Behavior Therapy

Volume 45, Issue 1, 2014, Pages 36-46

Clinical Experiences in Using CognitiveBehavior Therapy to Treat Panic Disorder

Wolf, A.W.a , Goldfried, M.R.b
a
b

Case Western Reserve University, United States

Stony Brook University, United States

View references (28)

Abstract
Although there is a growing body of research to support the use of psychological treatments
for specific disorders, there has been no way for practitioners to provide feedback to
researchers on the barriers they encounter in implementing these treatments in their day-today clinical work. In order to provide practitioners a means to give researchers information
about their clinical experience, the Society of Clinical Psychology and the Division of
Psychotherapy of the American Psychological Association collaborated on an initiative to
build a two-way bridge between practice and research. A questionnaire was developed on the
therapist, patient, and contextual variables that undermine the effective use of CBT in
reducing the symptoms of panic disorder, a clinical problem that occurs frequently in clinical
practice and has an extensive research base. An Internet-based survey was advertised
internationally in listservs and professional newsletters, asking clinicians to indicate all
aspects of CBT that they used in treating panic disorder, and to respond to a series of
questions with variables that presumably limited successful symptom reduction in clinical
work using CBT to treat panic disorder. The final database included responses from 338
participants who varied in experience in applying CBT to the treatment of panic disorders.
Participants identified a wide range of patient factors that were barriers to symptom reduction,
including symptoms related to panic, motivation, social system, and the psychotherapy
relationship, in addition to specific problems with implementing CBT for the treatment of
panic disorder. 2013.

Comprehensive Psychiatry
Volume 55, Issue 1, January 2014, Pages 87-92

Effect of cognitive-behavioral group

therapy for panic disorder in changing
coping strategies
Wesner, A.C.ab, Gomes, J.B.ab, Detzel, T.ab, Blaya, C.ac, Manfro, G.G.ab, Heldt, E.ab
a

Anxiety Disorders Program, Hospital de Clnicas de Porto Alegre, Brazil

Graduate Program in Medical Sciences: Psychiatry, Universidade Federal Do Rio Grande
Do sul, Porto Alegre, Brazil
c
Medical Clinic: Psychiatry, Universidade Federal de Cincias da Sade de Porto Alegre,
Brazil
b

View references (29)

Abstract
Background Cognitive-behavioral group therapy (CBGT) is an efficient treatment for panic
disorder (PD). However, the role of CBGT in enhancing strategies to cope with stressful
events has not been established. Aim To evaluate the effect of CBGT on the choice of coping
strategy by PD patients compared to a group of individuals without mental disorders. Methods
Forty-eight PD patients who completed a 12-session CBGT protocol were compared to 75
individuals without mental disorders regarding coping strategies as evaluated by the Coping
Strategies Inventory (CSI). The severity of PD was assessed at baseline and after CBGT
through the Clinical Global Impression (CGI) scale, the Hamilton Anxiety Scale (HAM-A),
and the Panic Inventory (PI). Results Treatment was effective in reducing PD severity in all
outcome measures. Patients used significantly fewer confrontation, escape and avoidance
strategies after CBGT. The use of more adaptive coping strategies was related to a decrease in
panic attacks and anticipatory anxiety. Application of the CSI showed that the use of strategies
was also significantly different in patients as compared to the control group, except for escape
and avoidance, which became similar after the CBGT protocol. Conclusions Despite the
changes observed after the CBGT protocol, the choice of coping strategy was still different in
patients vs. controls. The current CBGT protocol was used specifically to assess PD
symptoms. Other cognitive tools should be included to address maladaptive coping strategies.
2014 Elsevier Inc.

Neuroscience and Behavioral Physiology

Volume 44, Issue 1, January 2014, Pages 50-53

Gender role characteristics of patients with

panic disorder

Vorob'Eva, O.V. , Repina, V.V.

I. M. Sechenov First State Medical University, Moscow, Russian Federation
View references (15)

Abstract
Individual gender types were identified using the Bem Sex Role Inventory. A total of 70
patients with panic disorder (PD) and 50 healthy subjects (controls) were studied. In the
control group, one in five (22%) of subjects had masculine characteristics, while among
patients with PD, the masculine subgroup constituted a very small proportion (4.3%); p =
0.0002. Relationships were found between the low proportion of masculine characteristics
(fewer than 10 characteristics) and the development of agoraphobia in PD and a progressive
course of PD with inadequate responses to treatment and severe social maladaptation. The
results lead to the conclusion that insufficient masculinization is a very characteristic
personality feature of patients with PD and is a predisposing factor for the formation of
avoidance behavior. 2013 Springer Science+Business Media New York.

Behaviour Research and Therapy

Volume 51, Issue 12, December 2013, Pages 830-839

Long-term stability of cognitive behavioral

therapy effects for panic disorder with
agoraphobia: A two-year follow-up study
Gloster, A.T.ab , Hauke, C.a, Hfler, M.a, Einsle, F.a, Fydrich, T.c, Hamm, A.d, Sthrhle,
A.e, Wittchen, H.-U.a
a

Technische Universitt Dresden, Institute of Clinical Psychology and Psychotherapy,

Germany
b
University of Basel, Department of Psychology, Division of Clinical Psychology and
Epidemiology, Switzerland
c
Department of Psychology, Humboldt University - Berlin, Germany
d
Department of Psychology, Ernst-Moritz-Arndt University Greifswald, Germany
e
Department of Psychiatry and Psychotherapy, Charit - Universittsmedizin Berlin,
Germany
View additional affiliations
View references (53)

Abstract

Objective: Cognitive-behavioral therapy (CBT) aims to help patients establish new behaviors
that will be maintained and adapted to the demands of new situations. The long-term
outcomes are therefore crucial in testing the durability of CBT. Method: A two-year follow-up
assessment was undertaken on a subsample of n=146 PD/AG patients from a multicenter
randomized controlled trial. Treatment consisted of two variations of CBT: exposure in situ in
the presence of the therapist (T+) or on their own following therapist preparation (T-).
Results: Both variations of CBT had high response rates and, overall, maintained the level of
symptomatology observed at post-treatment with high levels of clinical significance. Effect
sizes 24 months following treatment were somewhat lower than at the 6-month follow up.
Once patients reached responder status, they generally tended to remain responders at
subsequent assessments. Differences were observed for patients that obtained additional
treatment during the follow-up period. Expert opinion and subjective appraisal of treatment
outcome differed. No robust baseline predictors of 2-year outcome were observed.
Conclusion: Most patients maintain clinically meaningful changes two years following
treatment across multiple outcome measures. Approximately 1/3 of patients continued to
experience meaningful residual problems. 2013 Elsevier Ltd.

Author keywords
Psychiatry and clinical neurosciences
Volume 67, Issue 5, July 2013, Pages 332-339

In-situation safety behaviors among

patients with panic disorder: descriptive
and correlational study.
Funayama, T., Furukawa, T.A., Nakano, Y., Noda, Y., Ogawa, S., Watanabe, N., Chen,
J., Noguchi, Y.
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University
Graduate School of Medical Sciences, Nagoya, Japan.

