Treatment of Panic Disorder with Agoraphobia: Randomized Placebo‐Controlled Trial of Four Psychosocial Treatments Combined with Imipramine or Placebo Does brief dynamic psychotherapy reduce the relapse rate of panic disorder? Randomised placebo-controlled trial of moclobemide, cognitive-behavioural therapy and their combination in panic disorder with agoraphobia. A randomized clinical trial of cognitive behavioral therapy and interpersonal psychotherapy for panic disorder with agoraphobia. Does concurrent drug intake affect the long-term outcome of group cognitive behaviour therapy in panic disorder with or without agoraphobia? Global measures of outcome in a controlled comparison of pharmacological and psychological treatment of panic disorder and agoraphobia in primary care. A randomized controlled trial of fluoxetine and cognitive behavioral therapy for bulimia nervosa: short-term outcome. Cognitive-behavioral therapy helps prevent relapse and recurrence of panic disorder following alprazolam discontinuation: a long-term follow-up of the Peoria and Dartmouth studies. Emotion-focused psychotherapy for patients with panic disorder. Longitudinal outcome with pharmacotherapy in a naturalistic study of panic disorder. The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes. Study and course of the psychological profile in 77 patients expressing panic disorder with agoraphobia after cognitive behaviour therapy with or without buspirone. A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. A crossover study of focused cognitive therapy for panic disorder. Delivering cognitive-behavior therapy for panic disorder with agoraphobia in videoconference. Treatment of panic disorder with agoraphobia: comparison of fluvoxamine, placebo, and psychological panic management combined with exposure and of exposure in vivo alone. Panic and avoidance in agoraphobia. Application of path analysis to treatment studies. Self-exposure therapy for panic disorder with agoraphobia: randomised controlled study of external v. interoceptive self-exposure. Comparing Physical Exercise in Groups to Group Cognitive Behaviour Therapy for the Treatment of Panic Disorder in a Randomized Controlled Trial Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. II. Psychotherapy alone or in combination with antidepressant medication. A comparative trial of psychotherapy and pharmacotherapy for "pure" dysthymic patients. MAOA and mechanisms of panic disorder revisited: from bench to molecular psychotherapy
Few r and omized controlled trials have included panic disorder patients with moderate to severe agoraphobia . Therefore , this population was studied using pharmacotherapy as well as psychotherapy . At the time of the study , imipramine was widely used as a pharmacological treatment . Also , current practice guidelines for patients with panic disorder find selective serotonin reuptake inhibitors and tricyclic antidepressants roughly comparable in terms of efficacy . Therefore , the main objective of this study is to compare four psychosocial treatments — cognitive and grade d in vivo exposure treatments , grade d in vivo exposure , cognitive treatment , and supportive therapy — to evaluate the benefits of combining cognitive therapy with exposure in vivo . These treatments were combined with imipramine or placebo for a total of eight experimental conditions . Participants presented moderate to severe agoraphobia . The method involved a r and omized , double‐blind , placebo‐controlled trial with 137 participants who completed a 14‐session protocol involving the treatments just mentioned . Measures were taken at baseline and posttreatment and at 3‐ , 6‐ , and 12‐month follow‐up . All treatment conditions were statistically and clinical ly effective in reducing self‐reported panic – agoraphobia symptoms over the 1‐year follow‐up . No statistical differences were observed between imipramine and placebo conditions . This study found that all treatment modalities helped reduce panic and agoraphobic symptomatology over a 1‐year follow‐up period . These surprising results support the need to document the relations among the various components of an intervention . This would make it possible to assess the relative efficacy of the treatment components rather than of the intervention as a whole BACKGROUND Although panic disorder can be effectively alleviated by drug treatment , the relapse rate is high . By adding brief dynamic psychotherapy focused on the psychosocial vulnerability of patients with panic disorder to an established drug treatment regimen , we hypothesized that this would result in a lower relapse rate after pharmacotherapy . METHODS Patients with panic disorder ( defined by DSM-III-R ) were r and omized to treatment with either clomipramine for 9 months ( n = 20 ) , or clomipramine for 9 months combined with 15 weekly sessions of brief dynamic psychotherapy ( n = 20 ) . Measures of anxiety and depression were collected at intake and at regular intervals . The patients had blind follow-up interviews at 6 , 12 , and 18 months after beginning treatment . RESULTS All patients in both groups became free of panic attacks within 26 weeks of the start of treatment . On termination of pharmacotherapy , the relapse rate was significantly higher in the clomipramine-only group during the follow-up period . There were significantly lower scores for most anxiety measures in the clomipramine plus psychotherapy group at the 9-month follow-up . CONCLUSION The addition of brief dynamic psychotherapy to treatment with clomipramine significantly reduces the relapse rate of panic disorder compared with clomipramine treatment alone BACKGROUND In the treatment of panic disorder with agoraphobia  , the efficacy of pharmacological , psychological and combined treatments has been established . Unanswered questions concern the relative efficacy of such treatments . AIMS To demonstrate that moclobemide and cognitive-behavioural therapy ( CBT ) are effective singly and more effective in combination . METHOD Fifty-five patients were r and omly assigned to an eight-week treatment of : moclobemide plus CBT ; moclobemide plus clinical management ( ' psychological placebo ' ) ; placebo plus CBT ; or placebo plus clinical management . RESULTS Comparisons between treatments revealed strong effects for CBT . Moclobemide with clinical management was not superior to placebo . The combination of moclobemide with CBT did not yield significantly better short-term results than CBI with placebo . The CBT results remained stable during a six-month follow-up , although a substantial proportion of patients treated with placebo plus CBT needed additional treatment . CONCLUSIONS CBT was highly effective in the treatment of panic disorder with agoraphobia and reduced agoraphobia to levels that were comparable to those of non- clinical controls BACKGROUND Interpersonal psychotherapy ( IPT ) seems to be as effective as cognitive behavioral therapy ( CBT ) in the treatment of major depression . Because the onset of panic attacks is often related to increased interpersonal life stress , IPT has the potential to also treat panic disorder . To date , a preliminary open trial yielded promising results but there have been no r and omized controlled trials directly comparing CBT and IPT for panic disorder . METHOD This study aim ed to directly compare the effects of CBT versus IPT for the treatment of panic disorder with agoraphobia . Ninety-one adult patients with a primary diagnosis of DSM-III or DSM-IV panic disorder with agoraphobia were r and omized . Primary outcomes were panic attack frequency and an idiosyncratic behavioral test . Secondary outcomes were panic and agoraphobia severity , panic-related cognitions , interpersonal functioning and general psychopathology . Measures were taken at 0 , 3 and 4 months ( baseline , end of treatment and follow-up ) . RESULTS Intention-to-treat ( ITT ) analyses on the primary outcomes indicated superior effects for CBT in treating panic disorder with agoraphobia . Per- protocol analyses emphasized the differences between treatments and yielded larger effect sizes . Reductions in the secondary outcomes were equal for both treatments , except for agoraphobic complaints and behavior and the credibility ratings of negative interpretations of bodily sensations , all of which decreased more in CBT . CONCLUSIONS CBT is the preferred treatment for panic disorder with agoraphobia compared to IPT . Mechanisms of change should be investigated further , along with long-term outcomes The present study investigated the impact of pre-existing pharmacotherapy regimes on the long-term outcome of brief intensive group cognitive-behavioural therapy ( BIGCBT ) in the treatment of panic disorder with or without agoraphobia in 106 patients ( 74 females ) . Forty patients were allocated to BIGCBT without medication , 40 to BIGCBT plus anti-anxiety medication , 10 to BIGCBT plus anti-depressant medication and 16 to BIGCBT plus combined anti-anxiety and anti-depressant medications . The mean follow-up period was 3.2 yr and ranged from 1.1 to 6.2 yr . The results demonstrated that patients who received BIGCBT concurrent with pre-existing medication regimes did not differ significantly ( P > 0.001 ) from each other or from patients who underwent BIGCBT without medication on any of the dependent measures either at pre-treatment assessment or long-term follow-up . However , BIGCBT ( with or without pharmacotherapy ) was associated with significant ( P < 0.001 ) long-term improvements in frequency of panic attacks , avoidance behaviour and question naire measures of anxiety , depression and agoraphobia . Furthermore , the large majority ( 80 % ) of patients in the BIGCBT without medication group remained medication-free at long-term follow-up . Of those patients who underwent BIGCBT concurrent with pre-existing pharmacotherapy , a large percentage ( 44 % ) reported no longer taking medication for their condition at long-term follow-up . Overall , it is concluded that pre-existing medication regimes ( anti-anxiety , anti-depressant or combinations of these ) do not significantly enhance or detract from