Hostname: page-component-745bb68f8f-mzp66 Total loading time: 0 Render date: 2025-01-25T01:06:46.491Z Has data issue: false hasContentIssue false
  • English
  • Français

A Comparison of Cognitive Therapy, Applied Relaxation and Imipramine in the Treatment of Panic Disorder

Published online by Cambridge University Press:  02 January 2018

David M. Clark ,
Paul M. Salkovskis ,
Ann Hackmann ,
Hugh Middleton ,
Pavlos Anastasiades  and
Michael Gelder
David M. Clark*
Affiliation:
Department of Psychiatry, University of Oxford
Paul M. Salkovskis
Affiliation:
Department of Psychiatry, University of Oxford
Ann Hackmann
Affiliation:
Department of Psychiatry, University of Oxford
Hugh Middleton
Affiliation:
Department of Psychiatry, University of Oxford and Department of Psychiatry, University of Cambridge
Pavlos Anastasiades
Affiliation:
Department of Psychiatry, University of Oxford
Michael Gelder
Affiliation:
University of Oxford
*
∗Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX
Get access Rights & Permissions [Opens in a new window]

Abstract

Recent studies have shown that cognitive therapy is an effective treatment for panic disorder. However, little is known about how cognitive therapy compares with other psychological and pharmacological treatments. To investigate this question 64 panic disorder patients were initially assigned to cognitive therapy, applied relaxation, imipramine (mean 233 mg/day), or a 3-month wait followed by allocation to treatment. During treatment patients had up to 12 sessions in the first 3 months and up to three booster sessions in the next 3 months. Imipramine was gradually withdrawn after 6 months. Each treatment included self-exposure homework assignments. Cognitive therapy and applied relaxation sessions lasted one hour. Imipramine sessions lasted 25 minutes. Assessments were before treatment/wait and at 3, 6, and 15 months. Comparisons with waiting-list showed all three treatments were effective. Comparisons between treatments showed that at 3 months cognitive therapy was superior to both applied relaxation and imipramine on most measures. At 6 months cognitive therapy did not differ from imipramine and both were superior to applied relaxation on several measures. Between 6 and 15 months a number of imipramine patients relapsed. At 15 months cognitive therapy was again superior to both applied relaxation and imipramine but on fewer measures than at 3 months. Cognitive measures taken at the end of treatment were significant predictors of outcome at follow-up.

Type
Papers
Information
The British Journal of Psychiatry , Volume 164 , Issue 6 , June 1994 , pp. 759 - 769
Copyright
Copyright © 1994 The Royal College of Psychiatrists 

