TREATMENT OF PANIC DISORDER WITH AGORAPHOBIA - COMPARISON OF FLUVOXAMINE, PLACEBO, AND PSYCHOLOGICAL PANIC MANAGEMENT COMBINED WITH EXPOSURE AND OF EXPOSURE IN-VIVO ALONE

Objective: The purpose of this comparative outcome study was to invest igate whether the effects of exposure in vivo treatment for panic diso rder with agoraphobia could be enhanced by adding interventions specif ically for panic attacks before the start of exposure treatment. The a dditional effect of two types of treatment for panic attacks-pharmacol ogical (fluvoxamine) and psychological (repeated hyperventilation prov ocations and respiratory training)-was examined. Thus, the combined tr eatment of panic interventions with exposure in vivo could be compared to exposure in vivo alone. Method: Ninety-six patients were randomly assigned to four treatment conditions: double-blind, placebo-controlle d fluvoxamine followed by exposure in vivo, psychological panic manage ment followed by exposure, and exposure in vivo alone. Outcome was ass essed by self-report measures, a standardized multitask behavioral avo idance test, and continuous monitoring of panic attacks. Seventy-six p atients completed the study. Results: All four treatments were effecti ve and resulted in a significant decrease of agoraphobic avoidance. Mo reover, the combination of fluvoxamine and exposure in vivo demonstrat ed efficacy superior to that of the other treatments and had twice as large an effect size (difference between pre- and posttreatment scores ) on self-reported agoraphobic avoidance. The other treatments did not differ among each other in effectiveness. Conclusions: Results of the study indicate that the short-term outcome of exposure in vivo treatm ent can be enhanced by adding fluvoxamine treatment. Psychological pan ic management combined with exposure was not superior to exposure alon e of equal duration.