Fewer Panic Attacks With Talk Therapy
Combining Talk Therapy and Drug Treatment Is an Effective Combination, Researchers Say
March 7, 2005 -- People get fewer when they get talk therapy as well as drug treatment.
The therapy -- a simplified version of a psychotherapy known as cognitive behavioral therapy or CBT -- took only six, hour-long sessions over 12 weeks. Since many panic-attack patients do not ever see a clinical psychologist or psychiatrist, the treatment was designed to be given in doctors' offices by nurses trained in the technique.
University of Washington researcher Peter P. Roy-Byrne, MD, and colleagues report the findings in the March issue of Archives of General Psychiatry.
"In a real-world setting … cognitive-behavioral therapy is still capable of exerting a significant beneficial effect," they conclude. "The outcomes achieved in this study cannot definitively be attributed to cognitive-behavioral therapy alone. Nonetheless, the possibility that … cognitive-behavioral therapy alone tailored for the primary care setting might be an efficacious treatment for panic disorder should be systematically tested."
Fewer Panic Attacks With Therapy
Roy-Byrne's team enrolled 232 people who had frequent panic attacks. Most of them also suffered from other psychiatric problems. More than half had chronic depression -- which makes panic attacks much harder to treat.
Half the patients got standard therapy. That is, their primary care doctors gave them antipanic drugs according to a drug therapy "roadmap" designed by psychiatrists. Their doctors were also free to refer these patients to mental health specialists.
The other half of the patients got the same drug therapy. They also got free sessions with a psychologist-in-training with little or no experience in cognitive behavioral therapy. The idea was to imitate the kind of nonspecialist who might be trained to treat patients in primary care doctors' offices.
Therapy sessions taught patients how to respond to symptoms of panic attacks, depression, and social anxiety. They received a video and a workbook, and were asked to attend at least three therapy sessions in person, for a total of six in-person or telephone sessions over 12 weeks. Six follow-up "booster" telephone sessions also were scheduled over rest of the year.
The bottom line: Patients getting talk therapy plus antipanic drugs did better than those on standard treatment. After a year, 29% of these patients -- but only 16% of standard-treatment patients -- had zero panic attacks and minimal anxiety or fearful avoidance behavior. Nearly two-thirds of patients treated with the therapy/drug combination responded to treatment, while only 38% of patients responded to drugs alone.
Roy-Byrne and colleagues note that many patients did not complete the cognitive behavioral therapy program -- even though it was free and scheduling was highly flexible.
"A major goal of future work in this area should be to develop, implement, and disseminate approaches to treatment of anxiety disorders that are maximally acceptable to patients, physicians, and payers," they write.