Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-22T06:47:54.487Z Has data issue: false hasContentIssue false

Temporal Patterns of Change in Panic Disorder during Cognitive Behaviour Therapy: An Indian Study

Published online by Cambridge University Press:  02 August 2013

M. Manjula*
Affiliation:
National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
P.S.D.V. Prasadarao
Affiliation:
Waikato Hospital, Hamilton, New Zealand
V. Kumaraiah
Affiliation:
National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
R. Raguram
Affiliation:
Kempegowda Institute of Medical Sciences, Bangalore, India
*
Reprint requests to M. Manjula, Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India. E-mail: [email protected]

Abstract

Background: CBT has been proven to be effective in the treatment of panic disorder; however, attempts to study the process of change are limited. Aim: The study evaluated the temporal patterns of change in the panic symptoms, cognitions, behaviours, and anxiety sensitivity in subjects with panic disorder being treated with CBT. Method: Thirty subjects with panic disorder were allocated to two groups: Cognitive Behaviour Therapy (CBT, n = 15) and Behaviour Therapy (BT, n = 15). Assessments were carried out weekly for five consecutive weeks using the Semi-Structured Interview Schedule, the Anxiety Sensitivity Index, the Agoraphobic Cognitions Questionnaire, and the Texas Panic Attack Record Form. The CBT group received comprehensive CBT and the BT group received psycho-education and Applied Relaxation. Results: Following intervention the change was continuous and gradual on all the variables in the CBT group and the scores reduced to a functional range after 4–5 weeks of therapy. Such a change was not evident in the BT group. Significant change was evident in cognitive domains following the introduction of the exposure and cognitive restructuring within the CBT group. Both cognitive and behavioural techniques contributed to the overall change. Conclusion: CBT had an impact on the cognitive domains and significant changes were evident corresponding to the addition of cognitive restructuring and exposure techniques in the 3rd to 5th week. Both cognitive and behavioural components are therefore crucial for overall improvement to occur.

Type
Empirically Grounded Clinical Interventions
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

