Specific Cognitive-behavioral Therapy Research Articles

A Meta-Analytical Approach of the Relationships Between the Irrationality of Beliefs and the Functionality of Automatic Thoughts

Although irrational beliefs (IBs) and automatic thoughts (ATs) have been proposed as mechanisms that contribute to psychopathology in the Cognitive Behavioral Therapy (CBT) model, surprisingly, no previous study systematically evaluated the magnitude and direction of the relationship between the two central constructs. Therefore, the present meta-analysis aimed to evaluate this association, considering its theoretical and clinical importance. We conducted a systematic search of the literature and included 34 experimental and correlational studies suited for the purpose of this meta-analysis, comprising 5086 participants. Results indicated a significant (p < .001) medium sized association (r = .43) for the relationship between the irrationality of beliefs and the functionality of ATs, higher levels of IBs being associated with more dysfunctional ATs. The magnitude of the relationship does not depend on the specific CBT theoretical model through which the two variables were approached and it is not influenced by the context, nor by the object of the beliefs. However, the content of beliefs appears to impact on this relationship, given that the results revealed a significant (p < .001) large effect size (r = .58) for the association of ATs with certainty beliefs, but no association was present for control beliefs. Results also suggest that primary and secondary IBs equally impact on ATs’ functionality and should be equally addressed in psychological interventions. Further theoretical and practical implications, and future directions are discussed.

Cognitive behavioral therapy program for cannabis use cessation in first-episode psychosis patients: study protocol for a randomized controlled trial.

BackgroundThe high rate of cannabis use among patients with first-episode psychosis (FEP), as well as the associated negative impact on illness course and treatment outcomes, underlines the need for effective interventions in these populations. However, to date, there have been few clinical treatment trials (of pharmacological or psychological interventions) that have specifically focused on addressing comorbid cannabis use among these patients. The aim of this paper is to describe the design of a study protocol for a randomized controlled trial in which the objective is to assess the efficacy of a specific cognitive behavioral therapy program for cannabis cessation in patients with FEP compared to standard treatment (psychoeducation).Methods/designThis is a single-blind randomized study with 1 year of follow-up. Patients are to be randomly assigned to one of two treatments: (1) specific cognitive behavioral therapy for cannabis cessation composed of 1-hour sessions once a week for 16 weeks, in addition to pharmacological treatment scheduled by the psychiatrist, or (2) a control group (psychoeducation + pharmacological treatment) following the same format as the experimental group. Participants in both groups will be evaluated at baseline (pre-treatment), at 16 weeks (post-treatment), and at 3 and 6 months and 1 year of follow-up. The primary outcome will be that patients in the experimental group will have greater cannabis cessation than patients in the control group at post-treatment. The secondary outcome will be that the experimental group will have better clinical and functional outcomes than the control group.DiscussionThis study provides the description of a clinical trial design based on specific cognitive behavioral therapy for cannabis cessation in FEP patients, aiming to improve clinical and functional outcome, as well as tackling the addictive disorder.Trial registrationNCT02319746 ClinicalTrials.gov Identifier. ClinicalTrials.gov Protocol and Results Registration System (PRS) Receipt Release Date: 15 December 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1507-x) contains supplementary material, which is available to authorized users.

Randomized Controlled Trial of Group-Based Culturally Specific Cognitive Behavioral Therapy Among African American Smokers