Abstract
In-situation safety behaviors play an important role in the maintenance of anxiety because
they prevent patients from experiencing unambiguous disconfirmation of their unrealistic
beliefs about feared catastrophes. Strategies for identifying particular safety behaviors,
however, have not been sufficiently investigated. The aims of the present study were to (i)
develop a comprehensive list of safety behaviors seen in panic disorder and to examine their
frequency; and (ii) correlate the safety behaviors with panic attack symptoms, agoraphobic
situations and treatment response. The subjects consisted of 46 consecutive patients who
participated in group cognitive behavioral treatment (CBT) for panic disorder. All the patients
completed a Safety Behavior List that was developed based on experiences with panic

disorder patients. Carrying medications, distracting attention, carrying a plastic bottle, and
drinking water were reported by more than half of the patients. The strongest correlations
between panic symptoms and safety behaviors were found between symptoms of derealization
and listening to music with headphones, paresthesia and pushing a cart while shopping, and
nausea and squatting down. The strongest association between agoraphobic situations and
safety behaviors was found between the fear of taking a bus or a train alone and moving
around. Staying still predicted response to the CBT program, while concentrating on
something predicted lack of response. An approximate guideline has been developed for
identifying safety behaviors among patients with panic disorder and should help clinicians use
CBT more effectively for these patients. 2013 The Authors. Psychiatry and Clinical
Neurosciences 2013 Japanese Society of Psychiatry and Neurology.

Indexed keywords
Biological Psychiatry
Volume 73, Issue 11, 1 June 2013, Pages 1064-1070

Changes in automatic threat processing

precede and predict clinical changes with
exposure-based cognitive-behavior therapy
for panic disorder
Reinecke, A.a , Waldenmaier, L.a, Cooper, M.J.b, Harmer, C.J.a
a

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX37JX,

United Kingdom
b
Isis Education Centre, University of Oxford, Oxford, United Kingdom
View references (40)

Abstract
Background: Cognitive behavioral therapy (CBT) is an effective treatment for emotional
disorders such as anxiety or depression, but the mechanisms underlying successful
intervention are far from understood. Although it has been a long-held view that
psychopharmacological approaches work by directly targeting automatic emotional
information processing in the brain, it is usually postulated that psychological treatments
affect these processes only over time, through changes in more conscious thought cycles. This
study explored the role of early changes in emotional information processing in CBT action.
Methods: Twenty-eight untreated patients with panic disorder were randomized to a single
session of exposure-based CBT or waiting group. Emotional information processing was
measured on the day after intervention with an attentional visual probe task, and clinical

symptoms were assessed on the day after intervention and at 4-week follow-up. Results:
Vigilance for threat information was decreased in the treated group, compared with the
waiting group, the day after intervention, before reductions in clinical symptoms. The
magnitude of this early effect on threat vigilance predicted therapeutic response after 4 weeks.
Conclusions: Cognitive behavioral therapy rapidly affects automatic processing, and these
early effects are predictive of later therapeutic change. Such results suggest very fast action on
automatic processes mediating threat sensitivity, and they provide an early marker of
treatment response. Furthermore, these findings challenge the notion that psychological
treatments work directly on conscious thought processes before automatic information
processing and imply a greater similarity between early effects of pharmacological and
psychological treatments for anxiety than previously thought. 2013 Society of Biological
Psychiatry

Journal of Clinical Psychology

Volume 69, Issue 6, June 2013, Pages 616-629

Specificity of Homework Compliance

Effects on Treatment Outcome in CBT:
Evidence from a Controlled Trial on Panic
Disorder and Agoraphobia
Cammin-Nowak, S.a , Helbig-Lang, S.bc, Lang, T.acd, Gloster, A.T.c, Fehm, L.e, Gerlach,
A.L.fg, Strhle, A.h, Deckert, J.i, Kircher, T.j, Hamm, A.O.kl, Alpers, G.W.m, Arolt,
V.n, Wittchen, H.-U.c
a

University of Bremen, Center for Clinical Psychology and Rehabilitation, Germany

University of Hamburg, Department of Clinical Psychology and Psychotherapy, Germany
c
Technical University of Dresden, Institute of Clinical Psychology and Psychotherapy,
Germany
d
Christoph-Dornier Foundation for Clinical Psychology, Germany
e
Humboldt University of Berlin, Department of Psychology, Germany
f
University of Mnster, Department of Psychology, Germany
g
University of Cologne, Department of Psychology, Germany
h
Charit, Universittsmedizin Berlin, Department of Psychology, Germany
i
University of Wrzburg, Department of Psychiatry, Psychosomatics and Psychotherapy,
Germany
j
Philips-University Marburg, Department of Psychiatry and Psychotherapy, Germany
k
Ernst-Moritz-Arndt-University Greifswald, Department of Psychology, Germany
l
University of Wrzburg, Department of Psychology, Germany
m
University of Mannheim, Department of Psychology, Germany
n
University of Mnster, Department of Psychiatry, Germany
b

View additional affiliations

View references (33)

Abstract
Objectives: Although homework assignments are an integral component of cognitivebehavioral therapy (CBT) and relate to positive therapy outcomes, it is unclear whether
specific homework types and their completion have specific effects on outcome. Method:
Data from N = 292 patients (75% female, mean age 36 years) with panic disorder and
agoraphobia and treated with standardized CBT were analyzed with homework compliance
quality and quantity for different types of homework serving as predictors for different
outcome variables. Results: Quality ratings of homework completion were stronger outcome
predictors than quantitative compliance ratings. Exposure homework was a better outcome
predictor than homework relating to psychoeducation and self-monitoring. Conclusion:
Different aspects of homework compliance and specific homework types might differentially
relate to CBT outcome. 2013 Wiley Periodicals, Inc.

Revista Brasileira de Psiquiatria

Volume 35, Issue 2, April 2013, Pages 193-200

Cognitive functions in patients with panic

disorder: A literature review (Review)
Alves, M.R.P.ab , Pereira, V.M.ab, Machado, S.bcd, Nardi, A.E.ab, de Oliveirae e Silva, A.C.be
a

Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
b
Panic and Respiration Laboratory, Institute of Psychiatry, UFRJ, National Science and
Technology Institute for Translational Medicine (INCT-TM), Rio de Janeiro, RJ, Brazil
c
Universidade Salgado de Oliveira (UNIVERSO), Rio de Janeiro, RJ, Brazil
d
Institute of Philosophy, Universidade Federal de Uberlndia (UFU), Uberlndia, MG, Brazil
e
Laboratory of Thanatology and Psychometrics, Universidade Federal Fluminense (UFF),
Niteri, RJ, Brazil
View additional affiliations
View references (28)

Abstract
Objective: To conduct a review of the literature on the possible neuropsychological deficits
present in patients with panic disorder. Methods: We performed a systematic review and
search of the PubMed, ISI and PsycInfo scientific databases, with no time limits, using the
following key words: cognitive, function, panic, and disorder. Of the 971 articles found, 25
were selected and 17 were included in this review. The inclusion criterion was at least one

neuropsychological assessment task in patients with panic disorder. Results: The number of
publications has grown gradually, especially those assessing executive functions,
corresponding to the neurobiological model most widely accepted. Of all the functions
evaluated, these patients had lower performance in memory tasks and higher performance in
affective processing tasks related to the disorder. However, these data require further
investigation due to the high rate of comorbidities, the small sample sizes of the included
studies and little standardization of instruments used. Conclusion: The results showed a
greater occurrence of deficits in memory and enhanced affective processing related to panic
disorder. 2013 Associao Brasileira de Psiquiatria.