the long-term outcome of a BIGCBT program used in the treatment of panic disorder and agoraphobia BACKGROUND Panic disorder , with and without agoraphobia , is a prevalent condition which presents primarily in general practice . Previous clinical outcome studies have been conducted mainly in specialist university departments or hospital setting s , and have tended to employ complex rating scales that are not well suited for use as outcome measures in primary care . AIM To evaluate the outcome , in a primary care setting , of fluvoxamine versus cognitive behaviour therapy , each used alone and in combination in a double-blind placebo-controlled framework , balanced for therapist contact . METHOD A total of 149 patients satisfying DSMIII-R criteria for panic disorder were r and omly allocated to receive one of the following : fluvoxamine , placebo , fluvoxamine plus cognitive behaviour therapy , placebo plus cognitive behaviour therapy , and cognitive behaviour therapy alone . These five treatment groups represent the minimum number acceptable for such a comparison to be made . All patients received an identical schedule of contact over 13 weeks . Measures of symptom severity , general health and social disruption were taken at entry point and end point ; measures of change in symptoms were taken at end point only . Outcome was reported in terms of brief global ratings of severity of illness and change in symptoms , and of ratings of general health and social disruption that are suitable for use in general practice . RESULTS All active treatment groups showed statistically significant advantages over placebo over a range of outcome ratings . The groups employing cognitive behaviour therapy showed the most robust and consistent response . CONCLUSION The brief global measures reported here proved adequate to the task of assessing treatment outcome . Results indicate that treatments including cognitive behaviour therapy can be effective in the treatment of panic disorder and agoraphobia in primary care This study compared and combined fluoxetine and individual cognitive behavioral therapy in the treatment of bulimia nervosa . Participants were 76 women who sought treatment at the Eating Disorders Program of the Toronto Hospital and who met DSM-III-R criteria for bulimia nervosa . Subjects were r and omly assigned to receive fluoxetine alone , cognitive behavior therapy alone , or the two in combination and were treated over 16 weeks . Short-term outcome revealed that all three treatment conditions were associated with clinical improvement across a wide range of parameters . The combination of pharmacotherapy and psychotherapy was superior to pharmacotherapy alone on specific parameters and there was no statistically significant advantage to the combination over psychotherapy alone . Limitations to the study include the absence of a placebo pill group and a waiting list control group as well as a substantial dropout rate across all three treatment conditions The present research evaluated patients from 2 previous studies ( 1 conducted in Peoria , the other at Dartmouth ) during a 2- to 5-year posttreatment period . Results showed that 75 % of the Peoria sample and 76 % of the Dartmouth sample were able to discontinue alprazolam therapy , remain abstinent of any type of treatment for panic disorder , and maintain their acute-treatment clinical gains over this follow-up period . The degree to which patients ' anxiety sensitivity declined during treatment predicted relapse versus survival during the 1st 6 months of follow-up , when most relapses occurred . Implication s of these findings for benzodiazepine discontinuation , combined pharmacotherapy and psychotherapy , and relapse prevention in panic disorder are discussed OBJECTIVE Recent studies have suggested that most patients treated for panic disorder receive forms of psychotherapy other than cognitive behavior therapy , even though there is little information about the efficacy of such treatments or how they compare to proven active treatments . The authors compared one of these other forms , emotion-focused psychotherapy ( given to 30 patients with panic disorder ) , to results obtained with recommended st and ard treatment ( either cognitive behavior therapy [ N=36 ] or imipramine [ N=22 ] ) . The authors also compared emotion-focused psychotherapy to results obtained in subjects given pill placebo ( N=24 ) . METHOD Subjects met DSM-IV criteria for panic disorder with no more than mild agoraphobia . Treatment consisted of approximately 3 months of weekly visits followed by 6 monthly maintenance visits . Assessment s were conducted after each treatment phase and at a follow-up visit after 6 months of no treatment . RESULTS Emotion-focused psychotherapy  was less effective for symptoms of panic disorder than treatment with either cognitive behavior therapy or imipramine ; results obtained with emotion-focused psychotherapy after the acute and maintenance phases were similar to those seen with placebo .  