Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-14T17:25:56.988Z Has data issue: false hasContentIssue false

A randomized clinical trial of cognitive behavioral therapy and interpersonal psychotherapy for panic disorder with agoraphobia

Published online by Cambridge University Press:  30 April 2012

S. P. F. Vos*
Affiliation:
Department of Clinical Psychological Science, Faculty of Neuroscience and Psychology, Maastricht University, The Netherlands
M. J. H. Huibers
Affiliation:
Department of Clinical Psychological Science, Faculty of Neuroscience and Psychology, Maastricht University, The Netherlands
L. Diels
Affiliation:
Regional Hospital AZ Vesalius, Tongeren, Belgium
A. Arntz
Affiliation:
Department of Clinical Psychological Science, Faculty of Neuroscience and Psychology, Maastricht University, The Netherlands
*
*Address for correspondence: S. P. F. Vos, M.Sc., Department of Clinical Psychological Science, Maastricht University, PO Box 616, NL-6200 MD Maastricht, The Netherlands. (Email: [email protected])

Abstract

Background

Interpersonal psychotherapy (IPT) seems to be as effective as cognitive behavioral therapy (CBT) in the treatment of major depression. Because the onset of panic attacks is often related to increased interpersonal life stress, IPT has the potential to also treat panic disorder. To date, a preliminary open trial yielded promising results but there have been no randomized controlled trials directly comparing CBT and IPT for panic disorder.

Method

This study aimed to directly compare the effects of CBT versus IPT for the treatment of panic disorder with agoraphobia. Ninety-one adult patients with a primary diagnosis of DSM-III or DSM-IV panic disorder with agoraphobia were randomized. Primary outcomes were panic attack frequency and an idiosyncratic behavioral test. Secondary outcomes were panic and agoraphobia severity, panic-related cognitions, interpersonal functioning and general psychopathology. Measures were taken at 0, 3 and 4 months (baseline, end of treatment and follow-up).

Results

Intention-to-treat (ITT) analyses on the primary outcomes indicated superior effects for CBT in treating panic disorder with agoraphobia. Per-protocol analyses emphasized the differences between treatments and yielded larger effect sizes. Reductions in the secondary outcomes were equal for both treatments, except for agoraphobic complaints and behavior and the credibility ratings of negative interpretations of bodily sensations, all of which decreased more in CBT.

