Quick Reference Panic And Social Anxiety Disorder: Applications of Individual Cognitive-Behavioral Therapy to Specific Disorders Efficacy and Indications

Several meta-analytic reviews of the treatment outcome literature for panic disorder with or without agoraphobia have been conducted in the past decade, although some meta-analyses have exclusively examined behavioral treatments. Oei et al. (1999) conducted both a qualitative and a quantitative review of the literature. They found that CBT was efficacious at reducing self-reported agoraphobic symptoms and that its clinical efficacy was substantially demonstrated with community norms. They did not draw any definitive conclusions about the long-term efficacy of CBT, although they noted that different forms of CBT may vary in the minimum periods of time necessary for change. Results of their qualitative review demonstrated that CBT is associated with significant and positive changes on several measures (e.g., panic, fear, avoidance, anxiety, and depression) immediately posttreatment and at follow-up periods of up to 16 months. Gould et al. (1995) conducted a standard meta-analysis comparing pharmacotherapy, CBT, their combination, and a control (no treatment, waiting list, a placebo pill, or psychological placebo), for panic disorder with or without agoraphobia. All three types of active treatment were superior, in acute treatment, to control conditions. Long-term treatment effects were roughly equal to acute treatment effects, although assessment times were not reported.

CBT, including cognitive restructuring and exposure elements, is the standard approach in treating panic disorder (Butler et al. 2006). Gould et al. (1995) found this combination to be the most efficacious of the treatments they investigated. They also found that pharmacotherapy combined with CBT was not as efficacious as CBT alone. They noted, however, that selective serotonin reuptake inhibitors (SSRIs) are more efficacious at treating panic disorder than benzodiazepines and other commonly used antidepressants. Thus, the efficacy of the combination of SSRIs and CBT needs to be studied. Gould et al. (1995) also found that patients treated with pharmacotherapy alone experienced the greatest reduction of treatment effects over time. In contrast, the combination of CBT plus pharmacotherapy as well as CBT alone typically resulted in maintenance of treatment gains. Two more recent meta-analyses (van Balkom et al. 1997 and, in a later analysis of the same studies, Bakker et al. 1998) demonstrated that although CBT was superior to pill placebo, attention placebo, and waiting list, the most efficacious acute treatment method was the combination of antidepressants and in vivo exposure. The psychotherapeutic and pharmacotherapeutic treatment gains for panic disorder patients with and without agoraphobia, over an average follow-up of 62 weeks, tended to be stable.