Research article summary (published 27 Feb 2005):

A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder.

Full Abstract

BACKGROUND: Panic disorder is a prevalent, often disabling condition among patients in the primary care setting. Although numerous studies have assessed the effectiveness of treatments for depression in primary care, few such studies have been conducted for panic disorder. OBJECTIVE: To implement and test the effectiveness of a combined pharmacotherapy and cognitive-behavioral intervention for panic disorder tailored to the primary care setting. DESIGN: Randomized, controlled study comparing intervention to treatment as usual. SETTING: Six primary care clinics associated with 3 university medical schools, serving an ethnically and socioeconomically diverse patient population. PARTICIPANTS: Two hundred thirty-two primary care patients meeting DSM-IV criteria for panic disorder. Comorbid mental and physical disorders were permitted, provided these did not contraindicate the treatment to be provided and were not acutely life threatening. INTERVENTION: Patients were randomized to receive either treatment as usual or an intervention consisting of a combination of up to 6 sessions (across 12 weeks) of cognitive-behavioral therapy (CBT) modified for the primary care setting, with up to 6 follow-up telephone contacts during the next 9 months, and algorithm-based pharmacotherapy provided by the primary care physician with guidance from a psychiatrist. Behavioral health specialists, the majority inexperienced in CBT for panic disorder, were trained to deliver the CBT and coordinated overall care, including pharmacotherapy. MAIN OUTCOMES MEASURES: Proportion of subjects remitted (no panic attacks in the past month, minimal anticipatory anxiety, and agoraphobia subscale score <10 on Fear Questionnaire) and responding (Anxiety Sensitivity Index score <20) and change over time in World Health Organization Disability Scale and short form 12 scores. RESULTS: The combined cognitive-behavioral and pharmacotherapeutic intervention resulted in sustained and gradually increasing improvement relative to treatment as usual, with significantly higher rates at all points of both the proportion of subjects remitted (3 months, 20% vs 12%; 12 months, 29% vs 16%) and responding (3 months, 46% vs 27%; 12 months, 63% vs 38%) and significantly greater improvements in World Health Organization Disability Scale (all points) and short form 12 mental health functioning (3 and 6 months) scores. These effects were obtained in spite of similar rates of delivery of guideline-concordant pharmacotherapy to the 2 groups. CONCLUSION: Delivery of evidence-based CBT and medication using the collaborative care model and a CBT-naive, midlevel behavioral health specialist is feasible and significantly more effective than usual care for primary care panic disorder.

Author information

Author/s: Roy-Byrne, Peter P (PP); Craske, Michelle G (MG); Stein, Murray B (MB); Sullivan, Greer (G); Bystritsky, Alexander (A); Katon, Wayne (W); Golinelli, Daniela (D); Sherbourne, Cathy D (CD);

Affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine at Harborview Medical Center, Seattle, USA.

Grants: K24 MH064122-03 (Agency:NIMH NIH HHS) ; K24 MH065324-03 (Agency:NIMH NIH HHS) ; MH065324 (Agency:NIMH NIH HHS) ; MH57835 (Agency:NIMH NIH HHS) ; MH57858 (Agency:NIMH NIH HHS) ; MH58915-03 (Agency:NIMH NIH HHS) ; MH64122 (Agency:NIMH NIH HHS) ; R01 MH057835-03 (Agency:NIMH NIH HHS) ; R01 MH057858-03 (Agency:NIMH NIH HHS) ; R01 MH058915-03 (Agency:NIMH NIH HHS)

Journal and publication information

Publication Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.

Journal: Archives of general psychiatry (Arch Gen Psychiatry), published in United States. (Language: eng)

Reference: 2005-Mar; vol 62 (issue 3) : pp 290-8

Dates: Created 2005/03/08; Completed 2005/03/21; Revised 2008/11/20;

PMID: 15753242, status: MEDLINE (last retrieved date: 2/18/2009)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Evid Based Ment Health. 2005 Nov;8(4):110. (PMID: 16246886)

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MeSH headings (categories)

This article was linked to the MeSH Headings (categories) shown below.

Adult Anti-Anxiety Agents - therapeutic use Cognitive Therapy Combined Modality Therapy Diagnostic and Statistical Manual of Mental Disorders Female Follow-Up Studies

Follow-Up Studies Humans Male Panic Disorder - drug therapy; psychology; therapy Primary Health Care Psychiatric Status Rating Scales - statistics & numerical data Treatment Outcome

Note: Bold headings indicate primary MeSH headings or qualifiers.

Associated Chemicals: Anti-Anxiety Agents (0)

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