Treatment expectations were not different among the different groups . Patients receiving emotion-focused psychotherapy had the highest completion rate . CONCLUSIONS The results suggest that emotion-focused psychotherapy ( a supportive form of psychotherapy ) has low efficacy for the treatment of panic disorder . However , emotion-focused psychotherapy may be superior to medical management in helping patients stay in treatment BACKGROUND Current recommendations suggest that pharmacotherapy for patients with panic disorder should be continued for at least 1 year [ Am . J. Psychiatry 155 ( 1998 ) 1 ] , despite a paucity of data systematic ally examining outcome for periods greater than 3 - 6 months . It is critically important to obtain more information on the effectiveness of medications over time for patients who initially responded to pharmacotherapy for panic disorder . METHODS Long-term outcome was examined for 78 patients who attained a 2-month period of sustained remission on medication and received maintenance pharmacotherapy for up to 24 months during the Massachusetts General Hospital Longitudinal Study of Panic Disorder , a prospect i ve , naturalistic study . Participants were categorized by their maintenance treatment condition at remission : benzodiazepine alone ( N = 45 , 58 % ) , antidepressant alone ( N = 12 , 16 % ) , and combined treatment with a benzodiazepine and an antidepressant ( N = 21 , 27 % ) . RESULTS Approximately half ( N = 36 , 46 % ) of the patients who had achieved remission relapsed at some time over the 2-year naturalistic study period , despite continued and adequate pharmacotherapy . There was no difference in timing or frequency of relapse by type of maintenance pharmacotherapy . LIMITATIONS Interpretation of the data is limited by the naturalistic nature of the study , and by the relatively low sample size . CONCLUSIONS This data suggests that patients with panic disorder have a high rate of relapse even after acute response to pharmacotherapy , despite continued treatment . In addition , the use of combined pharmacotherapy with antidepressants and benzodiazepines does not appear to provide greater protection from relapse than monotherapy The efficacy of tricyclic antidepressants and various psychotherapies , in comparison with one another or in combination , has not been fully established in r and omized clinical trials . The authors present a r and omized controlled trial comparing the combination of amitriptyline and short-term interpersonal psychotherapy , either treatment alone , and nonscheduled supportive psychotherapy in ambulatory patients with acute depression . They found that pharmacotherapy and psychotherapy alone were equally efficacious and better than nonscheduled treatment . The combination treatment of  psychotherapy and pharmacotherapy was more effective than either treatment alone and delayed the onset of symptomatic failure BACKGROUND The change of psychopathological dimensions during treatment of panic disorder is attracting increasing interest . METHODS A population of subjects experiencing panic disorder with agoraphobia is evaluated with the French version of the factor structure of the Symptom Checklist 90 R ( SCL 90 R ) . Two groups of patients are compared : a group receiving cognitive behaviour therapy ( CBT ) combined with buspirone and a group receiving cognitive behaviour therapy combined with placebo .  RESULTS Comparative analysis of pre- and post-test changes between both groups completing treatment showed that the combination cognitive behaviour therapy plus buspirone provided better results than those in patients who had received cognitive behaviour therapy plus placebo . This difference between treatments did not persist at the 1-year follow-up , since , while results had been effectively maintained in the CBT plus buspirone group , the CBT plus placebo group continued to improve significantly for the target dimensions of treatment . CONCLUSIONS Psychopathological dimensions on the SCL 90 R show that combination of buspirone and cognitive behaviour therapy accelerates the behaviour modification process only in the short term 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 R and omized , 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 r and omized 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 Question naire ) 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 result ed 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 OBJECTIVE This study sought to determine the short- and long-term effects of focused cognitive therapy for  panic disorder . METHOD Thirty-three psychiatric out patients with the DSM-III diagnosis of panic disorder were r and omly assigned to either 12 weeks of individual , focused cognitive therapy or 8 weeks of brief supportive psychotherapy based on principles of client-centered therapy . The patients who received supportive psychotherapy were subsequently given the opportunity to cross over to cognitive therapy for 12 weeks . Patients were rated for panic and depression before therapy , after 4 and 8 weeks of therapy , and at 6-month and 1-year follow-up . RESULTS Clinician