Journal of Consulting and Clinical Psychology

Volume 81, Issue 1, February 2013, Pages 47-57

Does maintenance CBT contribute to longterm treatment response of panic disorder

with or without agoraphobia? A
randomized controlled clinical trial
White, K.S.a , Payne, L.A.b, Gorman, J.M.c, Shear, M.K.d, Woods, S.W.e, Saksa, J.R.e, Barlow,
D.H.f
a

Department of Psychology, University of Missouri, St. Louis, MO 63121, United States

Department of Pediatrics, Pediatric Pain Program, David Geffen School of Medicine, Los
Angeles, United States
c
Franklin Behavioral Health Consultants, Bronx, NY, United States
d
Department of Psychiatry and School of Social Work, Columbia University, United States
e
Department of Psychiatry, Yale University School of Medicine, United States
f
Center for Anxiety and Related Disorders and Department of Psychology, Boston
University., United States
b

View additional affiliations

View references (53)

Abstract
Objective: We examined the possibility that maintenance cognitive behavior therapy (MCBT) may improve the likelihood of sustained improvement and reduced relapse in a multisite randomized controlled clinical trial of patients who met criteria for panic disorder with or
without agoraphobia. Method: Participants were all patients (N = 379) who first began an
open trial of acute-phase CBT. Patients completing and responding to acute-phase treatment
were randomized to receive either 9 monthly sessions of M-CBT (n = 79) or assessment only
(n = 78) and were then followed for an additional 12 months without treatment. Results: M-

CBT produced significantly lower relapse rates (5.2%) and reduced work and social
impairment compared to the assessment only condition (18.4%) at a 21-month follow-up.
Multivariate Cox proportional hazards models showed that residual symptoms of agoraphobia
at the end of acute-phase treatment were independently predictive of time to relapse during
21-month follow-up (hazards ratio = 1.15, p <.01). Conclusions: M-CBT aimed at reinforcing
acute treatment gains to prevent relapse and offset disorder recurrence may improve long-term
outcome for panic disorder with and without agoraphobia. (PsycINFO Database Record.
2012 American Psychological Association.

Zhurnal Nevrologii i Psihiatrii imeni S.S. Korsakova

Volume 112, Issue 10, 2012, Pages 4-7

Characteristics of gender differences in

patients with panic disorder
Vorobyova, O.V., Repina, V.V.
Sechenov First Moscow State Medical University, Moscow, Russian Federation
View references (12)

Abstract
The individual gender type was assessed using the Bem sex role inventory. Seventy patients
with panic disorders (PD) and 50 healthy people (controls) were studied. There was a few
patients with masculine features (4.3%) compared to the control group (22%). The
correlations between a small number of masculine characteristics (less than 10 traits), the
development of agoraphobia in PD, the progressive course of PD with the poor response to
treatment and marked social maladaptation were found. It has been concluded that the
insufficient masculinization is a personality feature of PD patients predisposing to avoidant
behavior.

Psychological Medicine
Volume 42, Issue 12, December 2012, Pages 2661-2672

A randomized clinical trial of cognitive

behavioral therapy and interpersonal
psychotherapy for panic disorder with
agoraphobia
Vos, S.P.F.a , Huibers, M.J.H.a, Diels, L.b, Arntz, A.a
a

Department of Clinical Psychological Science, Faculty of Neuroscience and Psychology,

Maastricht University, PO Box 616, NL-6200 MD Maastricht, Netherlands
b
Regional Hospital AZ Vesalius, Tongeren, Belgium
View references (47)

Abstract
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 randomized controlled trials directly comparing CBT and IPT for panic disorder. Method
This study aimed 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 randomized. 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. 2012 Cambridge University Press.

Psychiatry Research Journal

Volume 3, Issue 1-2, 2012, Pages 81-106

Why physical exercise should be prescribed

in panic disorder

Dratcu, L.
Guy's Hospital, Division of Psychiatry, Guy's, King's and St Thomas' School of Medical
Sciences, London, United Kingdom
View references (123)

Abstract
A significant progress in understanding the neurochemistry of anxiety has followed the advent
of biochemical methods to induce anxiety symptoms. There has been particular interest in
panic attacks since the discovery that they may be provoked in the laboratory, and thus are
amenable to experimental investigation. For this reason, and because the episodic nature of a
panic attack makes the disorder easy to quantify, panic disorder has been extensively studied
in the last decades. Another reason why provocation of panic has attracted interest is that, in
theory, knowledge gained from such studies can be extrapolated to anxiety in general. While
research on the pathogenesis of panic disorder has concentrated on panic attacks, what
happens to panic patients in the non-panic state has been largely overlooked. And yet, patients
remain clinically unwell between attacks. Panic patients experience background anxiety and
they also chronically hyperventilate. Hyperventilation was thought to induce panic by
lowering CO2, but provocation studies using carbon dioxide (CO2) demonstrated that, in fact,
panic patients have hypersensitive CO2 chemoreceptors. Klein proposed that panic patients
hyperventilate in the attempt to keep pCO2 low, thereby preventing activation of the brain's
suffocation alarm and the panic attacks that ensue. However, panic patients in the non-panic
state have been shown to have EEG abnormalities, as well as abnormal cerebral blood flow
and cerebral glucose metabolism, an indication of cerebral hypoxia. Hyperventilation can
indeed induce cerebral hypoxia, as it leads to systemic alkalosis and cerebral vasoconstriction.
Cerebral hypoxia contributes to the onset of anxiety symptoms in chronic obstructive
pulmonary disease. By chronically hyperventilating, panic patients may likewise risk
prolonged exposure to cerebral hypoxia which, in turn, may contribute to symptom chronicity,
thereby engendering a self-perpetuating cycle of panic and anxiety symptoms. Panic patients
may therefore benefit from adopting more physiological patterns of breathing. Aerobic
exercise may help patients to normalise ventilatory patterns and attenuate the adverse effects
of chronic hyperventilation on the brain. The role of pharmacological and psychological
treatments in anxiety disorders is now well established, but there is evidence that aerobic
exercise regularly is itself therapeutic in panic disorder and that it can also effectively
augment antipanic treatment. Exercise may prove an adjunct treatment for anxiety disorders
that is non-pharmacological, non-addictive, and one that has few adverse effects and
contraindications. In addition to reducing the risk of coronary heart disease, stroke and
obesity-related disorders, exercise offers a range of psychological benefits. Nova Science
Publishers, Inc.

