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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?

  • MICHELLE G. CRASKE (a1), DANIELA GOLINELLI (a2), MURRAY B. STEIN (a3), PETER ROY-BYRNE (a4), ALEXANDER BYSTRITSKY (a5) and CATHY SHERBOURNE (a2)...

Abstract

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.

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Corresponding author

Departments of Psychology and Psychiatry & Biobehavioral Sciences, UCLA, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA. (Email: craske@psych.ucla.edu)

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