This study tested the efficacy of group-based culturally specific cognitive behavioral therapy (CBT) for smoking cessation among low-income African Americans. Participants (N = 342; 63.8% male; M = 49.5 years old; M cigarettes per day = 18) were randomly assigned to eight sessions of group-based culturally specific or standard CBT, plus 8 weeks of transdermal nicotine patches. Biochemically verified 7-day point prevalence abstinence (ppa) was assessed at the end-of-therapy (ie, CBT) (EOT), and 3-, 6-, and 12-month follow-ups. Primary outcomes were the longitudinal intervention effect over the 12-month follow-up period, and 7-day ppa at the 6-month follow-up. Secondary outcomes included 7-day ppa at the EOT and 12-month follow-up, and intervention ratings. Generalized linear mixed modeling tested the longitudinal effect and logistic regression tested effects at specific timepoints. Generalized linear mixed modeling demonstrated a longitudinal effect of intervention condition. Specifically, 7-day ppa was two times (P = .02) greater following culturally specific CBT versus standard CBT when tested across all timepoints. Analyses by timepoint found no significant difference at 6 or 12 months, yet culturally specific CBT was efficacious at the EOT (62.5% vs. 51.5% abstinence, P = .05) and the 3-month follow-up (36.4% vs. 22.9% abstinence, P = .007). Finally, intervention ratings in both conditions were high, with no significant differences. Culturally specific CBT had a positive longitudinal effect on smoking cessation compared to a standard approach; however, the effects were driven by short-term successes. We recommend the use of group-based culturally specific CBT in this population when possible, and future research on methods to prevent long-term relapse. Culturally specific interventions are one approach to address smoking-related health disparities; however, evidence for their efficacy in African Americans is equivocal. Moreover, the methodological limitations of the existing literature preclude an answer to this fundamental question. We found a positive longitudinal effect of culturally specific CBT versus standard CBT for smoking cessation across the follow-up period. Analyses by assessment point revealed that the overall effect was driven by early successes. Best practices for treating tobacco use in this population should attend to ethnocultural factors, but when this is not possible, standard CBT is an alternative approach for facilitating long-term abstinence.

Cognitive-Behavioral Treatment of Posttraumatic Stress in Patients With Implantable Cardioverter Defibrillators: Results From a Randomized Controlled Trial.

Approximately 20% of patients with implantable cardioverter defibrillators (ICDs) suffer from posttraumatic stress disorder (PTSD) due to a history of cardiac arrest, device implantation, and ICD shock. There has been very little examination of treatment of PTSD symptoms in these patients. This study evaluated the effect of a specific cognitive-behavioral therapy (CBT) intervention for ICD patients with high levels of PTSD symptoms: a manualized program consisting of 8 telephone sessions with a trained counselor, a patient education book, and a stress management procedure on compact disc. Participants were 193 ICD patients, who were randomized to CBT or usual cardiac care (UCC) who completed self-report surveys at the time of recruitment and 6 and 12 months after initial measurement. Previous publication on the primary research evaluation questions reported that the CBT condition resulted in greater improvement on PTSD and depression symptoms than the UCC for the general population of ICD patients, but did not evaluate the effect on those with elevated symptoms of PTSD. The authors conducted secondary analyses of the effect of treatment on high and low PTSD symptom groups based on a cutoff for the Impact of Event Scale-Revised (Weiss & Marmar, 1997). Participants in the CBT group who had high symptoms experienced significantly greater symptom reduction from baseline to 12 months (d = 2.44, p = .021) than the UCC group (d = 1.12). Participants with low symptoms had small reductions regardless of group assignment (d = 0.16, p = .031). ICD-focused CBT was sufficient to produce a large, statistically significant reduction in PTSD symptoms in ICD patients with indications for treatment.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a psychotherapeutic approach that addresses unhelpful cognitions and behaviours that result in distress. It has been shown to be effective in the management of anxiety disorders, depression, eating disorders, chronic pain syndromes and personality disorders. Although there is a clear need for CBT services, access to them remains limited. GPs cannot be expected to fill this gap, but specific CBT techniques can help in the management of common conditions. In this paper, we will discuss several CBT techniques that a clinician can apply in 10-minute consultations with a case study to espouse how the techniques can be implemented in clinical practice.

Nightmare Frequency, Nightmare Distress and the Efficiency of Trauma-Focused Cognitive Behavioral Therapy for Post-Traumatic Stress Disorder.

BackgroundUp to 71% of trauma victims diagnosed with PTSD have frequent nightmares (NM), compared to only 2% to 5% of the general population.ObjectivesThe present study examined whether nightmares before the beginning of cognitive behavior therapy (CBT) for post-traumatic stress disorder (PTSD) could influence overall PTSD symptom reduction for 71 individuals with PTSD and different types of traumatic events.Patients and MethodsParticipants received a validated CBT of 20 weekly individual sessions. They were evaluated at five measurement times: at pre-treatment, after the third and ninth session, at post-treatment, and at 6 months follow-up.ResultsThe presence of nightmares did not impact overall CBT efficiency. Specific CBT components were efficient in reducing the frequency and distress of nightmares.ConclusionsMost participants no longer had PTSD but some still had nightmares.