Psychological Medicine
Volume 42, Issue 12, December 2012, Pages 2661-2672

A randomized clinical trial of cognitive

behavioral therapy and interpersonal
psychotherapy for panic disorder with
agoraphobia
Vos, S.P.F.a , Huibers, M.J.H.a, Diels, L.b, Arntz, A.a
a

Department of Clinical Psychological Science, Faculty of Neuroscience and Psychology,

Maastricht University, PO Box 616, NL-6200 MD Maastricht, Netherlands
b
Regional Hospital AZ Vesalius, Tongeren, Belgium
View references (47)

Abstract
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 randomized controlled trials directly comparing CBT and IPT for panic disorder. Method
This study aimed 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 randomized. 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. 2012 Cambridge University Press.

Seishin shinkeigaku zasshi = Psychiatria et neurologia

Japonica
Volume 114, Issue 9, 2012, Pages 1077-1084

[Cognitive behavior therapy for anxiety

disorders]. (Review)
Sakano, Y.
School of Psychological Sciences, Health Sciences University of Hokkaido.

Abstract
It is necessary to take the psychological characteristics of anxiety into account when we
consider the improvement of anxiety. Anxiety is generally observed basic emotion in human
and never extinguishable. Therefore, it is important for patients with anxiety disorders to learn
how to manage their daily anxious responses, even after their pathological anxiety is
successfully treated and improved. Considering these points, comprehensive psychological
treatment, including not only effective intervention to pathological anxiety but also anxiety
management program, is needed in treating anxiety disorders effectively. Reviewing previous
studies on effectiveness of psychotherapy for anxiety disorders shows that the cognitive
behavior therapy is the most effective intervention in terms of extinction of pathological
anxiety, prolonged effectiveness of the treatment, prognosis, prevention of recurrence, and
improvement of patients' quality of life. In this article, firstly, basic conceptualization and case
formulation of anxiety disorders are discussed theoretically. Secondly, effectiveness of
cognitive behavior therapy for anxiety disorders, including panic disorder, obsessive
compulsive disorder, social anxiety disorder, post-traumatic stress disorder, general anxiety
disorder, and specific phobia, is reviewed. And finally, challenges of cognitive behavior
therapy are discussed in terms of further development and dissemination of cognitive
behavior therapy in Japan.

Indexed keywords
Psychotherapy
Volume 49, Issue 3, September 2012, Pages 349-363

Exploring corrective experiences in a

successful case of short-term dynamic
psychotherapy
Friedlander, M.L.a , Sutherland, O.b, Sandler, S.c, Kortz, L.a, Bernardi, S.a, Lee, H.-H.a, Drozd,
A.d
a

Department of Educational and Counseling Psychology, University at Albany/SUNY,

Albany, NY, United States

Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON,
Canada
c
Department of Psychiatry, Albany Medical College, Albany, NY, United States
d
Department of Psychology, University of Guelph, Guelph, ON, Canada
View additional affiliations
View references (54)

Abstract
The concept of corrective emotional experience, originally formulated by psychoanalysts
Alexander and French (1946), has been redefined by contemporary researchers to be
theoretically nonspecific, that is, as "coming to understand or experience an event or
relationship in a different or unexpected way" (Castonguay & Hill, 2011). Using postsession
questionnaires, videotapes, and posttermination interviews, we explored whether (and how) a
corrective experience occurred in a successful case of short-term dynamic psychotherapy
(STDP; Davanloo, 1980). A 35-year-old woman suffering severe panic attacks was seen for
31 sessions by an experienced STDP therapist. The questionnaires and interviews focused on
(a) perceived intrapsychic and interpersonal changes, and (b) how these changes came about.
At termination, the client reported complete symptom relief, greater self-acceptance,
improved relationships, and more emotional flexibility. Her corrective experience was evident
in the qualitative themes, which showed that she came to understand and affectively
experience her relationships with both parents differently. Moreover, the themes reflected both
STDP-specific (e.g., confrontation of defenses) and nonspecific (e.g., rapport, acceptance)
mechanisms of change. Conversation analysis (Sacks, 1995) of what the client described as
"the 'gentle shove' of questions that make me see what I have been trying to ignore since
childhood" showed, on a microlinguistic level, how she overcame resistance to strong
emotional experience and expression. 2011 American Psychological Association.

Australian Family Physician

Volume 41, Issue 9, September 2012, Pages 668-671

Cognitive behaviour therapy: Incorporating

therapy into general practice
Harden, M.
View references (5)

Abstract
Background Cognitive behaviour therapy is a talking therapy that looks at the connections
between our emotions, thoughts and behaviours within the context of specific circumstances
and symptoms. Objective This article describes cognitive behaviour therapy, its evidence base
and applications. Pathways for further training for general practitioners in cognitive behaviour
therapy are described. Discussion Cognitive behaviour therapy is an effective treatment for

mild to moderate depression, generalised anxiety disorder, panic disorder with or without
agoraphobia, social phobia, post-traumatic stress disorder, and childhood depressive and
anxiety disorders. At its simplest, it can take the form of an exercise prescription, teaching
relaxation techniques, assistance with sleep hygiene, scheduling pleasurable activities and
guiding the patient through thought identification and challenge. With some basic training in
the area, GPs are well placed to provide basic cognitive behaviour therapy treatments,
particularly to patients at the mild end of the spectrum of mental health disease, as they
already know their patients well and have a therapeutic alliance with them. In some cases, this
may be all that is needed; however, patients who have more complicated issues or more
severe symptoms may require specialist psychiatrist or psychologist referral.

Author keywords
Journal of Tokyo Medical University
Volume 70, Issue 3, July 2012, Pages 351-359

The effectiveness of hypnosis for patients

with panic disorder (2): Its possibilities for
reduction of symptom severity
Kawashima, S.a, Ichiki, M.b, Ono, S.b, Katayama, S.c, Matsuki, S.d, Iimori, M.c
a

Department of Psychiatry, Tokyo Medical University Hachioji Medical Center, Japan

Department of Psychiatry, Tokyo Medical University Ibaraki Medical Center, Japan
c
Department of Psychiatry, Tokyo Medical University, Japan
d
Department of Clinical Psychology, Graduate School of Clinical Psychology, Kagoshima
University, Japan
b

View additional affiliations

View references (38)

