Long-term outcome of panic disorder with agoraphobia treated by exposure

Background. There is a paucity of long-term outcome studies of panic disord er that exceed a 2-year follow-up. The aim of the study was to evaluate the long-term follow-up of patients with panic disorder with agoraphobia treat ed according to a standardized protocol. Methods. A consecutive series of 200 patients satisfying the DSM-IV criteri a for panic disorder with agoraphobia was treated in an out-patient clinic with behavioural methods based on exposure homework. One hu nd red and thir ty-six patients became panic free after 12 sessions of psychotherapy and 13 2 were available for follow-up. A 2- to 14-year (median = 8 years) follow-u p was performed. Survival analysis was employed to characterize the clinica l course of patients. Results. Thirty-one of the 132 patients (23 %) had a relapse of panic disor der at some time during follow-up. The estimated cumulative percentage of p atients remaining in remission was 93(.)1 after 2 years. 82(.)4 after 5 yea rs. 78(.)8 after 7 years and 62(.)1 after 10 years Such probabilities incre ased with younger age, and in the absence of a personality disorder, of hig h pre-treatment levels of depressed mood, of residual agoraphobic avoidance after exposure, and of concurrent use of benzodiazepines and antidepressan t drugs. Conclusions. The findings suggest that exposure treatment can provide lasti ng relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not si mply of panic attacks, should be the aim of exposure therapy.