Conclusions

CBT is the preferred treatment for panic disorder with agoraphobia compared to IPT. Mechanisms of change should be investigated further, along with long-term outcomes.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arntz, A (2002). Cognitive therapy versus interoceptive exposure as treatment of panic disorder without agoraphobia. Behaviour Research and Therapy 40, 325341.CrossRefGoogle ScholarPubMed
Arrindell, WA, Ettema, JHM (1981). Dimensional structure, reliability and validity of the Dutch version of the Symptom Checklist (SCL-90): data based on a phobic and ‘normal’ population [in Dutch]. Nederlands Tijdschrift voor de Psychologie en Haar Grensgebieden 36, 77–108.Google Scholar
Barlow, DH (1988). Anxiety and its Disorders: The Nature and Treatment of Anxiety and Panic. Guilford Press: New York.Google Scholar
Barlow, DH, Craske, MG (1994). Mastery of your Anxiety and Panic, II. Graywind: Albany, NY.Google Scholar
Beck, AT, Emery, G, Greenberg, RL (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. Basic Books: New York.Google Scholar
Beck, AT, Rush, AJ, Shaw, BF, Emery, G (1979). Cognitive Therapy of Depression. Guilford Press: New York.Google Scholar
Borkovec, TD, Nau, SD (1972). Credibility of analogue therapy rationales. Journal of Behavior Therapy and Experimental Psychiatry 3, 257260.CrossRefGoogle Scholar
Bouman, TK (1998). The Body Sensation Questionnaire [in Dutch]. Gedragstherapie 31, 165168.Google Scholar
Chambless, DL, Caputo, GC, Bright, P, Gallagher, R (1984). Assessment of fear of fear in agoraphobics: the Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. Journal of Consulting and Clinical Psychology 52, 10901097.CrossRefGoogle ScholarPubMed
Clark, DM (1986). A cognitive approach to panic. Behaviour Research and Therapy 24, 461470.CrossRefGoogle ScholarPubMed
Clark, DM, Salkovskis, PM, Hackmann, A, Middleton, H, Anastasiades, P, Gelder, M (1994). A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. British Journal of Psychiatry 164, 759769.CrossRefGoogle ScholarPubMed
Clark, DM, Salkovskis, PM, Ost, LG, Breitholtz, E, Koehler, KA, Westling, BE, Jeavons, A, Gelder, M (1997). Misinterpretation of body sensations in panic disorder. Journal of Consulting and Clinical Psychology 65, 203213.CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn.Lawrence Erlbaum Associates: Hillsdale, NJ.Google Scholar
Craske, MG, Maidenberg, E, Bystritsky, A (1995). Brief cognitive-behavioral versus nondirective therapy for panic disorder. Journal of Behavior Therapy and Experimental Psychiatry 26, 113120.CrossRefGoogle ScholarPubMed
Derogatis, LR, Lipman, RS, Covi, L (1973). SCL-90: an outpatient psychiatric rating scale – preliminary report. Psychopharmacology Bulletin 9, 1327.Google ScholarPubMed
Devilly, JG, Borkovec, TD (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry 31, 7386.CrossRefGoogle ScholarPubMed
Elkin, I, Parloff, MB, Hadley, SW, Autry, JH (1985). NIMH treatment of depression collaborative research program. Archives of General Psychiatry 42, 305316.CrossRefGoogle ScholarPubMed
Elkin, I, Shea, T, Watkins, JT, Imber, SD, Sotsky, SM, Collins, JF, Glass, DR, Pilkonis, PA, Leber, WR, Docherty, JP, Fiester, SJ, Parloff, MB (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program. Archives of General Psychiatry 46, 971983.CrossRefGoogle ScholarPubMed
Evers, A, Vliet-Mulder, JC, Van Groot, CJ (2000). Documentation of Tests and Test Research in the Netherlands, parts 1 and 2 [in Dutch]. NIP/Van Gorcum: Amsterdam/Assen.Google Scholar
Fairburn, CG, Jones, R, Peveler, RC, Carr, SJ, Solomon, RA, O'Connor, ME, Burton, J, Hope, RA (1991). Three psychological treatments for bulimia nervosa: a comparative trial. Archives of General Psychiatry 48, 463469.CrossRefGoogle ScholarPubMed
Faravelli, C, Pallanti, S (1989). Recent life events and panic disorder. American Journal of Psychiatry 146, 622626.Google ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1990). Structured Clinical Interview for DSM-III-R. American Psychiatric Press: Washington, DC.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). American Psychiatric Press: Washington, DC.Google Scholar
Goisman, RM, Rogers, MP, Steketee, GS, Warshaw, MG, Cuneo, P, Keller, MB (1993). Utilization of behavioral methods in a multicenter anxiety disorders study. Journal of Clinical Psychiatry 54, 213218.Google Scholar
