A METAANALYSIS OF THE TREATMENT OF PANIC DISORDER WITH OR WITHOUT AGORAPHOBIA - A COMPARISON OF PSYCHOPHARMACOLOGICAL, COGNITIVE-BEHAVIORAL, AND COMBINATION TREATMENTS

To compare short-term efficacy of benzodiazepines, antidepressants, ps ychological panic management, exposure in vivo, and combination treatm ents in panic disorder with or without agoraphobia (PA), a meta-analys is was as conducted. Included were 106 studies, pertaining to 222 trea tment conditions, 5,011 patients at pretest and 4,016 at posttest. Pre /post effect, sizes Cohen's d were calculated with in the treatment co nditions for four clinical variables: panic, agoraphobia, depression, and general anxiety. Seven large treatment conditions were used in the main analyses: high-potency benzodiazepines, antidepressants, psychol ogical panic management, exposure in vivo, pill-placebo combined with exposure, antidepressants combined with exposure, and psychological pa nic management combined with exposure in vivo. First, these treatments were compared with a control condition, consisting of pill-placebo, a ttention placebo, and waiting list. Next, a comparison was made betwee n the treatments. Antidepressants, psychological panic management, hig h-potency benzodiazepines, and antidepressants combined with exposure in vivo were superior to the control condition for panic attacks. Expo sure in vivo alone was not effective for panic attacks. With regard to agoraphobic avoidance, all seven treatments mere superior to the cont rol condition. When comparing tile various treatment conditions, no di fferences concerning panic attacks were found. For agoraphobic avoidan ce, the combination of antidepressants with exposure in vivo was super ior to tile other conditions. The combination of antidepressants with. exposure in viva is the most potent short-term treatment of PA.