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

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Andersch, S., Rosenberg, N. K., Kullingslo, H., et al (1991) Efficacy and safety of alprazolam, imipramine and placebo in treating panic disorder. A Scandinavian multicenter study. Acta Psychiatrica Scandinavica (suppl. 365), 18–27.CrossRefGoogle ScholarPubMed
Barlow, D. H. & Cerny, J. A. (1988) Psychological Treatment of Panic. New York: Guilford.Google Scholar
Barlow, D. H., Cohen, A. S., Waddell, M. T., et al (1984) Panic and generalised anxiety disorders: nature and treatment. Behavior Therapy, 15, 431–449.Google Scholar
Barlow, D. H., & Craske, M. G. (1989) Mastery of your Anxiety and Panic. Albany: Graywind Publications.Google Scholar
Barlow, D. H., & Craske, M. G., Cerny, J. A., et al (1989) Behavioural treatment of panic disorder. Behavior Therapy, 20, 261–282.CrossRefGoogle Scholar
Beck, A. T., Emery, G. & Greenberg, R. L. (1985) Anxiety Disorders and Phobias. New York: Basic Books.Google Scholar
Beck, A. T., Epstein, N., Brown, G., et al (1988) An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.CrossRefGoogle ScholarPubMed
Beck, A. T., Sokol, L., Clark, D. A., et al (1992) Focused cognitive therapy of panic disorder: a crossover design and one year follow-up. American Journal of Psychiatry, 147, 778–783.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., et al (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle ScholarPubMed
Borkovec, T. D. & Nau, S. D. (1972) Credibility of analogue therapy rationales. Journal of Behaviour Therapy and Experimental Psychiatry, 3, 257–260.Google Scholar
Catalan, J., Gath, D., Edmonds, G., et al (1984) The effects of non-prescribing in general practice: 1. Controlled evaluation of psychiatric and social outcome. British Journal of Psychiatry, 144, 593–603.CrossRefGoogle Scholar
Chambless, D. L., Caputo, G. C., Bright, P., et al (1984) Assessment of fear of fear in agoraphobics: the Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090–1097.Google Scholar
Clark, D. M. (1986) A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470.CrossRefGoogle ScholarPubMed
Clark, D. M. (1989) Anxiety states: panic and generalized anxiety. In Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide (eds Hawton, K., Salkovskis, P., Kirk, J., et al), pp. 52–96. Oxford: Oxford University Press.Google Scholar
Clark, D. M. & Ehlers, A. (1993) An overview of the cognitive theory and treatment of panic disorder. Applied and Preventive Psychology, 2, 131–139.Google Scholar
Clark, D. M., Salkovskis, P. M. & Chalkley, A. J. (1985) Respiratory control as a treatment for panic attacks. Journal of Behaviour Therapy and Experimental Psychiatry, 16, 23–30.Google Scholar
Craske, M. G., Brown, T. A. & Barlow, D. H. (1991) Behavioural treatment of panic disorder: a two year follow-up study. Behaviour Therapy, 22, 289–304.CrossRefGoogle Scholar
Cross-National Collaborative Panic Study, Second Phase Investigators (1992) Drug treatment of panic disorder: comparative efficacy of alprazolam, imipramine and placebo. British Journal of Psychiatry, 160, 191–202.CrossRefGoogle Scholar
Ehlers, A., Margraf, J. & Roth, W. T. (1986) Selective information processing, interoception and panic attacks. In Panic and Phobias II (eds Hand, I. & Wittchen, H. U.). New York: Springer-Verlag.Google Scholar
Frank, E., Kupfer, D. J., Perel, J. M., et al (1990) Three-year outcomes for maintenance therapies in recurrent depression. Archives of General Psychiatry, 47, 1093–1099.CrossRefGoogle ScholarPubMed
Fyer, A. J. & Sandberg, D. P. (1988) Pharmacological treatment of panic disorder. In Review of Psychiatry (eds Frances, A. J. & Hales, R. E.). New York: American Psychiatric Press.Google Scholar
Hamilton, M. (1969) Diagnosis and rating of anxiety. British Journal of Psychiatry (special publication no. 3), 76–79.Google Scholar
Hollon, J. D., De Rubeis, R. J., Evans, M. D., et al (1992) Cognitive therapy and pharmacotherapy for depression: singly and in combination. Archives of General Psychiatry, 49, 774–781.Google Scholar