Hill, CE, O'Grady, KE (1992). Applying the Collaborative Study Psychotherapy Rating Scale to rate therapist adherence in cognitive-behavior therapy, interpersonal therapy, and clinical management. Journal of Consulting and Clinical Psychology 60, 7379.CrossRefGoogle Scholar
Hollon, SD, DeRubeis, RJ, Evans, MD, Wiemer, MJ, Garvey, MJ, Grove, WM, Tuason, VB (1992). Cognitive therapy and pharmacotherapy for depression: singly and in combination. Archives of General Psychiatry 49, 774781.CrossRefGoogle ScholarPubMed
Hollon, SD, Evans, MD, Auerbach, A, DeRubeis, RJ, Elkin, I, Lowery, A, Kriss, M, Grove, W, Thason, VB, Piasecki, J (1988). Development of a system for rating therapies for depression: differentiating cognitive therapy, interpersonal psychotherapy, and clinical management pharmacotherapy. Unpublished manuscript, University of Minnesota, Twin Cities Campus, Minneapolis, MN.Google Scholar
Hollon, SD, Waskow, IE, Evans, MD, Lowery, HA (1984). Systems for rating therapies for depression. Paper presented at the annual convention of the American Psychiatric Association, Los Angeles, CA.Google Scholar
Horowitz, M, Rosenberg, ME, Bear, BA, Ureno, G, Villaseñor, VS (1988). Inventory of interpersonal problems: psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology 56, 885892.CrossRefGoogle ScholarPubMed
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.CrossRefGoogle ScholarPubMed
Klerman, GL, Weissman, MM, Rounsaville, BJ, Chevron, E (1984). Interpersonal Psychotherapy of Depression. Basic Books: New York.Google Scholar
Lipsitz, JD, Gur, M, Miller, NL, Forand, N, Vermes, D, Fyer, AJ (2006). An open pilot study of interpersonal psychotherapy for panic disorder (IPT-PD). Journal of Nervous and Mental Disease 194, 440445.CrossRefGoogle ScholarPubMed
Luty, SE, Carter, JD, McKenzie, JM, Rae, AM, Frampton, CMA, Mulder, RT, Joyce, PR (2007). Randomised controlled trial of interpersonal psychotherapy and cognitive behavioural therapy for depression. British Journal of Psychiatry 190, 496502.CrossRefGoogle ScholarPubMed
Marks, IM, Mathews, AM (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy 17, 263267.CrossRefGoogle ScholarPubMed
Metzger, RC (1976). A reliability and validity study of the State-Trait Anxiety Inventory. Journal of Clinical Psychology 32, 276278.3.0.CO;2-G>CrossRefGoogle Scholar
Norman, GR, Sloan, JF, Wyrwick, KW (2003). Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Medical Care 41, 582592.CrossRefGoogle ScholarPubMed
Pollard, CA, Pollard, HJ, Corn, KJ (1989). Panic onset and major events in the lives of agoraphobics: a test of contiguity. Journal of Abnormal Psychology 89, 318321.CrossRefGoogle Scholar
R Development Core Team (2009). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria.Google Scholar
Reiss, S, Peterson, RA, Gursky, DM, McNaly, RJ (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy 24, 18.CrossRefGoogle ScholarPubMed
Shear, MK, Houck, P, Greeno, C, Masters, S (2001). Emotion-focused psychotherapy for patients with panic disorder. American Journal of Psychiatry 158, 19931998.CrossRefGoogle ScholarPubMed
Shear, MK, Pilkonis, PA, Cloitre, M, Leon, AC (1994). Cognitive behavioral treatment compared with nonprescriptive treatment of panic disorder. Archives of General Psychiatry 51, 395401.CrossRefGoogle ScholarPubMed
Shear, MK, Weiner, K (1997). Psychotherapy for panic disorder. Journal of Clinical Psychiatry 58, 3845.Google ScholarPubMed
Spielberger, CD, Gorsuch, RL, Lushene, R, Vagg, PR, Jacobs, GA (1983). Manual for the State–Trait Anxiety Inventory. Consulting Psychologists: Palo Alto, CA.Google Scholar
Van den Hout, MA, van der Molen, GM, Griez, E, Lousberg, H (1987). Specificity of interoceptive fear to panic disorder. Journal of Psychopathology and Behavioral Assessment 9, 99–109.CrossRefGoogle Scholar
Weissman, MM, Markowitz, JC, Klerman, GL (2000). Comprehensive Guide to Interpersonal Psychotherapy. Basic Books: New York.Google Scholar
Wilcox, RR (2005). Introduction to Robust Estimation and Hypothesis Testing, 2nd edn. Academic Press: San Diego, CA.Google Scholar
Wilfley, DE, Welsch, RR, Stein, RI, Spurrell, EB, Cohen, LR, Saelens, BE, Dounchis, JZ, Frank, MA, Wiseman, CV, Matt, GE (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge eating disorder. Archives of General Psychiatry 59, 713721.CrossRefGoogle ScholarPubMed
Supplementary material: File

Vos supplementary material

Appendix

Download Vos supplementary material(File)
File 78.8 KB