Treatment of Compulsive Hoarding: A Case Study 

The present case report describes an intensive treatment approach combining aggressive pharmacotherapy with daily cognitive behavioral therapy (CBT) directed at helping “Dee,” a 63-year-old female suffering from compulsive hoarding. The successful intervention consisted of individualized exposure and response prevention (ERP), in addition to cognitive restructuring to improve insight, decrease depressive and general anxiety symptoms, and address distorted beliefs. Pretreatment evaluation included assessment of clutter for all living spaces, including rooms in the house in addition to the car. After the six-week intensive treatment program, clutter decreased substantially in each of the rooms targeted for intervention. In addition, Dee’s scores on self-reported measures of obsessive-compulsive symptoms and anxiety steadily decreased during the intervention. Compulsive hoarding, when present in patients with obsessive-compulsive disorder (OCD), has been associated with poor response to both antianxiety medications and typical CBT. This case report illustrates that specific CBT strategies targeting the characteristic features of compulsive hoarding may provide better results for patients suffering from compulsive hoarding syndrome.

The psychosocial dimensions of fatigue in men treated for prostate cancer

ABSTRACTProstate cancer is one of the most prevalent forms of cancer in men worldwide. Cancer‐related fatigue (CRF) is the most frequently reported side effect of all cancer treatments and occurs in up to 74% of men treated for prostate cancer, particularly those receiving combined hormone and radiation therapies. Patients report the devastating impact of CRF on their quality of life and psychosocial functioning, affecting work, social, emotional and cognitive performance. It can manifest during treatment and persist long after its completion. A diagnosis of CRF is achieved once all other treatable factors such as anaemia or anxiety and depression have been managed, but does not alleviate the fatigue. The Functional Assessment of Cancer Therapy‐Fatigue (FACT‐F) is a brief and easily administered valid and reliable tool recommended for the assessment of CRF. Non‐pharmacological interventions such as activity‐based programs and psychosocial interventions including prostate cancer specific education and cognitive behavioural therapy have shown benefits in reducing levels of CRF. A multidisciplinary approach to the management of CRF in prostate cancer patients is advocated. The NICE four‐tier model of psychological support can be used as a framework to assist nurses and other health care professionals to alleviate the psychosocial burden of CRF. More research studies using a solid methodological foundation are required in men with prostate cancer to provide robust evidence which can be applied in practice.

Specific and general therapeutic mechanisms in cognitive behavioral treatment of chronic pain.

Many studies document efficacy of cognitive behavioral therapy (CBT) for chronic pain, but few studies have examined potential treatment mechanisms. In analyses of data from a controlled trial, we examined whether changes in attitudes toward adopting a pain self-management approach-CBT-specific mechanisms-and quality of working alliance and patient expectations-general mechanisms-early in treatment were related to later-treatment changes in outcomes. Our sample was composed of 94 adults (primarily White; mean age: 55.3 years, SD = 11.7; 23% female) who participated in enhanced or standard CBT, and completed measures of attitudes toward self-management (mechanisms), pain intensity, pain interference, depressive symptoms and goal accomplishment (outcomes) at pretreatment, 4- and 8-week assessments, and posttreatment. Working alliance was measured at 4 and 8 weeks, and patient expectations at 3 weeks. Because the CBT conditions produced comparable improvements, we combined them. Precontemplation and action attitudes toward pain self-management showed significant quadratic trends over assessments such that 67% and 94.1% (respectively) of total pre-post changes occurred in the first 4 weeks. Outcomes showed only significant linear trends. Cross-lagged regressions revealed that pretreatment-to-4-week changes in action attitudes and 4-week levels of working alliance were related significantly with 4-week-to-posttreatment changes in pain intensity and interference but not vice versa and that 3-week patient expectations were related to 4-week-to-posttreatment changes in interference. Analyses in which mechanism factors were entered simultaneously revealed nonsignificant unique effects on outcomes. Adopting an action attitude early in treatment may represent a specific CBT mechanism but with effects held largely in common with 2 general mechanisms.

Trajectories of change in youth anxiety during cognitive-behavior therapy.

