Panic and Agoraphobia

Cromarty, P., Robinson, G., Callcott, P., & Freeston, M. (2004). Cognitive therapy and exercise for panic and agoraphobia in primary care: Pilot study and service development. Behavioural and Cognitive Psychotherapy, 32, 371-374.

Correspondence Address:
Paul Cromarty, Newcastle Cognitive and Behavioural Therapies Centre, Plummer Court, Carliol Place, Newcastle Upon Tyne, United Kingdom, NE1 6UR, paul.cromarty@nmht.nhs.uk.

Abstract
Exercise is generally accepted as means of improving mental health yet few studies have examined its use in specific disorders. This study examines delivery and efficacy of cognitive behaviour therapy (CBT) for panic and agoraphobia combined with a gym-based exercise programme in a Healthy Living Centre. Preliminary evidence for this novel service has shown Group CBT followed by exercise targeting safety behaviours to be clinically successful and acceptable to clients. Details of the pilot service and some of the clinical issues are discussed. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

Haby, M. M., Donnelly, M., Corry, J., & Vos, T. (2006). Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: A meta-regression of factors that may predict outcome. Australian and New Zealand Journal of Psychiatry, 40, 9-19.

Correspondence Address:
Michelle M. Haby, Health Surveillance and Evaluation Section, Public Health Group, Department of Human Services, Level 18, 120 Spencer Street, Melbourne, VIC, Australia, 3000, michelle.haby@dhs.vic.gov.au.

Abstract
Objective: Objective: To determine which factors impact on the efficacy of cognitive behavioural therapy (CBT) for depression and anxiety. Factors considered include those related to clinical practice: disorder, treatment type, duration and intensity of treatment, mode of therapy, type and training of therapist and severity of patients. Factors related to the conduct of the trial were also considered, including: year of study, country of study, type of control group, language, number of patients and percentage of dropouts from the trial. Method: We used the technique of meta-analysis to determine an overall effect size (standardized mean difference calculated using Hedges' g) and meta-regression to determine the factors that impact on this effect size. We included randomized controlled trials with a wait list, pill placebo or attention/psychological placebo control group. Study participants had to be 18 years or older and all have diagnosed depression, panic disorder (with or without agoraphobia) or generalized anxiety disorder (GAD). Outcomes of interest included symptom, functioning and health-related quality of life measures, reported as continuous variables at post-treatment. Results: Cognitive behavioural therapy for depression, panic disorder and GAD had an effect size of 0.68 (95% 01 = 0.51-0.84, n = 33 studies, 52 comparisons). The heterogeneity in the effect sizes was fully explained by treatment, duration of therapy, inclusion of severe patients in the trial, year of study, country of study, control group, language and number of dropouts from the control group. Disorder was not a significant predictor of the effect size. Conclusions: Cognitive behavioural therapy is significantly less effective for severe patients and trials that compared CBT to a wait-list control group found significantly larger effect sizes than those comparing CBT to an attention placebo, but not to a pill placebo. Further research is needed to determine whether CBT is effective when provided by others than psychologists and whether it is effective for non-English-speaking patient groups. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Siev, J., & Chambless, D. L. (2007). Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders. Journal of Consulting and Clinical Psychology, 75, 513-522.

Correspondence Address:
Jedidiah Siev, Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA, USA, 19104-6241, jsiev@psych.upenn.edu.

Abstract
The aim of this study was to address claims that among bona fide treatments no one is more efficacious than another by comparing the relative efficacy of cognitive therapy (CT) and relaxation therapy (RT) in the treatment of generalized anxiety disorder (GAD) and panic disorder without agoraphobia (PD). Two fixed-effects meta-analyses were conducted, for GAD and PD separately, to review the treatment outcome literature directly comparing CT with RT in the treatment of those disorders. For GAD, CT and RT were equivalent. For PD, CT, which included interoceptive exposure, outperformed RT on all panic-related measures, as well as on indices of clinically significant change. There is ample evidence that both CT and RT qualify as bona fide treatments for GAD and PD, for which they are efficacious and intended to be so. Therefore, the finding that CT and RT do not differ in the treatment of GAD, but do for PD, is evidence for the specificity of treatment to disorder, even for 2 treatments within a CBT class, and 2 disorders within an anxiety class. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)

Toneatto, T. (2005). Cognitive versus behavioral treatment of concurrent alcohol dependence and agoraphobia: A pilot study. Addictive Behaviors, 30, 115-125.

Correspondence Address:
Tony Toneatto, Department of Clinical Research, Center for Addiction and Mental Health, 33 Russell St., Toronto, ON, Canada, tony_toneatto@camh.net.

Abstract
With the growing awareness of the prevalence of anxiety disorders among alcohol abusers there is a need for effective cognitive-behavioral treatments (CBTs). This study is a pilot investigation comparing two treatments for concurrent alcohol dependence and panic disorder with agoraphobia. A 10-session behavioral treatment (BT), consisting of five sessions treating alcohol dependence and five sessions treating panic disorder with agoraphobia, was compared to a 10-session cognitive treatment (CT) that addressed the dysfunctional cognitions mediating the alcohol problem and anxiety symptoms. There were no group differences in frequency or quantity of alcohol consumption or in anxiety symptoms post-treatment or at a 1-year follow-up in a sample of 14 subjects who completed the study. Both groups showed within-group improvements on measures of both alcohol and anxiety symptomatology. Approximately one-third of the subjects made clinically relevant gains on both alcohol and anxiety symptoms. A brief BT for concurrent alcohol dependence and agoraphobia appears encouraging. (PsycINFO Database Record (c) 2005 APA, all rights reserved)