Do selective serotonin re-uptake inhibitors enhance the efficacy of very brief cognitive behavioral therapy for panic disorder? A pilot study

Selective serotonin re-uptake inhibitors (SSRIs) and cognitive behavioral t herapies (CBTs) are both considered as first-line treatments for panic diso rder, but the advantages of a combined therapy have yet to be definitively demonstrated. We evaluated in this pilot study the effects of combining SSR Is (vs. a placebo) with a very brief form of cognitive-behavioral. therapy provided to all participants. Thirty-three subjects with DSM-IV panic disor der, with or without agoraphobia, were randomized to receive either paroxet ine or a placebo with flexible dosing (10-50 mg/day). Medication visits wer e brief (15 min), infrequent (6 in total) and non-directive. An expert cogn itive-behavior therapist administered one initial 45-min session and one su bsequent 30-min session of very brief CBT (vbCBT) at weeks 5 and 7, respect ively. Sessions were supplemented with educational and directive reading ma terials. Patients in both groups (i.e. vbCBT + paroxetine; vbCBT + placebo) improved similarly and substantially on most measures during the 10 weeks of acute treatment. At week 10, the proportion of panic-free patients was s ignificantly higher in the paroxetine-treated group than in the placebo gro up (80 vs. 25%; P < 0.007), as was the proportion of subjects who rated the mselves as 'very much improved' at week 10 (60 vs. 13%; P < 0.017). These f indings point to the need for additional studies to confirm the effectivene ss of very brief forms of CBT, and to document the circumstances in which c ombined treatment with an SSRI would be warranted. (C) 2000 Elsevier Scienc e Ireland Ltd. All rights reserved.