Abstract
[Background and objective] Although hypnosis has been utilized for treatment of panic
disorder, its evidence is yet to be established. Panic disorder has been known for its unique
psychodynamics. For patients with panic disorder, the authors have conducted hypnotherapy,
during which some patients could verbalize their insight while exposed to the targeted images
that would often elicit phobic reactions. For these patients techniques such as age regression
were used. Furthermore, even those who were unable to verbalize their insight seemed to be
able to benefit from experiencing the ideomotor responses, on the condition that the therapist
could approach them from a psychodynamic perspective. In this paper we describe the
process of hypnosis with psychodynamic interventions for patients with panic disorder, and
discuss its effectiveness in reducing the symptom severity. [Subjects and methods] The

subjects were recruited from patients who first visited the department of mental health at a
single hospital in the period from December, 2007 to November, 2009, fulfilled the DSM-IV
diagnostic criteria of panic disorder, and agreed to participate in a randomized placebocontrolled trial of selective serotonin reuptake inhibitor, hypnotherapy and their combination
(unpublished data). Hypnotherapy was administered weekly with each session lasting for 50
minutes and in the total of 9 sessions. Subjects were induced to experience relaxation in the
first session of hypnotherapy, and for the remaining 8 sessions were exposed to the image of
the situation that had been avoided. When psychodynamics was suspected to contribute to the
disorder, psychodynamically oriented interventions were attempted. The subjects' condition
was assessed with Panic Disorder Severity Scale, Japanese version (PDSS-J) and other scales
before and after treatment, and at the 6-months follow-up. [Results] Of the 31 candidates, 7
patients were determined to be suitable for hypnotherapy, and 6 out of 7 patients were
suspected to be influenced psychodynamically. Consistent improvement on PDSS-J was
observed in all the cases. Two cases showed moderate or more improvement and the other 4
showed mild improvement, and progressive improvement was observed in all 6 cases at the
end of treatment and at the 6-month follow-up. [Conclusions] The effectiveness of hypnosis in
reduction of symptom severity was observed, and also the possibility of hypnosis for
promoting generation of new neural networks, especially associating both hemispheres, was
suggested.

Behavior Therapy
Volume 43, Issue 2, June 2012, Pages 271-284

Coping Skills and Exposure Therapy in

Panic Disorder and Agoraphobia: Latest
Advances and Future Directions (Review)
Meuret, A.E.a , Wolitzky-Taylor, K.B.b, Twohig, M.P.c, Craske, M.G.b
a

Southern Methodist University, United States

University of California, Los Angeles, United States
c
Utah State University, United States
b

View references (116)

Abstract
Although cognitive-behavioral treatments for panic disorder have demonstrated efficacy, a
considerable number of patients terminate treatment prematurely or remain symtpomatic.
Cognitive and biobehavioral coping skills are taught to improve exposure therapy outcomes
but evidence for an additive effect is largely lacking. Current methodologies used to study the
augmenting effects of coping skills test the degree to which the delivery of coping skills
enhances outcomes. However, they do not assess the degree to which acquisition of coping
skills and their application during exposure therapy augment outcomes. We examine the
extant evidence on the role of traditional coping skills in augmenting exposure for panic

disorder, discuss the limitations of existing research, and offer recommendations for
methodological advances. 2011.

Author keywords

Psychiatria Hungarica
Volume 14, Issue 2, 1999, Pages 143-148

Possible role of increased sweating in the

generation of panic attacks
[A fokozott verejtekezes esetleges szerepe a
panikrohamok kialakulasaban]
Janszky, I., Szedmak, S., Kopp, M.
Pf. 370, 1445 Budapest, Hungary

Abstract
There is more and more information that underlines the role of hyperventilation in the
generation of panic attacks. Hyperventilation can elicit the somatic symptoms of panic due to
systemic alkalosis. In this paper it is suggested that since int the case of panic sweating might
cause alkalosis, it also could contribute to the generation of panic attacks. To prove this
hypothesis a statistical analysis of panic symptom lists of 111 panic patients diagnosed
according DSM-III criteria was carried out. It is found that a) there was a well identified
group of panic patients with minor breathing difficulties plus heavy sweating, b) all the
patients sampled had either severe breathing, or sweating symptoms, or both. It is concluded
than in the absence of the intensive physical activity of the 'flight or fight' reaction, sweating
as well as hyperventilation can cause alkalosis, which in turn might generate panic attacks.

Author keywords
Hyperventilation; Panic; Sweating

Prognostic indices with brief and standard CBT for panic

disorder: I. Predictors of outcome

DOW, MICHAEL G T ; KENARDY, JUSTIN A ; JOHNSTON, DEREK W ;

NEWMAN, MICHELLE G ; TAYLOR, C BARR ; s msok. Psychological Medicine
37.10 (Oct 2007): 1503-9.

Although the effectiveness of cognitive behavioural therapy (CBT) in the management of

panic disorder (PD) is now well established, there have been few studies of predictors of
outcome with this patient group using clinical effectiveness trial data, a hypothesis-testing
model, and a dependent measure of clinically significant change.
Method
The data for this study came from a randomized controlled trial of three forms of CBT
delivery for PD with and without agoraphobia (two 6-week CBT programmes, one of which
was computer assisted, and one therapist-directed 12-week CBT programme), comprising a
total of 186 patients across two sites. Based on previous related research, five hypothesized
predictors of post-treatment and follow-up outcome were identified and examined, using a
series of bivariate and multivariate analyses.
Results
The results in general supported the hypotheses. Strength of blood/injury fears, age of initial
onset of panic symptoms, co-morbid social anxieties and degree of agoraphobic avoidance
were predictive of both measures of post-treatment outcome. Degree of residual social
difficulties and the continued use of anxiolytics at post-treatment were also shown to predict
poor outcome at the 6-month follow-up. However, strength of continuing dysfunctional
agoraphobic cognitions by the end of active treatment did not predict outcome at follow-up
for the sample as a whole.
Conclusions
The identification of consistent predictors of outcome with CBT has many clinical and
research benefits. As CBT, however, is being delivered increasingly in a variety of brief
formats, further research is required to identify moderators of response to these 'non-standard'
treatment formats.

CBT-Based Early Intervention to Prevent Panic Disorder:

A Pilot Study
Nuthall, Alex; Townend, Michael
2007): 15-30.

. Behavioural and Cognitive Psychotherapy 35.1 (Jan

Dosing CBT for Panic Disorder: "Massed" Treatment vs. Usual Scheduling
Yager, Joel

. Journal Watch. Psychiatry (Sep 14, 2009).

Kapcsolja be a tallat kiemelst a hangos bngszkhz

Kiemels elrejtse
Absztrakt (sszefoglal)
Fordts [a jelen dokumentumhoz nem rhet el]

Is going to "mass" better for treating panic disorder?

Teljes szveg
Fordts [a jelen dokumentumhoz nem rhet el]

CBT administered in weekly sessions for several months is an effective treatment for panic
disorder. Several open trials have suggested that delivering CBT in a "massed" dosing pattern,
consisting of an intensive immersion experience for just a few weeks, may also be effective.
These investigators conducted a randomized controlled trial of this hypothesis by assigning 39
patients with panic disorder to 26 hours of CBT, either as massed treatment (20 hours in week
1; two 2-hour sessions in week 2; and a single 2-hour session in week 3) or on a standard
schedule (13 weekly 2-hour sessions). CBT after the first session was conducted in group
settings.
Follow-up at 3, 6, and 18 months after treatment revealed significant improvement in both
groups, with no differences in levels of clinical improvement, sustained improvement, or
patient satisfaction with treatment. The groups did not differ in treatment adherence or in
medication changes during follow-up. However, at 4 weeks, massed CBT recipients (who had
just completed treatment) had significantly greater self-reported change than did standard
CBT recipients; these changes in the massed treatment group were similar to those in the
standard CBT group at their end of treatment at 3 months.
Comment: This study involved a small number of patients. In a larger study, some of these
findings might not hold up. Nevertheless, the findings that massed treatment recipients
achieved full benefit early and sustained their improvement suggest that massed treatment
may be preferable for patients able to invest the necessary time upfront. This study invites us
to reexamine familiar treatment rituals that we take for granted -- specifically, the length and
schedule of treatment sessions.

