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Does the addition of cognitive behavioral therapy improve panic disorder treatment outcome relative to medication alone in the primary-care setting?

Published online by Cambridge University Press:  15 July 2005

MICHELLE G. CRASKE ,
DANIELA GOLINELLI ,
MURRAY B. STEIN ,
PETER ROY-BYRNE ,
ALEXANDER BYSTRITSKY  and
CATHY SHERBOURNE
MICHELLE G. CRASKE
Affiliation:
Departments of Psychology and Psychiatry & Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
DANIELA GOLINELLI
Affiliation:
The RAND Corporation, Santa Monica, CA, USA
MURRAY B. STEIN
Affiliation:
Departments of Psychiatry and Family & Preventive Medicine, University of California, San Diego (UCSD), CA, USA
PETER ROY-BYRNE
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine at Harborview Medical Center, Seattle, WA
ALEXANDER BYSTRITSKY
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
CATHY SHERBOURNE
Affiliation:
The RAND Corporation, Santa Monica, CA, USA
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Abstract

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Background.Randomized clinical trials indicate a benefit from combining medications with cognitive behavioral therapy (CBT) relative to medication alone for panic disorder. Using an as-treated analysis, we evaluated whether the addition of CBT enhanced outcomes for panic disorder relative to medications alone in the primary-care setting.

Method.Primary-care patients with panic disorder reported on their receipt of CBT and medications over the 3 months following baseline assessment. The degree to which outcomes for those who used anti-panic medications were enhanced by the receipt of at least one component of CBT was analyzed using a propensity score model that took into account observable baseline patient characteristics influencing both treatment selection and outcomes.

Results.The addition of CBT resulted in statistically and clinically significant improvements at 3 months on anxiety sensitivity, social avoidance, and disability. Also, patients receiving CBT in the first 3 months of the study were more improved at 12 months than patients who took medications only during the first 3 months of the study.

Conclusions.The clinical utility of the findings are discussed in terms of the importance of primary-care physicians encouraging their panic disorder patients to receive CBT as well as medications.

Type
Original Article
Information
Psychological Medicine , Volume 35 , Issue 11 , November 2005 , pp. 1645 - 1654
Copyright
2005 Cambridge University Press