Does the Addition of Cognitive Behavioral Therapy Improve Panic Disorder Treatment Outcome Relative to Medication Alone in the Primary-Care Setting?

Published in: Psychological Medicine, v. 35, no. 11, Nov. 2005, p. 1645-1654

Posted on RAND.org on January 01, 2005

by Michelle G. Craske, Daniela Golinelli, Murray Stein, Peter Roy-Byrne, Alexander Bystritsky, Cathy D. Sherbourne

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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, the authors 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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