Panic disorder remains a major health problem associated with high levels of
disability and medical care, compounded by difficulties accessing appropriate
treatment. Despite significant advances in understanding and effective treatment
with CBT, the scope for better recognition and early intervention to prevent panic
disorder has been relatively neglected in the CBT literature. This pilot study
utilized the prevalence of panic attacks presenting in emergency medical care to
test deployment of CBT as a practical early intervention strategy for panic
disorder in routine NHS conditions. Twenty-seven people attending two typical UK
Accident & Emergency (A&E) Departments with recent onset panic attacks were
given a single session of CBT-based intervention or assessment only, and

followed-up over 3 months. Basic measures of panic symptoms showed an

improving trend across the whole sample. The very limited experimental control
did not permit firm conclusions about the role of the intervention but at follow-up
nearly one-third reported persisting difficulties typical of panic disorder, which
then improved with brief additional CBT. Implications are discussed in relation to
the existing literature and regarding further research on panic disorder
prevention. [PUBLICATION ABSTRACT]

Long-Distance CBT for Panic Disorder

Yager, Joel

. Journal Watch. Psychiatry (Jan 22, 2007).

Kapcsolja be a tallat kiemelst a hangos bngszkhz

Kiemels elrejtse
Absztrakt (sszefoglal)
Fordts [a jelen dokumentumhoz nem rhet el]

Remotely administered cognitive-behavioral therapy via internet and telephone can

significantly benefit patients with panic disorder.
Teljes szveg
Fordts [a jelen dokumentumhoz nem rhet el]

Several studies suggest that cognitive-behavioral therapy delivered via the internet or
telephone may be effective for various psychiatric disorders. These investigators in Sweden
randomized 60 patients with panic disorder to remote CBT or a waiting list.
The treatment program consisted of 10 modules over 10 weeks. Each module involved about
25 pages of reading, supplemented with e-mails between patients and therapists (for
therapists, averaging about 12 minutes weekly per patient, including administrative time) and
weekly telephone calls (also averaging around 12 minutes). Weekly assignments included
essays and end-of-module quizzes. The modules covered psychoeducation, breathing
retraining, cognitive restructuring, interoceptive exposure, exposure in vivo, and, finally,
relapse prevention and assertiveness training.
Eighty percent of the 30 active-treatment patients completed all 10 modules within the
intended time limit. One month after treatment, 77% in the active-treatment group and none in
the control group no longer met criteria for panic disorder. At follow-up 9 months posttreatment, 60% of active-treatment recipients were rated as clinically improved for bodily
sensations, 67% for agoraphobic cognitions, 67% for mobility when alone, and 60% for
mobility when accompanied.
Comment: The authors credit the use of supplemental telephone calls for these completion
rates, which were higher than in their previous study. Participant satisfaction was quite high,
although most would have preferred a less rushed pace or more treatment time. Internet- and

phone-based therapies should be made more widely available, particularly to patients in rural
areas and to those with agoraphobia, who can benefit from these therapies but may have
limited access to care.
Cognitive-behavioral group therapy for panic disorder in the general clinical
setting: A naturalistic study with 1-year follow-up
Martinsen, Egil W ; Olsen, Thorbjorn; Tonset, Eli; Nyland, Kaj; Aarre, Trond F. The
Journal of Clinical Psychiatry 59.8 (Aug 1998): 437-42; quiz 443.
Kapcsolja be a tallat kiemelst a hangos bngszkhz
Kiemels elrejtse
Absztrakt (sszefoglal)
Fordts Absztrakt

BACKGROUND: Cognitive-behavioral therapy (CBT) is well documented in the treatment

of panic disorder. As most investigators have studied selected patients without comorbid
disorders, it is less clear how well the treatment will perform in the usual clinical setting for
patients with comorbid disorders and with physicians who do not have training in CBT.
During the last 6 years, we have offered CBT in outpatient groups for patients with panic
disorder and agoraphobia. The purpose of this prospective study was to assess the outcome of
group treatment and compare the results with those of studies that used individual treatment.
We wanted to identify variables that might predict outcome at follow-up and to assess the
number and characteristics of dropouts. METHOD: Eighty-three consecutive patients with
DSM-III-R panic disorder (56 women and 27 men; mean age = 34.5 years) were studied.
Mean duration of panic disorder was 7.5 years. There was a high degree of comorbid major
depression, social phobia, and psychoactive substance abuse/dependence. Treatment consisted
of 4-hour group sessions conducted once a week for 11 weeks. More than half of the patients
used antidepressant drugs. Degree of phobic avoidance, bodily sensations, anxiety cognitions,
and depression were assessed at pretreatment, baseline, and end of treatment and at follow-up
after 3 and 12 months. RESULTS: There was a large decrease in scores from start to end on
all assessments. Sixty-three (89%) of 73 completers responded ( or = 50% reduction in Phobic
Avoidance Rating Scale scores). Gains were maintained and even improved upon at followup. The results are comparable with studies that used individual therapy. A high depression
score at the end of treatment predicted poor outcome at 1-year follow-up. Twelve (14%) of 83
did not complete the program. The presence of severe personality disorders and ongoing
alcohol or substance abuse or dependence was associated with poor outcome and high dropout
rate. CONCLUSION: CBT appears to be effective in the usual clinical setting, even in the
hands of therapists without formal competence. Group therapy is a feasible arrangement, and
the results from group treatment are comparable to those of individual approaches. Precise
diagnosis and treatment of comorbid depression are of utmost importance. Patients with
additional substance abuse or dependence, as well as severe personality disorders, may find
this treatment modality less helpful.

Comparing Physical Exercise in Groups to Group Cognitive Behaviour Therapy for

the Treatment of Panic Disorder in a Randomized Controlled Trial
Hovland, Anders ; Nordhus, Inger Hilde; Sjb, Trond; Gjestad, Bente A; Birknes,
Birthe; s msok. Behavioural and Cognitive Psychotherapy 41.4 (Jul 2013):
408-32.
Kapcsolja be a tallat kiemelst a hangos bngszkhz
Kiemels elrejtse
Msolati ttelek megmutatsa ms adatbzisokbl
Absztrakt (sszefoglal)
Fordts Absztrakt

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 clinically significant effects. Method: PD-patients were randomized
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 Questionnaire (ACQ) and the Body Sensations Questionnaire
(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
clinically 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 assessments.
[PUBLICATION ABSTRACT]
on Number
Title
Publication Date
Year of Publication
Language
Author

Peer Reviewed Journal: 2004-11868-007.