To evaluate changes in the trajectory of youth anxiety following the introduction of specific cognitive-behavior therapy (CBT) components: relaxation training, cognitive restructuring, and exposure tasks. Four hundred eighty-eight youths ages 7-17 years (50% female; 74% ≤ 12 years) were randomly assigned to receive either CBT, sertraline (SRT), their combination (COMB), or pill placebo (PBO) as part of their participation in the Child/Adolescent Anxiety Multimodal Study (CAMS). Youths in the CBT conditions were evaluated weekly by therapists using the Clinical Global Impression Scale-Severity (CGI-S; Guy, 1976) and the Children's Global Assessment Scale (CGAS; Shaffer et al., 1983) and every 4 weeks by blind independent evaluators (IEs) using the Pediatric Anxiety Ratings Scale (PARS; RUPP Anxiety Study Group, 2002). Youths in SRT and PBO were included as controls. Longitudinal discontinuity analyses indicated that the introduction of both cognitive restructuring (e.g., changing self-talk) and exposure tasks significantly accelerated the rate of progress on measures of symptom severity and global functioning moving forward in treatment; the introduction of relaxation training had limited impact. Counter to expectations, no strategy altered the rate of progress in the specific domain of anxiety that it was intended to target (i.e., somatic symptoms, anxious self-talk, avoidance behavior). Findings support CBT theory and suggest that cognitive restructuring and exposure tasks each make substantial contributions to improvement in youth anxiety. Implications for future research are discussed. (PsycINFO Database Record

Adolescent bulimia nervosa (BN): a new therapeutic frontier

Enhanced Cognitive Behaviour Therapy (CBT-E) continues to gather evidence as the first line of treatment for Bulimia Nervosa (BN) in adulthood. However, there is limited evidence for empirically validated therapies for children and adolescents, despite the serious impact of medical complications during adolescence. In recent years, investigation into the effectiveness of Family Based Treatment (FBT) for BN has been instigated. It has been proposed that FBT may be particularly helpful for BN, by combating the secretive and shameful nature of BN, and increasing adolescent collaboration. The following case study contrasts the delivery of FBT to two adolescents presenting with BN; one is augmented with CBT-E. In both cases, the adolescents achieved remission from BN symptoms, with a cessation of bingeing and/or compensatory behaviours at the end of treatment. Parents and adolescents reported feeling as though FBT provided a platform to work together and view BN as a family issue, rather than leaving the onus on the young person to recover independently. Both families reported higher levels of cohesion at the end of treatment, and parents reported feeling more empowered to help their offspring. The application of specific CBT-E strategies was also reported as integral in achieving recovery. Further research in this area is indicated. This abstract was presented in the Treatment in Community and Inpatient Settings stream of the 2014 ANZAED Conference.

Treatment moderators of cognitive behavior therapy to reduce aggressive behavior: a meta-analysis.

Maladaptive aggression in adolescents is an increasing public health concern. Cognitive Behavior Therapy (CBT) is one of the most common and promising treatments of aggression. However, there is a lack of information on predictors of treatment response regarding CBT. Therefore, a meta-analysis was performed examining the role of predictors on treatment response of CBT. Twenty-five studies were evaluated (including 2,302 participants; 1,580 boys and 722 girls), and retrieved through searches on PubMed, PsycINFO and EMBASE. Effect sizes were calculated for studies that met inclusion criteria. Study population differences and specific CBT characteristics were examined for their explanatory power. There was substantial variation across studies in design and outcome variables. The meta-analysis showed a medium treatment effect for CBT to reduce aggression (Cohen'd=0.50). No predictors of treatment response were found in the meta-analysis. Only two studies did examine whether proactive versus reactive aggression could be a moderator of treatment outcome, and no effect was found of this subtyping of aggression. These study results suggest that CBT is effective in reducing maladaptive aggression. Furthermore, treatment setting and duration did not seem to influence treatment effect, which shows the need for development of more cost-effective and less-invasive interventions. More research is needed on moderators of outcome of CBT, including proactive versus reactive aggression. This requires better standardization of design, predictors, and outcome measures across studies.

Cognitive-Behavioral Therapy for Individuals with Schizophrenia: A Recovery Approach

There is growing evidence that recovery in the presence of schizophrenia is achievable. Taken from the perspective of those experiencing this illness, recovery may or may not involve complete symptom relief and seems to occur in stages involving the restoration of stability, self-efficacy, self-esteem, and a sense of connectedness to the world. Cognitive-behavioral therapy (CBT) is now a well-established treatment for the positive symptoms of psychosis, and preliminary data suggest that it might be effective in aiding other aspects of recovery. In an effort to facilitate a more systematic approach to psychotherapy for individuals with schizophrenia, we present a framework that integrates specific recovery tasks and CBT techniques that are well suited for achieving them.

