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Long-Term Effects of Behavioural Treatment for Panic Disorder with Agoraphobia

Published online by Cambridge University Press:  02 January 2018

Giovanni A. Fava ,
Maria Zielezny ,
Gianni Savron  and
Silvana Grandi
Giovanni A. Fava*
Affiliation:
Department of Psychology, University of Bologna, Italy
Maria Zielezny
Affiliation:
Department of Social and Preventive Medicine, State University of New York at Buffalo, USA
Silvana Grandi
Affiliation:
University of Bologna, Italy
*
Professor Fava, Department of Psychology, University of Bologna, Viale Berti Pichat 5, 1–40127 Bologna, Italy
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Abstract

Background

There are few long-term follow-up studies of panic disorder treatments, particularly when patients have been treated by behavioural methods only and have recovered.

Method

110 consecutive patients satisfying the DSM–III–R criteria for panic disorder with agoraphobia were treated in an out-patient clinic with behavioural methods based on exposure. After 12 sessions of psychotherapy, 81 patients became panic-free. A 2–9 year follow-up was available. Survival analysis was employed to characterise the clinical course of patients. Regular assessments by a clinical psychologist were based on the Clinical Interview for Depression.

Results

The estimated cumulative percentage of patients remaining in remission was 96.1% for at least two years, 77.6% for at least five years, and 67.4% for at least seven years. These outcomes greatly improved in the absence of a personality disorder or residual agoraphobia after treatment.

Conclusions

The findings suggest that, even though one patient in four is unable to complete treatment or does not benefit sufficiently from it, exposure treatment can provide lasting relief for the majority of patients. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.