Incorporating the Family in the Cognitive-Behavioral Treatment of an
African-American Female Suffering from Panic Disorder with
Agoraphobia. [References].
2003
2003
English
Gore, Kristie L; Carter, Michele M.

Correspondence Gore, Kristie L.: American U, Dept of Psychology, 4400 Massachusetts

Address
Ave., N.W., 321 Asbury Building, Washington, DC, US, 20016-8062
This article highlights interpersonal aspects of panic disorder with agoraphobia
(PDA) and discusses some family dynamics implicated in the creation and
maintenance of panic symptomatology. A case of complex PDA is presented to
demonstrate Panic Control Treatment and the integration of family therapy
approaches. Treatment techniques included psycho-education, breathing
retraining, cognitive restructuring, interoceptive exposure, in vivo exposure and
discussion of secondary gains and family dynamics. The importance of a flexible
approach to treatment of PDA using multidimensional techniques is emphasized.
(PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)

Peer Reviewed Journal: 1993-10557-001.

Title
Publication Date
Year of
Publication
Language
Author
Institution
Source
ISSN Print
Other Serial
Titles
Publisher
Information

Anxiety disorders and family therapy.

Jun 1992
1992
English
Hafner, R. Julian.
Hafner, R. Julian: Glenside Hosp, Dibden Research Unit, Eastwood, SA,
Australia
Australian and New Zealand Journal of Family Therapy. Vol.13(2), Jun
1992, pp. 99-104.
0814-723X
ANZJFT Australian and New Zealand Journal of Family Therapy,
Australian Journal of Family Therapy
Australian & New Zealand Journal of Family Therapy; Australia

Australian Academic Press, Australia; Cambridge University Press, United

Other Publishers Kingdom; Wiley-Blackwell Publishing Ltd., United Kingdom
Format Covered Print
Presents a classification of anxiety disorders, including panic disorder and
agoraphobia, social phobia, and obsessive-compulsive disorder (OCD), and
considers the role of family therapy (FT) in treating these conditions. Married
women make up most of the population of agoraphobics and, for many of these
women, FT that stresses spouse involvement and couples' communication can

have a successful outcome. Also, exposure in vivo is generally crucial to recovery

from persistent agoraphobia. In cases of OCD, spouse-aided therapy may also be
used, although high levels of family hostility may need to be overcome. The
essence of successful FT in cases of OCD is to facilitate clients' own attempts to
overcome their symptoms. (PsycINFO Database Record (c) 2013 APA, all rights
reserved)

ccession
Number
Title

Book: 2002-01051-004.
Chapter
Family therapy for panic disorder: A cognitive-behavioral interpersonal approach
to treatment. [References].

Publication 2001
Date
Year of
2001
Publication
English
Language
Author

Gore, Kristie L; Carter, Michele M.

Gore, Kristie L.: American U, Dept of Psychology, Washington, DC, US

Institution Carter, Michele M.: American U, Dept of Psychology, Washington, DC, US

Source
ISBN
Publisher
Information
Format
Covered
Publication
Type
Document
Type
Abstract

MacFarlane, Malcolm M [Ed]. (2001). Family therapy and mental health:

Innovations in theory and practice. (pp. 109-134). xxviii, 410 pp. Binghamton, NY,
US: Haworth Clinical Practice Press; US.
0-7890-0880-7 (Hardcover); 0-7890-1589-7 (Paperback)
Haworth Clinical Practice Press; US
Print
Book; Edited Book
Chapter
(from the chapter) Although the family system has been implicated in both the
development and maintenance of panic, therapists and researchers currently
disagree concerning whether marital or family therapy for panic disorder is
warranted. Given the interpersonal nature of the disorder, one might expect that
involving families in treatment could alter the interpersonal dynamics that may
serve to create and/or sustain the disorder. In this chapter, the authors briefly
review the literature on etiological theories of panic disorder. Next, they review the
theoretical relationship between family dynamics and agoraphobia. The authors
then discuss therapy techniques employing the spouse as partner and cotherapist,
highlighting cognitive-behavioral techniques and communication skills training.
Last, they present a case example of cognitive-behavioral interpersonal therapy for

a married woman (aged 37 yrs) suffering from panic disorder with agoraphobia.
(PsycINFO Database Record (c) 2012 APA, all rights reserved)
Key Concepts family therapy, pani
Peer Reviewed Journal: 2000-14172-004.
Title
Publication Date
Year of Publication
Language
Author
Institution
Source
Special Issue Title
ISSN Print
Other Serial Titles
Publisher Information
Format Covered
Publication Type
Document Type
Abstract

Treating panic disorder with agoraphobia: Integrating a

family systems and behavioral approach.
Fal, 1995
1995
English
Friedman, Steven.
Friedman, Steven: State U New York, Health Science
Ctr at Brooklyn, Dept of Psychiatry, Brooklyn, NY, US
In Session: Psychotherapy in Practice. Vol.1(3), Fal
1995, pp. 49-68.
Special Issue: Panic Disorder
1077-2413
Journal of Clinical Psychology
John Wiley & Sons; US
Print
Journal; Peer Reviewed Journal
Journal Article
Outlines a combined treatment program for panic
disorder (PD) with agoraphobia that includes
behavioral and family systems interventions and was
developed out of an actual case of a 58-yr-old woman
with PD who lived with her sister. The author states
that, in interactions that threaten to arouse anxiety,
individuals with PD tend to relate to significant others
as either safety-producing and soothing phobic
companions or as cruelly indifferent individuals. In
response to such urgent polarized requests, significant
others either regressively alleviate the client's anxiety,
thus reinforcing the pathology, or conversely "push"

independent behavior that is anxiety implosive and

similarly reinforces phobic avoidance. Commonly, the
2 patterns of response alternate, leaving both the
phobic and family members embroiled in a circular
transaction associated with declining satisfaction,
mutual resentment, and entrenched symptomatology.
The treatment approach is described in 4 stages, each
with specific goals: initial family contact, joining with
the family by keeping the focus on the client;
structured family interview, reframing the
dysfunctional transaction; education, cementing the
alliance; and the task, undoing the double bind through
graded separations. (PsycINFO Database Record (c)
2013 APA, all rights reserved)
Depression and Anxiety
2014
Critical review of outcome research on interpersonal psychotherapy for anxiety
disorders (

Article in press

Markowitz, J.C.ab , Lipsitz, J.bc, Milrod, B.L.bd

a

Anxiety Disorders Clinic Division of Clinical Therapeutics New York State Psychiatric
Institute New York, New York
b
Department of Psychiatry, Columbia University New York, New York
c
Department of Psychology, Ben-Gurion University of the Negev Beer-Sheva Israel
d
Department of Psychiatry, Weill Medical College of Cornell University New York, New
York
View additional affiliations
Abstract