Effectiveness of brief training in cognitive-behaviour therapy techniques for staff working with people with intellectual disabilities

Purpose – There is little research addressing the delivery of training for health professionals who are interested in using cognitive-behaviour therapy (CBT) techniques as an adjunct to their current role. This paper describes the establishment and evaluation of a CBT training course to develop CBT skills in staff working with people with intellectual disabilities in Trust healthcare settings. The course would enable staff to learn how they could incorporate these skills into their daily practice to help them understand and work more effectively with people with intellectual disabilities. Design/methodology/approach – A CBT training course was designed to teach staff the use of a number of basic and specific CBT techniques and principles that staff could use within their current roles. Specific issues in relation to people with intellectual disabilities were included, e.g. understanding cognitive deficits as well as cognitive distortions. The course ran for six sessions on a fortnightly basis, followed by a two-month follow-up session. Participants completed a pre- and post-assessment questionnaire and kept a reflective diary. Findings – The training clearly focused on teaching skills that were feasible for staff to use in their own work settings. The evaluations, especially from the reflective diaries and the post-course questionnaires clearly demonstrated that this aim was achieved. Originality/value – This was a pilot study as there has been no previously published evidence of using this approach within intellectual disabilities services. A further training course has been planned to continue evaluating the effectiveness of this approach.

Culturally specific versus standard group cognitive behavioral therapy for smoking cessation among African Americans: an RCT protocol.

BackgroundAfrican American smokers experience disproportionately higher rates of tobacco-related illnesses compared to Caucasians. It has been suggested that interventions targeted to specific racial/ethnic groups (i.e., culturally specific) are needed; however, the literature examining the efficacy of culturally specific interventions is equivocal. Moreover, there are few descriptions of methods used to create these interventions. The main aim of this study is to test the efficacy of a culturally specific smoking cessation intervention among African Americans.Methods/DesignA 2-arm randomized controlled trial (RCT) will be conducted to assess the efficacy of a culturally specific group cognitive behavioral therapy (CBT), compared to standard group CBT among treatment-seeking smokers from the community. Participants in both conditions receive the transdermal nicotine patch (TNP) for 8-weeks. We intend to randomize at least 247 adult smokers who self-identify as African American into the trial. Enrolled participants are block randomized into one of two groups: Standard group CBT (control) or a culturally specific group CBT (CS-CBT). Groups are matched for time and attention, and consist of eight sessions. The primary outcome variable is 7-day point prevalence abstinence (7-day ppa). Smoking status is assessed at the end-of-counseling (EOC), and 3, 6, and 12-month follow-ups, with self-reported abstinence verified by saliva cotinine. We hypothesize that the CS-CBT condition will produce significantly greater smoking cessation rates compared to the control condition. We also expect that this effect will be moderated by acculturation and ethnic identity, such that the CS-CBT will show the greatest effect on cessation among participants who are less acculturated and have greater ethnic identity.DiscussionAnswering the fundamental question of whether culturally specific interventions lead to incremental efficacy over established, evidence-based approaches is of utmost importance. This study will have implications for the development and implementation of smoking cessation interventions among African Americans and other racial/ethnic minority groups.Trial registrationNCT01811758

Regensburg Insomnia Scale (RIS): a new short rating scale for the assessment of psychological symptoms and sleep in insomnia; Study design: development and validation of a new short self-rating scale in a sample of 218 patients suffering from insomnia and 94 healthy controls

BackgroundThe Regensburg Insomnia Scale (RIS) is a new self-rating scale to assess cognitive, emotional and behavioural aspects of psychophysiological insomnia (PI) with only ten items. A specific purpose of the new scale is the evaluation of the outcome of insomnia- specific cognitive behaviour therapy (CBT-I).MethodsInternal consistency of the RIS has been validated in 218 patients with PI. For determining sensitivity and specificity, this sample has been compared to 94 healthy controls. Sensitivity to change and pre-post cross-validation with the Pittsburgh Sleep Quality Index (PSQI) has been tested in a separate sample of 38 patients with PI undergoing CBT-I.ResultsRIS distinguishes well between controls and patients with PI. Internal consistency was within a good range (Cronbach alpha = .890). RIS was sensitive for detecting improvements after CBT-I in sleep parameters and target symptoms such as sleep-related thinking.ConclusionThe RIS is a valid and feasible instrument for assessing psychological PI-symptoms and sleep parameters.

