A Randomized Effectiveness Trial of Cognitive-Behavioral Therapy and Medication for Primary Care Panic Disorder

• DOI: 10.1001/archpsyc.62.3.290
• Publication Date: 2005-03-07T16:15:45Z
• Authors: Peter P. Roy-Byrne; Michelle G. Craske; Murray B. Stein; Greer Sullivan; Alexander Bystritsky; Wayne Katon; Daniela Golinelli; Cathy D. Sherbourne
• Keywords: Agoraphobia; Pharmacotherapy; Collaborative Care

Panic disorder is a prevalent, often disabling condition among patients in the primary care setting. Although numerous studies have assessed effectiveness of treatments for depression care, few such been conducted panic disorder.To implement and test combined pharmacotherapy cognitive-behavioral intervention tailored to setting.Randomized, controlled study comparing treatment as usual.Six clinics associated with 3 university medical schools, serving an ethnically socioeconomically diverse patient population.Two hundred thirty-two meeting DSM-IV criteria disorder. Comorbid mental physical disorders were permitted, provided these did not contraindicate be acutely life threatening.Patients randomized receive either usual or consisting combination up 6 sessions (across 12 weeks) therapy (CBT) modified setting, follow-up telephone contacts during next 9 months, algorithm-based by physician guidance from psychiatrist. Behavioral health specialists, majority inexperienced CBT disorder, trained deliver coordinated overall including pharmacotherapy.Proportion subjects remitted (no attacks past month, minimal anticipatory anxiety, agoraphobia subscale score <10 on Fear Questionnaire) responding (Anxiety Sensitivity Index <20) change over time World Health Organization Disability Scale short form scores.The pharmacotherapeutic resulted sustained gradually increasing improvement relative usual, significantly higher rates at all points both proportion (3 20% vs 12%; 29% 16%) 46% 27%; 63% 38%) greater improvements (all points) functioning months) scores. These effects obtained spite similar delivery guideline-concordant 2 groups.Delivery evidence-based medication using collaborative model CBT-naive, midlevel behavioral specialist feasible more effective than