ratings and self-ratings of panic frequency and intensity indicated that the focused cognitive therapy group achieved significantly greater reductions in panic symptoms and general anxiety after 8 weeks of treatment than did the group that received brief supportive psychotherapy . At 8 weeks , 71 % of the cognitive therapy group were panic free , compared to 25 % of the psychotherapy group . Moreover , 94 % of the psychotherapy patients elected to cross over to 12 weeks of cognitive therapy . At 1-year follow-up , 87 % of the group that received cognitive therapy only and 79 % of the group that crossed over into cognitive therapy remained free of panic attacks . CONCLUSIONS Focused cognitive therapy offers a promising nonpharmacological alternative for the treatment of panic disorder Delivering psychotherapy by videoconference could significantly increase the accessibility of empirically vali date d treatments . The aim of this study was to compare the effectiveness of cognitive-behavior therapy ( CBT ) for panic disorder with agoraphobia ( PDA ) when the therapy is delivered either face-to-face or by videoconference .  A sample of 21 participants was treated either face-to-face or by videoconference . Results showed that CBT delivered by videoconference was as effective as CBT delivered face-to-face . There was a statistically significant reduction in all measures , and the number of panic-free participants among those receiving CBT by videoconference was 81 % at post-treatment and 91 % at the 6-month follow-up . None of the comparisons with face-to-face psychotherapy suggested that CBT delivered by videoconference was less effective . These results were confirmed by analyses of effect size . The participants reported the development of an excellent therapeutic alliance in videoconference as early as the first therapy session . The importance of these results for treatment accessibility is discussed . Hypotheses are proposed to explain the rapid creation of strong therapeutic alliances in videoconferencing OBJECTIVE The purpose of this comparative outcome study was to investigate whether the effects of exposure in vivo treatment for panic disorder with agoraphobia could be enhanced by adding interventions specifically for panic attacks before the start of exposure treatment . The additional effect of two types of treatment for panic attacks -- pharmacological ( fluvoxamine ) and psychological ( repeated hyperventilation provocations and respiratory training)--was examined . Thus , the combined treatment of panic interventions with exposure in vivo could be compared to exposure in vivo alone . METHOD Ninety-six patients were r and omly assigned to four treatment conditions : double-blind , placebo-controlled fluvoxamine followed by exposure in vivo , psychological panic management followed by exposure , and exposure in vivo alone . Outcome was assessed by self-report measures , a st and ardized multitask behavioral avoidance test , and continuous monitoring of panic attacks .  Seventy-six patients completed the study . RESULTS All four treatments were effective and result ed in a significant decrease of agoraphobic avoidance . Moreover , the combination of fluvoxamine and exposure in vivo demonstrated efficacy superior to that of the other treatments and had twice as large an effect size ( difference between pre- and posttreatment scores ) on self-reported agoraphobic avoidance . The other treatments did not differ among each other in effectiveness . CONCLUSIONS Results of the study indicate that the short-term outcome of exposure in vivo treatment can be enhanced by adding fluvoxamine treatment . Psychological panic management combined with exposure was not superior to exposure alone of equal duration We explored a causal sequence between panic and avoidance to provide recommendations for psychotherapy , pharmacotherapy , and their combination in treating agoraphobia . We produced a two-way [ ( imipramine hydrochloride vs placebo ] by [ office-based behavioral therapy vs in vivo exposure ] ) design by amalgamating two studies . We assessed agoraphobic patients for panic and avoidance at these time points : baseline ( week 0 ) , midcourse ( week 13 ) , and termination ( week 26 ) . The causal sequence model was tested by path analysis . Imipramine was superior to placebo in lowering panic and avoidance at both postbaseline time points . Exposure was superior to office-based treatment in lowering avoidance only at week 13 . Exposure appeared to produce quicker improvement of avoidance than office-based therapy , but relapse occurred if this improvement was not supported by medication . Exposure did not benefit panic . We believe patients should be informed that imipramine is superior to exposure in inducing a panic-free state . Exposure without imipramine is of benefit only in reducing avoidance , but adding imipramine to exposure is necessary for panic control and substantially improves exposure and exposure maintenance BACKGROUND Exposure to external phobic cues is an effective therapy for  panic/agoraphobia  but