September 24, 2018
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Patients with panic disorder maintain long-term improvement after treatment

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Patients with panic disorder who responded to treatment with either panic-focused psychodynamic psychotherapy, cognitive-behavioral therapy or applied relaxation training maintained improvement 1 year after end of therapy, study data revealed.

“Panic disorder is associated with disability and higher health care costs and often persists chronically or episodically,” Kevin S. McCarthy, PhD, from the department of psychology at Chestnut Hill College and the University of Pennsylvania Perlman School of Medicine, and colleagues wrote. “There are effective treatments for panic disorder, including a number of psychotherapies and medications. However, relapse is likely for many patients, suggesting that, for many patients, underlying mechanisms or conflicts predisposing vulnerability to panic may not be successfully resolved.”

A previous randomized clinical trial comparing panic-focused psychodynamic psychotherapy, CBT and applied relaxation treatment found that most patients (58%) with panic disorder responded successfully to one of the three psychotherapies, according to the researchers. In the current study, researchers examined the long-term outcomes of patients with panic disorder who respond well to these psychotherapies.

Researchers assessed 91 patients who experienced a 40% or more reduction in panic and avoidance symptoms on the Panic Disorder Severity Scale (PDSS) after 12 to 14 weeks of one of the three treatments. The patients were evaluated each month for 1 year following treatment using the PDSS, the Sheehan Disability Scale and the Hamilton Depression Rating Scale, and twice with the Anxiety Disorders Interview Schedule.

McCarthy and colleagues found that patients who responded to one of these treatments maintained their improvements on all scales over the follow-up period (all P values > .2). Moreover, there were no differences by treatment condition in rates of change over follow-up, according to the results. By the end of 1 year, 57% of improved patients did not report a panic disorder diagnosis, regardless of the treatment received. There were no differences found in the rates of panic disorder diagnosis across conditions at 6 months or 12 months (all P values .78).

Although these results were positive, the investigators noted that patients with data at follow-up saw lower symptom levels at treatment end than those who did not provide data.

“When patients improve in a well-administered and monitored panic-focused psychotherapy, it appears that gains are maintained over the year following treatment regardless of the specific type of psychotherapy for panic disorder that is delivered,” McCarthy and colleagues concluded. “It is encouraging that multiple psychological interventions have sustained effects up to a year after treatment and targeting symptom reduction in the active phase of these therapies may reduce the health care burden of patients with panic disorder in the longer term.” – by Savannah Demko

Disclosure: McCarthy reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.