: A Naturalistic Study of Short-Term Cognitive-Behavioral Group Therapy for Panic Disorder

Background: It is often suggested in the literature that alexithymic patients are less responsive to psychotherapy than nonalexithymic patients. However, few empirical studies have examined this issue. Furthermore, it is unclear whether or not alexithymia itself may improve during psychotherapy. Methods: Fifty-five consecutive outpatients with panic disorder received short-term cognitive-behavioral group therapy (CBGT) and were followed up 6 months later. Nineteen patients (35%) were on concomitant antidepressant medication. Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20). Both completers and intention-to-treat analyses were calculated, taking into consideration the potentially confounding effect of comorbid conditions. Results: Baseline alexithymia did not predict outcome of CBGT, neither at posttreatment nor at follow-up. The presence of comorbid axis I disorders predicted nonresponse at posttreatment but not at follow-up. TAS-20 total scores decreased over time, with the TAS-20 factors 1 (difficulty identifying feelings) and 2 (difficulty describing feelings) decreasing significantly, while factor 3 (externally oriented thinking) remained largely stable. Conclusions: These findings are encouraging for cognitive-behavioral therapists working with patients with alexithymia who suffer from panic disorder: CBGT outcome does not appear to be negatively affected by alexithymia, and some alexithymic characteristics may even be reduced following CBGT. Assessing alexithymia at treatment onset may be useful for individually tailoring therapeutic interventions.

Changes in quality of life following cognitive-behavioral group therapy for panic disorder

Background Data about quality of life (QoL) are important to estimate the impact of diseases on functioning and well-being. The present study was designed to assess the association of different aspects of panic disorder (PD) with QoL and to examine the relationship between QoL and symptomatic outcome following brief cognitive-behavioral group therapy (CBGT). Method The sample consisted of 55 consecutively recruited outpatients suffering from PD who underwent CBGT. QoL was assessed by the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) at baseline, post-treatment and six months follow-up. SF-36 baseline scores were compared with normative data obtained from a large German population sample. Results Agoraphobia, disability, and worries about health were significantly associated with decreased QoL, whereas frequency, severity and duration of panic attacks were not. Treatment responders showed significantly better QoL than non-responders. PD symptom reduction following CBGT was associated with considerable improvement in emotional and physical aspects of QoL. However, the vitality subscale of the SF-36 remained largely unchanged over time. Conclusions Our results are encouraging for cognitive-behavior therapists who treat patients suffering from PD in groups, since decrease of PD symptoms appears to be associated with considerable improvements in QoL. Nevertheless, additional interventions designed to target specific aspects of QoL, in particular vitality, may be useful to enhance patients’ well-being.

P03-65 Assessing response to cognitive-behavioral group therapy for panic disorder with comorbid mood disorders

Objective:To evaluate the response to group cognitive-behavioral therapy (CBGT) for panic disorder (PD) in patients with and without comorbid mood disorders (MD).Method:A total of 113 patients took part in 12 CBGT sessions for PD. the diagnoses of PD and comorbid MD (depression and/or dysthymia) were established using the Mini International Neuropsychiatric Interview (MINI). Outcome measures were assessed by Clinical Global Impression (CGI), Hamilton-Anxiety and Panic Inventory. Remission was considered when CGI ≤ 2 and there was absence of panic attacks.Results:One-hundred patients (91%) completed the CBGT protocol and 37(32.7%) patients had PD with comorbid MD. at the end of the treatment, 41 (36.3%) patients met criteria for symptom remission. the remission rates were 47.4% in patients without MD versus 13.5% in patients presenting with comorbid MD (RR = 3.50; IC95%[1.5 to 8.19]; p &lt; 0.001). both groups showed significant improvement on all clinical outcomes throughout treatment. A differential effect was identified between those with and those without comorbid MD both in the CGI (pgroup x time = 0.020) and in anticipatory anxiety (pgroup x time = 0.017).Conclusions:Panic patients without MD improved better to CBGT than those with MD. Maybe more sessions regarding depression should be added to the protocol in this subgroup of patients with MD. However, given that there is a general reduction of PD symptoms in all patients, CBGT must not be excluded.

Standard versus massed cognitive behavioural group therapy for panic disorder

Standard versus massed cognitive behavioural group therapy for panic disorder