Type
Papers
Information
The British Journal of Psychiatry , Volume 166 , Issue 1 , January 1995 , pp. 87 - 92
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Clair, A. L., Oei, T. P. S. & Evans, L. (1992) Personality and treatment response in agoraphobia with panic attacks. Comprehensive Psychiatry, 33, 310–318.Google Scholar
Conti, S., Savron, G., Bartolucci, G., et al (1989) Cardiac neurosis and psychopathology. Psychotherapy and Psychosomatics, 52, 88–91.Google Scholar
Cross-National Collaborative Panic Study (1992) Drug treatment of panic disorder. British Journal of Psychiatry, 160, 191–202.CrossRefGoogle Scholar
Cutler, S. J. & Ederer, F. (1958) Maximum utilization of the life-table method in analyzing survival. Journal of Chronic Diseases, 8, 699–713.CrossRefGoogle ScholarPubMed
Dixon, W. J., Brown, M. B., Engelman, L., et al (eds) (1990) BMDP Statistical Software Manual. Berkeley, CA: University of California Press.Google Scholar
Endicott, J. & Spitzer, R. L. (1978) A diagnostic review: The Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry, 35, 837–844.Google Scholar
Evans, L., Holt, C. & Oei, T. P. S. (1991) Long term follow-up of agoraphobics treated by brief intensive group cognitive behavioural therapy. Australian and New Zealand Journal of Psychiatry, 25, 343–349.Google Scholar
Fava, G. A. (1994) Do antianxiety and antidepressant drugs increase chronicity in affective disorders? Psychotherapy and Psychosomatics, 61, 125–131.CrossRefGoogle ScholarPubMed
Fava, G. A., Zielezny, M., Luria, E., et al (1988a) Obsessive-compulsive symptoms in panic disorder with agoraphobia. Psychiatry Research, 23, 57–63.Google Scholar
Fava, G. A., Grandi, S. & Canestrari, R. (1988b) Prodromal symptoms in panic disorder with agoraphobia. American Journal of Psychiatry, 145, 1564–1567.Google Scholar
Fava, G. A., & Kellner, , (1991) Prodromal symptoms in affective disorders. American Journal of Psychiatry, 148, 823–830.Google ScholarPubMed
Fava, G. A., Grandi, S., Canestrari, R., et al (1991) Mechanisms of change of panic attacks with exposure treatment of agoraphobia. Journal of Affective Disorders, 22, 65–71.CrossRefGoogle ScholarPubMed
Fava, G. A., Grandi, S., Rafanelli, C., et al (1992) Prodromal symptoms in panic disorder with agoraphobia. A replication study. Journal of Affective Disorders, 26, 85–88.Google Scholar
Fyer, A. J., Liebowitz, M. R., Gorman, J. M., et al (1987) Discontinuation of alprazolam in panic patients. American Journal of Psychiatry, 144, 303–308.Google Scholar
Goldthorpe, J. H. & Hope, K. (1974) The Social Grading of Occupations. Oxford: Oxford University Press.Google Scholar
Katon, W., Vitaliano, P. P., Anderson, K., et al (1987) Panic disorder: residual symptoms after the acute attacks abate. Comprehensive Psychiatry, 28, 151–158.Google Scholar
Keller, M. B. & Hanks, D. L. (1993) Course and outcome in panic disorder. Progress in Neuropsychopharmacology and Biological Psychiatry, 17, 551–570.CrossRefGoogle ScholarPubMed
Kellner, R. (1972) Improvement criteria in drug trials with neurotic patients. Part 2. Psychological Medicine, 2, 73–80.CrossRefGoogle Scholar
Lelliott, P. T., Marks, I. M., Monteiro, W. O., et al (1987) Agoraphobics five years after imipramine and exposure. Journal of Nervous and Mental Disease, 175, 599–605.CrossRefGoogle ScholarPubMed
Lelliott, P. T., Marks, I. M., McNamee, G., et al (1989) Onset of panic disorder with agoraphobia. Archives of General Psychiatry, 46, 1000–1004.Google Scholar
Margraf, J., Barlow, D. H., Clark, D. M., et al (1993) Psychological treatment of panic. Behaviour Research and Therapy, 31, 11–8.CrossRefGoogle Scholar
Marks, I. M. (1986) Behavioural and drug treatments of phobic and obsessive-compulsive disorders. Psychotherapy and Psychosomatics, 46, 35–44.Google Scholar
Marks, I. M., Swinson, R. P., Basoglu, M., et al (1993) Alprazolam and exposure alone and combined in panic disorder with agoraphobia. British Journal of Psychiatry, 162, 776–787.CrossRefGoogle ScholarPubMed
Mathews, A., Teasdale, J., Munby, M., et al (1977) A home-based treatment program for agoraphobia. Behavior Therapy, 8, 915–924.CrossRefGoogle Scholar
Mavissakalian, M. & Perel, J. M. (1992) Clinical experiments in maintenance and discontinuation of imipramine therapy in panic disorder with agoraphobia. Archives of General Psychiatry, 49, 318–323.Google Scholar
McDonald, R., Sartory, G., Grey, S. J., et al (1979) The effects of self-exposure instructions on agoraphobic outpatients. Behaviour Research and Therapy, 17, 83–89.Google Scholar
Michelson, L. K. & Marchione, K. (1991) Behavioral, cognitive, and pharmacological treatments of panic disorder with agoraphobia. Journal of Consulting and Clinical Psychology, 59, 100–114.Google Scholar
Nagy, L. M., Krystal, J. H., Woods, S. W., et al (1989) Clinical and medication outcome after short-term alprazolam and behavioral group treatment in panic disorder. Archives of General Psychiatry, 46, 993–999.CrossRefGoogle ScholarPubMed
Naoy, L. M., Krystal, J. H., Charney, D. S., et al (1993) Long-term outcome of panic disorder after short-term imipramine and behavioral group treatment. Journal of Clinical Psychopharmacology, 13, 16–24.Google Scholar
Noyes, R., Garvey, M. J. & Cook, B. L. (1989) Follow-up study of patients with panic disorder and agoraphobia with panic attacks treated with tricyclic antidepressants. Journal of Affective Disorders, 16, 249–257.Google Scholar
Noyes, R., Garvey, M. J. Cook, B. L., et al (1991) Controlled discontinuation of benzodiazepine for patients with panic disorder. American Journal of Psychiatry, 148, 517–523.Google Scholar
O'Sullivan, G. & Marks, I. (1990) Long-term outcome of phobic and obsessive-compulsive disorders after treatment. In Handbook of Anxiety, vol. 4 (eds Noyes, R., Roth, M. & Burrows, G. D.), pp. 87–108. Amsterdam: Elsevier.Google Scholar
Paykel, E. S. (1985) The clinical interview for depression. Journal of Affective Disorders, 9, 85–96.Google Scholar
Pecknold, J. C., Swinson, R. P., Kuch, K., et al (1988) Alprazolam in panic disorder and agoraphobia: results from a multicenter trial: III. Discontinuation effects. Archives of General Psychiatry, 45, 429–436.CrossRefGoogle ScholarPubMed
Rickels, K., Schweizer, E., Weiss, S., et al (1993) Maintenance drug treatment for panic disorder. Archives of General Psychiatry, 50, 61–68.Google Scholar
Saviotti, F. M., Grandi, S., Savron, G., et al (1991) Characterological traits of recovered patients with panic disorder and agoraphobia. Journal of Affective Disorders, 23, 113–117.Google Scholar
Thase, M. E., Simons, A. D., McGeary, J., et al (1992) Relapse after cognitive behavior therapy of depression. American Journal of Psychiatry, 149, 1046–1052.Google ScholarPubMed
Vollrath, M. & Angst, J. (1989) Outcome of panic and depression in a seven-year follow-up. Acta Psychiatrica Scandinavica, 80, 591–596.CrossRefGoogle Scholar
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