COGNITIVE-BEHAVIORAL GROUP-THERAPY FOR PANIC DISORDER IN THE GENERAL CLINICAL SETTING - A NATURALISTIC STUDY WITH 1-YEAR FOLLOW-UP

Background: Cognitive-behavioral therapy (CBT) is well documented in t he treatment of panic disorder. As most investigators have studied sel ected patients without comorbid disorders, it is less clear how well t he treatment will perform in the usual clinical setting for patients w ith comorbid disorders and with physicians who do not have training in CBT. During the last 6 years, we have offered CBT in outpatient group s for patients with panic disorder and agoraphobia. The purpose of thi s prospective study was to assess the outcome of group treatment and c ompare the results with those of studies that used individual treatmen t. We wanted to identify variables that might predict outcome at follo w-up and to assess the number and characteristics of dropouts. Method: Eighty-three consecutive patients with DSM-III-R panic disorder (56 w omen and 27 men; mean age = 34.5 years) were studied. Mean duration of panic disorder was 7.5 years. There was a high degree of comorbid maj or depression, social phobia, and psychoactive substance abuse/depende nce. Treatment consisted of 4-hour group sessions conducted once a wee k for 11 weeks. More than half of the patients used antidepressant dru gs. Degree of phobic avoidance, bodily sensations, anxiety cognitions, and depression were assessed at pretreatment, baseline, and end of tr eatment and at follow-up after 3 and 12 months. Results: There was a l arge decrease in scores from start to end on all assessments. Sixty-th ree (89%) of 73 completers responded (greater than or equal to 50% red uction in Phobic Avoidance Rating Scale scores), Gains were maintained and even improved upon at follow-up. The results are comparable with studies that used individual therapy. A high depression score at the e nd of treatment predicted poor outcome at 1-year follow-up. Twelve (14 %) of 83 did not complete the program. The presence of severe personal ity disorders and ongoing alcohol or substance abuse or dependence was associated with poor outcome and high dropout rate. Conclusion: CBT a ppears to be effective in the usual clinical setting, even in the hand s of therapists without formal competence. Group therapy is a feasible arrangement, and the results from group treatment are comparable to t hose of individual approaches. Precise diagnosis and treatment of como rbid depression are of utmost importance. Patients with additional sub stance abuse or dependence, as well as severe personality disorders, m ay find this treatment modality less helpful.