Content area
Full text
Treatment studies demonstrate approximately equal effectiveness of cognitive-behavioral and pharmacologic strategies in the short term, but a very different picture emerges when long-term efficacy is examined.
The recent NIH Consensus Conference on Panic Disorder concluded that the available evidence supports 'the short-term efficacy of pharmacologic and cognitive-behavioral treatments for panic disorder.1 The Consensus Conference also encouraged clinicians to evaluate the efficacy of treatments after 6 to 8 weeks in order to address the need for alternative or additional treatment if no response is evident. This conference statement helps direct clinicians toward the most effective acute-treatment options, but does not help guide treatment over the longer term, when patients fail to respond fully to initial treatments. This article considers cognitive-behavioral interventions for the short- and long-term treatment of panic disorder, with emphasis on the identification of factors and strategies for maximizing longterm outcome.
There is good evidence for the short-term efficacy of cognitive-behavioral treatments for panic disorder. In recent, well -controlled clinical trials, cognitive-behavioral programs utilizing cognitive-restructuring and interoceptive exposure interventions (see below) have been associated with panic-free rates ranging from 719c2 to above 80^ for short-term treatment in individual or group formats.'3,4 These panic-free rates are above the 50% to 70% range reported for benzodiazepine and antidepressant treatments.5,6 Studies comparing the relative efficacy of pharmacologic and cognitive behavioral interventions report similar panic-free rates above 80% for cognitivebehavioral interventions, and between 50% and 60% for pharmacotherapy, although the difference between the treatment conditions does not generally reach statistical significance.4,7
Treatment studies provide evidence for approximately equal effectiveness of cognitivebehavioral and pharmacologic strategies in the short term. A very different picture emerges, however, when long-term efficacy is examined. In the case of pharmacotherapy, it appears that many patients require ongoing medication treatment and remain symptomatic despite this ongoing treatment. For example, longitudinal studies of medicationtreated patients found that approximately 40'7( of patients continue to experience panic attacks, and 50% to 80^ of patients continue to remain symptomatic at assessments ranging from 1.5 to 6 years after the initiation of medication treatment.8 In addition, the discontinuation of medication treatment, whether benzodiazepine or antidepressant, is associated with relapse and discontinuation-related symptomatology. The discontinuation of highpotency benzodiazepine treatment has received particular attention, with reports that the majority of patients...