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

Adler, C., Craske, M. G., Kirshenbaum, S. and Barlow, D. (1989). “Fear of panic”: an investigation of its role in panic occurrence, phobic avoidance and treatment outcome. Behaviour Research and Therapy, 27, 391399.CrossRefGoogle ScholarPubMed
Arntz, A. (2002). Cognitive therapy versus interoceptive exposure as treatment of panic disorder without agoraphobia. Behaviour Research and Therapy, 40, 325341.CrossRefGoogle ScholarPubMed
Barlow, D. H. and Craske, M. J. (1988). Mastery of your Anxiety and Panic. Albany, NY: Graywind Publications.Google Scholar
Barlow, D. H., Gorman, J. M., Shear, M. K. and Woods, S. W. (2000). Cognitive behavior therapy, imipramine or their combination for panic disorder: a randomized control trial. Journal of the American Medical Association, 283, 25292536.Google Scholar
Bouchard, S., Gauthier, J., Laberge, B., French, D., Pelletier, M. H. and Godbout, C. (1996). Exposure versus cognitive restructuring in the treatment of panic disorder with agoraphobia. Behaviour Research and Therapy, 34, 213224.CrossRefGoogle ScholarPubMed
Bouchard, S., Gauthier, J., Nouwen, A., Ivers, H., Vallières, A., Simard, S., et al. (2007). Temporal relationship between dysfunctional beliefs, self-efficacy and panic apprehension in the treatment of panic disorder with agoraphobia. Journal of Behaviour Therapy Experimental Psychology, 38, 275292.CrossRefGoogle ScholarPubMed
Casey, L. M., Oei, T. P., Newcombe, P. A. and Kenardy, J. (2004). Cognitive mediation of panic severity: the role of catastrophic misinterpretation of bodily sensations and panic self-efficacy in predicting panic severity. Journal of Anxiety Disorders, 18, 325340.Google Scholar
Chambless, D. L., Caputo, G. C., Bright, P. and 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, D. M., Salkovskis, P. M., Ost, L. G., Breitholz, K. A., Koehler, E., Westling, B. E., et al. (1997). Misinterpretation of body sensations in panic disorder. Journal of Consulting and Clinical Psychology, 65, 203213.Google Scholar
Craske, M. G., Rowe, M., Lewin, M. M. and Noriega-Dimitri, R. (1997). Interoceptive exposure versus breathing retraining within cognitive-behavioural therapy for panic disorder with agoraphobia. British Journal of Clinical Psychology, 36, 8599.CrossRefGoogle ScholarPubMed
Dannon, P. N., Iancu, I. and Grunhaus, L. (2002). Psychoeducation in panic disorder patients: effect of a self-information booklet in a randomized, masked-rater study. Depression and Anxiety, 16, 7176.Google Scholar
Hino, T., Takeuchi, T. and Yamanouchi, N. (2002). A 1-year follow-up study of coping in patients with panic disorder. Comprehensive Psychiatry, 43, 279284.Google Scholar
Hoffart, A. (1998). Cognitive and guided mastery therapy of agoraphobia: long-term outcome and mechanisms of change. Cognitive Therapy and Research, 22, 195207.Google Scholar
Hofmann, S. G., Suvak, M. K., Barlow, D. H., Shear, M. K., Meuret, A. E., Rosenfield, D., et al. (2007). Preliminary evidence for cognitive mediation during cognitive-behavioural therapy of panic disorder. Journal of Consulting and Clinical Psychology, 75, 374379.Google Scholar
Manjula, M., Kumaraiah, V., Prasadarao, P.S.D.V. and Raguram, R. (2009). Cognitive behaviour therapy in the treatment of panic disorder. Indian Journal of Psychiatry, 51, 108116.Google Scholar
Margraf, J., Taylor, C. B., Ehlers, A., Roth, W. T. and Agras, W. S. (1987). Panic attacks in the natural environment. Journal of Nervous and Mental Diseases, 175, 558565.Google Scholar
Meulenbeek, P., Spinhoven, P., Smit, F., Van Balkom, A. and Cuijpers, P. (2010). Cognitive mediation of panic reduction during an early intervention for panic. Acta Psychiatrica Scandinavica, 122, 2029.CrossRefGoogle ScholarPubMed
Mitte, K. (2005). A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia. Journal of Affective Disorders, 88, 2745.CrossRefGoogle ScholarPubMed
Newman, M. G., Kenardy, J., Herman, S. and Taylor, B. (1997). Comparison of palmtop-computer-assisted brief cognitive-behavioural treatment to cognitive behavioural treatment for panic disorder. Journal of Consulting and Clinical Psychology, 65, 178183.CrossRefGoogle Scholar
Norton, P. J. and Price, E. C. (2007). A meta-analytic review of adult cognitive behavioural treatment outcome across the anxiety disorders. Journal of Nervous and Mental Diseases, 195, 521531.CrossRefGoogle ScholarPubMed
Otto, M. W. and Deveney, C. (2005). Cognitive-behavioral therapy and the treatment of panic disorder: efficacy and strategies. Journal of Clinical Psychiatry, 66, 2832.Google ScholarPubMed
Öst, L. G., Thulin, U. and Ramnerö, J. (2004). Cognitive behavior therapy vs exposure in vivo in the treatment of panic disorder with agrophobia. Behaviour Research and Therapy, 42, 11051127.Google Scholar
Penava, S. J., Otto, M. W., Maki, K. M. and Pollack, M. H. (1998). Rate of improvement during cognitive-behavioral group treatment for panic disorder. Behaviour Research and Therapy, 36, 665673.CrossRefGoogle ScholarPubMed
Peterson, R. A. and Reiss, S. (1993). Anxiety Sensitivity Index. Worthington, OH: IDS Publishing Corporation.Google Scholar
Salkovskis, P. M., Clark, D. M. and Gelder, M. G. (1996). Cognition-behaviour links in the persistence of panic. Behaviour Research and Therapy, 34, 453458.Google Scholar
Salkovskis, P. M., Clark, D. M. and Hackmann, A. (1991). Treatment of panic attacks using cognitive therapy without exposure or breathing retraining. Behaviour Research and Therapy, 29, 161166.Google Scholar
Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., et al. (1997). Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry, 154, 15711575.Google Scholar
Stanley, M. A., Beck, J. G., Averill, P. M., Baldwin, L. E., Deagle, E. A. 3rd and Stadler, J. G. (1996). Patterns of change during cognitive behavioral treatment for panic disorder. Journal of Nervous Mental Diseases, 184, 567572.Google Scholar
Teachman, B. A., Marker, C. D. and Clerkin, E. M. (2010). Catastrophic misinterpretations as a predictor of symptom change during treatment for panic disorder. Journal of Consulting and Clinical Psychology, 78, 964973.Google Scholar
Teachman, B. A., Marker, C. D. and Smith-Janik, S. B. (2008). Automatic associations and panic disorder: trajectories of change over the course of treatment. Journal of Consulting and Clinical Psychology, 76, 9881002.CrossRefGoogle ScholarPubMed
Telch, M. J. (1987). The Panic Appraisal Inventory. Unpublished scale, University of Texas.Google Scholar
Young, J. E. (1999). Cognitive Therapy for Personality Disorders: a schema-focused approach (3rd ed.). Sarasota, FL: Professional Resource Press/Professional Resource Exchange, Inc.Google Scholar
Wenzel, A., Sharp, I., Sokol, L. and Beck, A. T. (2006). Attentional fixation in panic disorder. Cognitive Behaviour Therapy, 35, 6573.CrossRefGoogle ScholarPubMed
World Health Organization (1993). The ICD-10 Classification of Mental and Behavioural Disorders: diagnostic criteria for research. Geneva: WHO.Google Scholar
Submit a response

Comments

No Comments have been published for this article.