Academic journal article Canadian Journal of Behavioural Science

Group vs Individual Cognitive Behaviour Therapy in Panic Disorder: An Open Clinical Trial with a Six Month Follow-Up

Academic journal article Canadian Journal of Behavioural Science

Group vs Individual Cognitive Behaviour Therapy in Panic Disorder: An Open Clinical Trial with a Six Month Follow-Up

Article excerpt

Abstract

Panic with or without agoraphobia (PD/A) is an often incapacitating and chronic disorder. Cognitive behaviour therapy (CBT) has been shown to be effective in reducing panic frequency and intensity in PD/A. However, the effect of treatment modality (group vs individual) on the efficacy of CBT is unclear. Twenty patients meeting DSM-III-R criteria for PD/A were treated, by the same therapist, with either group (CBTgr) or individual (CBTi) CBT and followed monthly for six months post treatment. Both CBTgr and CBTi significantly (and to the same extent) reduced panic frequency at treatment end. However, a differential effect favouring CBTi over CBTgr was observed with regards symptoms other than panic, such as generalized anxiety-like and depressive symptoms. This differential effect favouring CBTi was also observed at the end of the follow-up phase, where outcome was measured as the number of patients maintaining remission.

Panic with or without agoraphobia (PD/A) is an often incapacitating and chronic disorder. Such patients are over-represented (even compared to populations considered to be of poor or fair health) with regards the use of medical services, such as emergency room visits, number of visits to physicians per year and the use of psychotropic medications (Beitman, Lamberti, Mukerji, DeRosear, Basha & Schmid, 1987; Chignon, Lepine & Ades, 1993; Coryell, Noyes & Clancy, 1982; Fifer, Mathias, Patrick, Mazonson, Lubeck & Busesching, 1994; Markowitz, Weissman & Klerman, 1989; Reich, 1986; Siegel, Jones & Wilson, 1990). In addition, their rate of attempted suicide has been reported to be either greater to that of the general population or equal to that of patients suffering from major depression (Allgulander, 1994; Allgulander & Lavori, 1991; Coryell, Noyes & House, 1986; Johnson, Weissman & Klerman, 1990; Lepine, Chignon & Teharani, 1993; Weissman, Klerman, Markowitz & Ouellette, 1989).

Clinical evidence suggests that cognitive-behaviour therapy (CBT) is an effective treatment for PD/A (Barlow, Craske, Cerny & Klosko, 1989; Beck, Sokol, Clark, Berchick & Wright, 1992; Clark, Salkovskis & Chalkley, 1985; Clum, Clum & Surls, 1993; Craske, Brown & Barlow, 1991; Klosko, Barlow, Tassinari & Cerny, 1990; Michelson, Marchione, Greenwald, Glanz, Testa & Marchione, 1990; ost, 1988; Salkovskis, Jones & Clark, 1986; Sokol, Beck, Greenberg, Wright & Berchick, 1989). Craske & Barlow (1990) have suggested that CBT is equally effective whether administered in an individual (CBTi) or group (CBTgr) setting. To our knowledge, however, few reports have compared the effect of treatment modality on outcome in PD/A. Rather, CBTgr versus CBTi trials have studied heterogeneous groups of patients with mild to moderate mixed anxiety and depressive symptoms (Shaffer, Shapiro, Sank & Caghlan, 1981; Shapiro, Sank, Shaffer & Donovan, 1982). In this open preliminary clinical trial the short-and medium-term (6 months) efficacy of CBTgr was compared to CBTi in the treatment of PD/A.

METHOD

Participants

Twenty consecutive referrals (18 to 65 years of age) to an anxiety disorders clinic were assessed, each with a presumptive diagnosis of PD/A of at least six months duration. For each patient, the diagnosis was confirmed and the degree of agoraphobia graded (DSM-III-R criteria) by two of the principal investigators (PI) using an unstructured clinical interview. In addition, upon clinical evaluation, patients clearly suffering from comorbid generalized anxiety disorder (DSM-III-R criteria) were excluded. All were free of serious medical illnesses that might mimic PD/A signs and symptoms (thyroid disorders, hypoglycaemia). Those suffering from PD/A without, with mild or moderate agoraphobia (Table 1) were required to score 20 or greater on the Beck Anxiety Inventory (BAI) and the Hamilton Anxiety Rating Scale (HAMA). …

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