COGNITIVE-BEHAVIOR THERAPY FOR TREATMENT-REFRACTORY PANIC DISORDER

Background: The purpose of this pilot study is to assess the efficacy of cognitive behavior therapy for the treatment of patients with panic disorder who experience an incomplete response to a trial of pharmaco therapy. Method: Fifteen consecutive patients with a DSM-III-R diagnos is of panic disorder referred for further treatment because of an inco mplete response to pharmacotherapy were treated with 12-weeks of group cognitive behavior therapy. Patients were evaluated at baseline, endp oint, and at a mean of 2-months' follow-up to assess changes in panic attack frequency and global outcome. Eight of the 15 patients were dee med to have received an inadequate prior trial of medication at baseli ne, mainly because of a desire to control their symptoms without medic ation or fear of withdrawal and/or addiction. Seven of the patients we re symptomatic at baseline despite an adequate prior trial of medicati on. Results: Overall, patients experienced a significant improvement i n global function at the end of the cognitive behavior therapy interve ntion, as well as a decrease in panic attack frequency. Improvement wa s maintained at follow-up. Conclusion: This study is consistent with a growing body of evidence that many patients with panic disorder remai n symptomatic over time and are receiving inadequate pharmacotherapeut ic treatment. Further, we observed that patients with panic disorder w ho are incompletely responsive or resistant to pharmacotherapeutic man agement may benefit from the addition of cognitive behavior therapy.