Background: Interpersonal psychotherapy (IPT) has demonstrated efficacy in treating mood

and eating disorders. This article critically reviews outcome research testing IPT for anxiety
disorders, a diagnostic area where cognitive behavioral therapy (CBT) has dominated research
and treatment. Methods: A literature search identified six open and five controlled trials of
IPT for social anxiety disorder (SAD), panic disorder, and posttraumatic stress disorder.
Results: Studies were generally small, underpowered, and sometimes methodologically
compromised. Nonetheless, minimally adapted from its standard depression strategies, IPT for
anxiety disorders yielded positive results in open trials for the three diagnoses. In controlled
trials, IPT fared better than waiting list (N = 2), was equipotent to supportive psychodynamic
psychotherapy (N = 1), but less efficacious than CBT for SAD (N = 1), and CBT for panic
disorder (N = 1) in a methodologically complicated study. IPT equaled CBT in a group
residential format (N = 1). Conclusions: IPT shows some promise for anxiety disorders but
has thus far shown no advantages in controlled trials relative to other therapies.
Methodological and ecological issues have complicated testing of IPT for anxiety disorders,

clouding some findings. The authors discuss difficulties of conducting non-CBT research in a
CBT-dominated area, investigator bias, and the probable need to further modify IPT for
anxiety disorders. Untested therapies deserve the fairest possible testing. 2014 Wiley
Periodicals, Inc.
Comprehensive Psychiatry
Volume 55, Issue 1, January 2014, Pages 87-92
Effect of cognitive-behavioral group therapy for panic disorder in changing coping
strategies

Wesner, A.C.ab, Gomes, J.B.ab, Detzel, T.ab, Blaya, C.ac, Manfro, G.G.ab, Heldt, E.ab
a

Anxiety Disorders Program, Hospital de Clnicas de Porto Alegre, Brazil

Graduate Program in Medical Sciences: Psychiatry, Universidade Federal Do Rio Grande
Do sul, Porto Alegre, Brazil
c
Medical Clinic: Psychiatry, Universidade Federal de Cincias da Sade de Porto Alegre,
Brazil
b

View references (29)

Abstract

Background Cognitive-behavioral group therapy (CBGT) is an efficient treatment for panic

disorder (PD). However, the role of CBGT in enhancing strategies to cope with stressful
events has not been established. Aim To evaluate the effect of CBGT on the choice of coping
strategy by PD patients compared to a group of individuals without mental disorders. Methods
Forty-eight PD patients who completed a 12-session CBGT protocol were compared to 75
individuals without mental disorders regarding coping strategies as evaluated by the Coping
Strategies Inventory (CSI). The severity of PD was assessed at baseline and after CBGT
through the Clinical Global Impression (CGI) scale, the Hamilton Anxiety Scale (HAM-A),
and the Panic Inventory (PI). Results Treatment was effective in reducing PD severity in all
outcome measures. Patients used significantly fewer confrontation, escape and avoidance
strategies after CBGT. The use of more adaptive coping strategies was related to a decrease in
panic attacks and anticipatory anxiety. Application of the CSI showed that the use of strategies
was also significantly different in patients as compared to the control group, except for escape
and avoidance, which became similar after the CBGT protocol. Conclusions Despite the
changes observed after the CBGT protocol, the choice of coping strategy was still different in
patients vs. controls. The current CBGT protocol was used specifically to assess PD
symptoms. Other cognitive tools should be included to address maladaptive coping strategies.
2014 Elsevier Inc.
Journal of Affective Disorders
Volume 157, 20 March 2014, Pages 25-32

The relationship between interpersonal problems, therapeutic alliance, and

outcomes following group and individual cognitive behaviour therapy

McEvoy, P.M.ab , Burgess, M.M.ab, Nathan, P.a

a
b

Centre for Clinical Interventions, 223 James Street, Northbridge, Perth, WA 6003, Australia
School of Psychology and Speech Pathology, Curtin University, Perth, Australia

View references (37)

Abstract

Background Cognitive behavioural therapy (CBT) is efficacious, but there remains individual
variability in outcomes. Patient's interpersonal problems may affect treatment outcomes,
either directly or through a relationship mediated by helping alliance. Interpersonal problems
may affect alliance and outcomes differentially in individual and group (CBGT) treatments.
The main aim of this study was to investigate the relationship between interpersonal
problems, alliance, dropout and outcomes for a clinical sample receiving either individual or
group CBT for anxiety or depression in a community clinic. Methods Patients receiving
individual CBT (N=84) or CBGT (N=115) completed measures of interpersonal problems,
alliance, and disorder specific symptoms at the commencement and completion of CBT.
Results In CBGT higher pre-treatment interpersonal problems were associated with increased
risk of dropout and poorer outcomes. This relationship was not mediated by alliance. In
individual CBT those who reported higher alliance were more likely to complete treatment,
although alliance was not associated with symptom change, and interpersonal problems were
not related to attrition or outcome. Limitations Allocation to group and individual therapy was
non-random, so selection bias may have influenced these results. Some analyses were only
powered to detect large effects. Helping alliance ratings were high, so range restriction may
have obscured the relationship between helping alliance, attrition and outcomes. Conclusions
Pre-treatment interpersonal problems increase risk of dropout and predict poorer outcomes in
CBGT, but not in individual CBT, and this relationship is not mediated by helping alliance.
Stronger alliance is associated with treatment completion in individual, but not group CBT.
2014 Elsevier B.V.
Crisis
Volume 32, Issue 3, 2011, Pages 169-172
Panic disorder and suicidal behavior: A follow-up study of patients treated with
cognitive therapy and SSRIs in Hungary

Zonda, T.a, Nagy, G.b, Lester, D.c

a

Hungarian Association for Suicide Prevention, Hungary

Outpatient Care Unit for Panic Disorders, Jahn F. Hospital, Budapest, Hungary
c
The Richard Stockton College, Pomona, NJ, United States
b

View references (26)

Abstract

Background: Previous research has suggested that patients with panic disorder but no
comorbid disorder are not at greater risk for suicidal behavior. Aims: The present study
followed up patients with panic disorder in order to assess the frequency of their suicidal
behavior. Methods: A sample of 281 outpatients with panic disorder, but without a comorbid
psychiatric disorder, was followed up for an average of 5 years. The patients were given 6-8
weeks of cognitive therapy, and 65% were prescribed SSRIs. Results: At the time of first
admission, 5 patients (1.7%) reported a previous (lifetime) suicide attempt, and 53 patients
(18.2%) reported previous (lifetime) suicidal ideation (both thoughts and plans), not greatly
different from the Hungarian population in general. During the follow-up period, no patient
committed suicide, 2 patients attempted suicide (0.7%), and 4 patients (1.4%) reported
suicidal ideation. Conclusions: This study indicates that people with panic disorders without
comorbid disorders have no higher suicidal risk than the general population in Hungary. After
treatment with cognitive therapy and SSRIs, 38.5% were symptom-free, and only 7.8%
required continued close therapeutic contact after the follow-up period. 2011 Hogrefe
Publishing.