the value of exposure to interoceptive cues is unclear . AIMS R and omised controlled comparison in panic/agoraphobia of the effects of ( a ) external , ( b ) interceptive or ( c ) combined external and interoceptive self-exposure to ( d ) control subjects . METHOD Eighty out- patients were r and omised to a control group or to one of three forms of self-exposure treatment ( external , interoceptive , or combined ) . Each treatment included seven sessions over 10 weeks and daily self-exposure homework . Assessment s were at pre- and post-treatment and up to 1 year post-entry . Assessors remained blind during treatment . RESULTS The three self-exposure groups improved significantly and similarly at post-treatment and up to 1-year followup , and significantly more than did the control subjects . Rates of improvement on main outcome measures averaged 60 % at post-treatment and 77 % at follow-up . CONCLUSIONS The three methods of self-exposure were equally effective in reducing panic and agoraphobic symptoms in the short- and long-term Background : Previous studies have suggested that physical exercise can reduce symptoms for subjects suffering from panic disorder ( PD ) . The efficacy of this intervention has so far not been compared to an established psychotherapy , such as cognitive behaviour therapy ( CBT ) . Assessment of controlled long-term effects and the clinical significance of the treatment are also lacking . Aim : To compare physical exercise to CBT as treatment for PD , and assess controlled long-term and clinical ly significant effects . Method : PD- patients were r and omized to either three weekly sessions of physical exercise ( n = 17 ) , or one weekly session of CBT ( n = 19 ) . Both treatments ran for 12 weeks , were manualized and administered in groups . Patients were assessed twice before the start of treatment , at post-treatment and at 6 and 12 months thereafter . Primary outcome - measures consisted of the Mobility Inventory ( MI ) , the Agoraphobia Cognitions Question naire ( ACQ ) and the Body Sensations Question naire ( BSQ ) . Results : A two-way repeated measures MANOVA of these measures demonstrated a significant effect of time , F(16 , 544 ) = 7.28 , p < .01 , as well as a significant interaction effect , F(16 , 544 ) = 1.71 , p < .05 , in favour of CBT . This finding was supported by the assessment of clinical ly significant changes of avoidant behaviour and of treatment-seeking one year later . Conclusion : Group CBT is more effective than group physical exercise as treatment of panic disorder , both immediately following treatment and at follow-up assessment Major depressive disorder is associated with considerable morbidity , disability , and risk for suicide . Treatments for depression most commonly include antidepressants , psychotherapy , or the combination . Little is known about predictors of treatment response for depression . In this study , 681 patients with chronic forms of major depression were treated with an antidepressant ( nefazodone ) , Cognitive Behavioral Analysis System of Psychotherapy ( CBASP ) , or the combination . Overall , the effects of the antidepressant alone and psychotherapy alone were equal and significantly less effective than combination treatment . Among those with a history of early childhood trauma ( loss of parents at an early age , physical or sexual abuse , or neglect ) , psychotherapy alone was superior to antidepressant monotherapy . Moreover , the combination of  psychotherapy and pharmacotherapy was only marginally superior to  psychotherapy  alone among the childhood abuse cohort . Our results suggest that psychotherapy may be an essential element in the treatment of patients with chronic forms of major depression and a history of childhood trauma BACKGROUND In 2001 , the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments ( CANMAT ) partnered to produce evidence -based clinical guidelines for the treatment of depressive disorders .  A revision of these guidelines was undertaken by CANMAT in 2008 - 2009 to reflect advances in the field . This article , one of five in the series , review s new studies of psychotherapy in the acute and maintenance phase of MDD , including computer-based and telephone-delivered psychotherapy . METHODS The CANMAT guidelines are based on a question -answer format to enhance accessibility to clinicians . Evidence -based responses are based on up date d systematic review s of the literature and recommendations are grade d according to the Level of Evidence , using pre-defined criteria . Lines of Treatment are identified based on criteria that included evidence and expert clinical support . RESULTS Cognitive-Behavioural Therapy ( CBT ) and Interpersonal Therapy ( IPT ) continue to have the most evidence for efficacy , both in acute and maintenance phases of MDD , and have been studied in combination with antidepressants . CBT is well studied in conjunction with computer-delivered methods and bibliotherapy . Behavioural Activation and Cognitive-Behavioural Analysis System of Psychotherapy have significant evidence , but need replication . Newer psychotherapies including Acceptance and Commitment Therapy , Motivational Interviewing , and Mindfulness-Based Cognitive Therapy do not yet have significant evidence as acute treatments ; nor does psychodynamic therapy . LIMITATIONS Although many forms of psychotherapy have been studied , relatively few types have been evaluated for MDD in r and omized controlled trials . Evidence about the combination of different types of psychotherapy and antidepressant medication is also limited despite widespread use of these therapies concomitantly . CONCLUSIONS CBT and IPT are the only first-line treatment recommendations for acute MDD and remain highly recommended for maintenance . Both computer-based and telephone-delivered psychotherapy -- primarily studied with CBT and IPT -- are useful second-line recommendations . Where feasible , combined antidepressant and CBT or IPT are recommended as first-line treatments for acute MDD BACKGROUND Psychotherapy of " pure " dysthymic disorder remains understudied . This article reports outcomes of an acute r and omized trial of 94 subjects treated for 16 weeks with either interpersonal psychotherapy ( IPT ) , brief supportive psychotherapy ( BSP ) , sertraline , or sertraline plus IPT .  METHODS Recruited by clinical referral and advertising , subjects met DSM-IV criteria for early onset dysthymic disorder , with no episode of major depression in the prior six months . They were r and omly assigned to one of four 16-week treatments , with options for crossover or continuation treatment . Results were analyzed from the intention-to-treat sample by ANCOVA , controlling for baseline depressive severity . RESULTS Subjects improved in all conditions over time , with the cells including sertraline pharmacotherapy showing superiority over psychotherapy alone for response and remission . Response rates were 58 % for sertraline alone , 57 % for combined treatment , 35 % for IPT , and 31 % for BSP . LIMITATIONS The study was underpowered and may have employed too " active " a control condition . Follow-up data were unobtainable . CONCLUSIONS In this acute trial for " pure " dysthymic disorder , sertraline with or without IPT showed advantages relative to IPT and BSP . Method ological difficulties may have limited differential outcome findings . This study bolsters a small but growing literature on the treatment of dysthymic disorder , suggesting that pharmacotherapy may acutely benefit patients more than psychotherapy Panic disorder with agoraphobia ( PD/AG ) is a prevalent mental disorder featuring a substantial complex genetic component . At present , only a few established risk genes exist . Among these , the gene encoding monoamine oxidase A ( MAOA ) is noteworthy given that genetic variation has been demonstrated to influence gene expression and monoamine levels . Long alleles of the MAOA-uVNTR promoter polymorphism are associated with PD/AG and correspond with increased enzyme activity . Here , we have thus investigated the impact of MAOA-uVNTR on therapy response , behavioral avoidance and brain activity in fear conditioning in a large controlled and r and omized multicenter study on cognitive behavioral therapy ( CBT ) in PD/AG . The study consisted of 369 PD/AG patients , and genetic information was available for 283 patients . Carriers of the risk allele had significantly worse outcome as measured by the Hamilton Anxiety scale ( 46 % responders vs 67 % , P=0.017 ) . This was accompanied by elevated heart rate and increased fear during an anxiety-provoking situation , that is , the behavioral avoidance task . All but one panic attack that happened during this task occurred in risk allele carriers and , furthermore , risk allele carriers did not habituate to the situation during repetitive exposure . Finally , functional neuroimaging during a classical fear conditioning paradigm evidence d that the protective allele is associated with increased activation of the anterior cingulate cortex upon presentation of the CS+ during acquisition of fear . Further differentiation between high- and low-risk subjects after treatment was observed in the inferior parietal lobes , suggesting differential brain activation patterns upon CBT . Taken together , we established that a genetic risk factor for PD/AG is associated with worse response to CBT and identify potential underlying neural mechanisms . These findings might govern how psychotherapy can include genetic information to tailor individualized treatment approaches
After the acute phase treatment , as long as the drug was continued , the superiority of the combination over either monotherapy appeared to persist .
BACKGROUND Panic disorder can be treated with pharmacotherapy , psychotherapy or in combination , but the relative merits of combined therapy have not been well established .
OBJECTIVES To review evidence concerning short- and long-term advantages and disadvantages of combined psychotherapy plus antidepressant treatment for panic disorder with or without agoraphobia , in comparison with either therapy alone .