2783 – Distress level and treatment outcome in obsessive-compulsive personality disorder (OCPD)

Previous research has linked OCPD with increased distress levels that may lead to differences in treatment response. The present study aimed to investigate the influence of pre-treatment distress on patient's response to groupbased cognitive-behavioral therapy (CBT) for OCPD. 116 out-patients who met DSM-IV-TR diagnostic criteria for OCPD completed a pre-treatment assessment including BDI, STAI, STAXI-2, GRAI and Rosemberg Self-Esteem Scale. Pre-treatment distress was operationalized as depression and anxiety levels. Intervention was comprised of ten group sessions including psychoeducation, specific CBT techniques and relapse prevention. In order to assess treatment response after intervention, the sample was divided in two groups: 1) discharged patients - responders and 2) patients who needed to continue treatment - non responders. Assessment scores were compared using t test in order to analyze differences between groups. The extent to which potential predictor variables were related to treatment response was assessed using logistic regression. Results showed statistically significant differences (p < 0.05) in depressed mood and state anxiety scores between responder and non-responder groups. Initial variable selection for logistic regression model included age, sex, depression, anxiety, anger, assertiveness and selfesteem scores. The final model included state anxiety as a significant predictor of treatment response. Our findings indicate that responder patients had lower pre-treatment distress levels than non-responder patients and that state anxiety score is a significant predictor of group-based CBT response in OCPD. According to this, pretreatment distress levels might be considered for treatment planning, despite more research in this direction would be necessary.

What cognitive behavioral techniques do therapists report using when delivering cognitive behavioral therapy for the eating disorders?

Clinicians commonly "drift" away from using proven therapeutic techniques. This study examined the degree to which such drift occurs among cognitive behavioral therapy (CBT) clinicians working with a specific clinical population-adults with eating disorders. The study used a correlational design. The participants were 80 qualified clinicians (69 women, 11 men; mean age = 39.2 years, range = 23-62 years) who routinely offered what they described as CBT to adults with eating disorders. Each clinician detailed whether and how often he or she used different cognitive behavioral techniques when delivering CBT to such patients, and each completed the anxiety scale of the Brief Symptom Inventory (Derogatis, 1983). Implementation of specific CBT techniques was far lower than protocols would suggest, particularly for clinicians who were anxious, older, or more experienced in working with the eating disorders (p < .05, in all cases). The use of treatment manuals was associated with greater use of recommended CBT techniques (p < .05, in all cases). Cluster analysis showed that clinicians fell into three types-behavior, motivation, and mindfulness oriented. These findings need to be extended to other therapies and other disorders, but they indicate the need for stronger training and closer supervision if clinicians are to give patients the best chance of recovery. They demonstrate that clinicians' use of the label CBT is not a reliable indicator of the therapy that is being offered.

ECP06-01 - How to improve communication with persons with psychosis

This interactive workshop will focus on experiences and challenges of communicating with patients about psychosis. It is based on research identifying what works and what does not work in naturally occurring communication between psychiatrists and psychotic patients. It will include a voices simulation exercise, learning specific cognitive behaviour therapy techniques (e.g. Socratic questioning, normalising) and applying them in role play exercises. Participants will work in small groups and there will be time for feedback and questions with the larger group.

Efficacy of a specific model for cognitive-behavioral therapy among panic disorder patients with agoraphobia: a randomized clinical trial.

Cognitive-behavioral therapy is frequently indicated for panic disorder. The aim here was to evaluate the efficacy of a model for cognitive-behavioral therapy for treating panic disorder with agoraphobia. Randomized clinical trial at Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. A group of 50 patients with a diagnosis of panic disorder with agoraphobia was randomized into two groups to receive: a) cognitive-behavioral therapy with medication; or b) medication (tricyclic antidepressants or selective serotonin reuptake inhibitors). Although there was no difference between the groups after the treatment in relation to almost all variables with the exception of some items of the Sheehan disability scale and the psychosocial and environmental problems scale, the patients who received the specific therapy presented significant reductions in panic attacks, anticipatory anxiety, agoraphobia avoidance and fear of body sensations at the end of the study, in relation to the group without the therapy. On the overall functioning assessment scale, overall wellbeing increased from 60.8% to 72.5% among the patients in the group with therapy, thus differing from the group without therapy. Although both groups responded to the treatment and improved, we only observed significant differences between the interventions on some scales. The association between specific cognitive-behavioral therapy focusing on somatic complaints and pharmacological treatment was effective among this sample of patients with panic disorder and the response was similar in the group with pharmacological treatment alone.