Jansson, L. & Öst, L. G. (1982) Behavioural treatments for agoraphobia: an evaluative review. Clinical Psychology Review, 2, 311–336.CrossRefGoogle Scholar
Klosko, J. S., Barlow, D. H., Tassinari, R., et al (1990) A comparison of alprazolam, and behaviour therapy in the treatment of panic disorder. Journal of Consulting and Clinical Psychology, 58, 77–84.Google Scholar
Kopp, M., Milhaly, K. & Vadasz, P. (1986) Agoraphobics es panikneurotikus betegek legzesi kontroll keyelese. Ideggyogyaszati Szemle, 39, 185–196.Google Scholar
Margraf, J., Barlow, D. H., Clark, D. M., et al (1993) Psychological treatment of panic: work in progress on outcome, active ingredients, and follow-up. Behaviour Research and Therapy, 31, 1–8.Google Scholar
Marks, I. & Mathews, A. M. (1979) Brief standard self-rating for phobic patients. Behaviour Research and Therapy, 17, 263–267.CrossRefGoogle ScholarPubMed
Marks, I., Swinson, R. P., Basoglu, M., et al (1993) Alprazolam and exposure alone and combined in panic disorder with agoraphobia: a controlled study in London and Toronto. British Journal of Psychiatry, 162, 776–787.Google Scholar
Mathews, A. M., Gelder, M. G. & Johnston, D. W. (1981) Agoraphobia: Nature and Treatment. New York: Guilford Press.Google Scholar
McNally, R. (1990) Psychological approaches to panic disorder: a review. Psychological Bulletin, 108, 403–419.Google Scholar
Michelson, L. K. & Marchione, K. (1991) Behavioral, cognitive, and pharmacological treatments for panic disorder with agoraphobia: critique and synthesis. Journal of Consulting and Clinical Psychology, 59, 100–114.Google Scholar
Michelson, L. K., Marchione, K., Greenwald, M., et al (1990) Panic disorder: cognitive-behavioural treatment. Behaviour Research and Therapy, 28, 141–153.CrossRefGoogle Scholar
Nutt, D. J. & Glue, P. (1989) Clinical pharmacology of anxiolytics and antidepressants; a psychopharmacological perspective. Pharmacology and Therapeutics, 44, 309–334.Google Scholar
Öst, L. G. (1987) Applied relaxation: description of a coping technique and review of controlled studies. Behaviour Research and Therapy, 25, 397–410.CrossRefGoogle ScholarPubMed
Öst, L. G. (1988) Applied relaxation vs. progressive relaxation in the treatment of panic disorder. Behaviour Research and Therapy, 26, 13–22.Google Scholar
Rosenthal, R. & Rosnow, R. L. (1991) Essentials of Behavioral Research: Methods and Data Analysis (2nd edn). New York: McGraw-Hill.Google Scholar
Salkovskis, P. M. (1988) Phenomenology, assessment and the cognitive model of panic. In Panic: Psychological Perspectives (eds Rachman, S. & Maser, J.). New Jersey: Erlbaum.Google Scholar
Salkovskis, P. M. & Clark, D. M. (1991) Cognitive therapy for panic disorder. Journal of Cognitive Psychotherapy, 5, 215–226.CrossRefGoogle Scholar
Salkovskis, P. M., Salkovskis, P. M. & Hackmann, A. (1991) Treatment of panic attacks using cognitive restructuring without exposure or breathing retraining. Behaviour Research and Therapy, 29, 161–166.CrossRefGoogle ScholarPubMed
Salkovskis, P. M., Jones, D. R. O. & Clark, D. M. (1986) Respiratory control in the treatment of panic attacks: replication and extension with concurrent measurement of behaviour and pCO2 . British Journal of Psychiatry, 148, 526–532.CrossRefGoogle ScholarPubMed
Shear, M. K., Ball, G., Fitzpatrick, M., et al (1991) Cognitive-behavioural therapy for panic: an open study. Journal of Nervous and Mental Disease, 8, 468–474.CrossRefGoogle Scholar
Sokol, L., Beck, A. T., Greenberg, R. L., et al (1989) Cognitive therapy of panic disorder: a non-pharmacological alternative. Journal of Nervous and Mental Disease, 177, 711–716.CrossRefGoogle Scholar
Spitzer, R. L. & Williams, J. B. (1986) Structured Clinical Interview for DSM–III–R, Patient Version (SCID–P, 1/1/86). New York State Psychiatric Institute, 722 West 168th Street, New York, NY 10032: Biometrics Research Department.Google Scholar
Welkowitz, L. A., Papp, L. A., Cloitre, M., et al (1991) Cognitive-behaviour therapy for panic disorder delivered by psychopharmacologically oriented clinicians. Journal of Nervous and Mental Disease, 179, 473–477.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.