Treatment of Panic Disorder: Long Term Strategies
Cognitive behavior therapy (CBT) with or without medication has been used in the treatment of panic disorder (PD). The purpose of this study is 1) to determine whether nine months of maintenance cognitive-behavior therapy (CBT) significantly improves the likelihood of sustained improvement; and 2) to determine the acute acceptability and efficacy of medication therapy or continued CBT alone among patients who fail to respond sufficiently to an initial course of CBT alone.
It has been found that patients with PD respond as well to CBT or medication alone as they do to a combination of the two. Since the combined treatments are expensive and CBT is associated with less risk of medical toxicity compared to medications, CBT alone will be used first.
All patients will first receive CBT alone. If the patient responds to this therapy, the patient will be assigned randomly (like tossing a coin) to 1 of 2 groups. One group will continue to receive CBT (maintenance therapy) for 9 months. The other group of responders will not receive any further therapy. If a patient does not respond to CBT alone, he/she will be assigned randomly to 1 of 2 different groups. One group will receive paroxetine; the other will continue to receive CBT for a longer period. The response to treatment will be evaluated to see which regimen works best to treat PD. The study will last approximately 3 years.
An individual may be eligible for this study if he/she has panic disorder with no more than mild agoraphobia (fear of being in public places) and is at least 18 years old.
Behavioral: Cognitive behavior therapy
Drug: Paroxetine or other medication - algorithm used
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Treatment of Panic Disorder: Long Term Strategies|
- Panic Disorder Severity Scale [ Time Frame: At baseline and major assessment points plus monthly. ]This is a 7-item scale providing ratings of core features of panic disorder and the degree of work and social impairment/interference due to the disorder.
- Clinical Global Impressions [ Time Frame: Monthly, including all nonpretreatment major assessments. ]Commonly used global rating of improvement.
- Albany Panic and Phobia Questionnaire [ Time Frame: All major assessment points. ]This is a 27-item scale consisting of three subscales that assess fear of agoraphobic situations, social situations, and situations and activities that produce bodily sensations commonly feared by individuals with panic disorder.
- Anxiety Sensitivity Index [ Time Frame: All major assessments and treatment visits. ]This is a 16-item scale that assesses person's tendency to regard physiologic arousal as harmful.
- Subjective Symptoms Scale [ Time Frame: All major assessment points ]This is an individual's rating of the extent to which anxiety symptoms interfere with five areas of daily functioning: work, home management, private leisure, social leisure, and family relationships.
|Study Start Date:||February 1999|
|Study Completion Date:||July 2004|
|Primary Completion Date:||July 2004 (Final data collection date for primary outcome measure)|
To determine if maintenance CBT produces a more sustained improvement among patients with panic disorder (PD) who respond to an initial course of cognitive behavior therapy (CBT) alone. For those who do not respond sufficiently to CBT alone, to determine if the addition of pharmacotherapy is acceptable and if this improves response among those inadequate responders to CBT alone.
This multicenter study builds upon the findings of a prior study comparing imipramine, placebo, CBT, and their combination in the treatment of PD patients with no more than mild agoraphobia. That study found response rates were as high with CBT or imipramine alone as with their combination. Given the added cost of combined treatments, it therefore seems reasonable to begin with monotherapy. Further, following general principles of medical practice, it would be reasonable to initiate treatment with the less invasive cognitive behavioral intervention. It is then important to learn what should be done following initial treatment.
All patients initially receive CBT alone. Patients are then randomized into 1 of 2 post-acute studies, depending on response status. Responders are randomized to a maintenance study comparing no maintenance with 9 months of continued CBT. Nonresponders are randomized to a study comparing paroxetine with continued CBT. The following outcomes will be examined: the necessity of maintenance therapy in maintaining response; the ability of adjunct pharmacotherapy to improve the response of patients who did not respond to CBT alone; possible predictors of response and relapse; and possible mediators of response.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00000368
|United States, Connecticut|
|Yale University, Department of Psychiatry, Anxiety Disorders Research Clinic|
|New Haven, Connecticut, United States|
|United States, Massachusetts|
|Boston University, Department of Psychology, Center for Anxiety and Related Disorders|
|Boston, Massachusetts, United States|
|United States, New York|
|Hillside Hospital Phobia Clinic|
|New York, New York, United States|
|United States, Pennsylvania|
|University of Pittsburgh, Department of Psychiatry, Panic, Anxiety and Traumatic Grief Program|
|Pittsburgh, Pennsylvania, United States, 15213|
|Study Chair:||Katherine H. Shear, MD||University of Pittsburgh|
|Principal Investigator:||David H Barlow, PhD||Boston University Department of Psychology|
|Principal Investigator:||Jack Gorman, MD||Columbia University School of Medicine|
|Principal Investigator:||Scott Woods, MD||Yale University|