Academic journal article Journal of Cognitive Psychotherapy

Models and Treatment of Panic: Behavioral Therapy of Panic

Academic journal article Journal of Cognitive Psychotherapy

Models and Treatment of Panic: Behavioral Therapy of Panic

Article excerpt

In this presentation, the results from two studies examining the effectiveness of behavioral treatments for panic disorder are presented. In the first study, a dismantling treatment study design was used to compare relaxation training, exposure and cognitive procedures, the combination of relaxation plus expoosure and cognitive procedures, and a Wait-List control. Subjects with panic disorder and mild or no agoraphobic avoidance were compared immediately after the 15-week treatment program and 6 months and 24 months later. Overall, exposure and cognitive procedures were found to be more effective than relaxation for the control of panic attacks in the short term and over the long term. In the second study, the combination of relaxation plus exposure and cognitive procedures was compared to Alprazolam, Placedbo, and Wait-List control conditions. Overall, the Cognitive-Behavioral therapy condition showed strongest improvements by the end of treatment in terms of panic, general enxiety and global functioning. Finally, it was noted that although exposure and cognitive procedures effectively controlled panic attacks in approximately 80% of subjects (immediately post treatment and 24-months post treatment), only 50% of the subjects were no longer distressed in general.

Controlled investigations of behavioral treatments for agoraphobic avoidance have demonstrated repeatedly the effectiveness of in vivo exposure procedures (Barlow & Waddell, 1985). While the mechanisms of fear and avoidance reduction remain unclear, in vivo exposure is considered to be substantially more effective than a number of other alternative psychotherapeutic techniques. In contrast, controlled investigations of nonpharmacological treatments for panic attacks are relatively recent. The first systematic attempts to research the effectiveness of psychological treatments for panic disorder (without extensive situational avoidance) utilized multicomponent packages, entailing cognitive, relaxation and exposure methodologies. Examples of multicomponent approaches include the report by Gitlin et al. (1985) of the successful treatment of 11 panic disorder patients using 6 to 32 individual sessions of education, relaxation training, breathing retraining, in vivo exposure and assertiveness training. Also, Barlow et al. (1984) reported upon the efficacy of 18 individual sessions of progressive muscle relaxation training, EMG biofeedback training and cognitive restructuring, in comparison to a Wait-List condition. Other examples include reports by Shear, Ball, and Josephson (in press), Jannoun, Oppenheimer, and Gelder (1982) and Tarrier and Main (1986). Overall, these studies have shown that multicomponent approaches are far more effective than the passage of time alone, with success rates of up to 91% at post-treatment, in terms of panic frequency (Craske, 1988). However, evaluation of the multicomponent packages was relatively lacking in the area of follow-up assessment, and the specificity of effectiveness of the separate treatment components required investigation. For that reason, a treatment dismantling design was used in the first study presented herein (the full analyses from which are available in Barlow, Craske, Cerny, & Klosko, 1989). The treatment design entailed a comparison between cognitive plus interocepti ve exposure procedures and a procedure perhaps most basic to the multicomponent approach, which was relaxation. In addition, the study allowed examination of enhancement of effectiveness derived from the combination of the Cognitive-Exposure and Relaxation treatment procedures, all of which was compared to the effect of the passage of time alone. The design is presented in Figure 1.

The Relaxation condition entailed a modified version of Jacobson's progressive relaxation training (Bernstein & Borkovec, 1973) which extended from 16-muscle tension-release exercises to 8-muscle tension-release exercises, 4-muscle tension-release exercises, recall relaxation and cue-controlled relaxation. …

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