Effectiveness of cognitive behavioral group therapy for patients in panic disorder in a specialized unit

Prats E, Domínguez E, Rosado S, Pailhez G, Bulbena A, Fullana MA. Effectiveness of cognitive-behavioral group therapy for panic disorder in a specialized unit. Actas Esp Psiquiatr. 2014;42(4):176-184. PMID 25017495

Introduction

The purpose of the current study was to evaluate the effectiveness of a short format (nine sessions) of group CBT based on the Panic Control Model that does not include activation control techniques (relaxation training and/or controlled breathing) in a sample of patients with PD in a specialized unit.

Although CBT is well established as a treatment for PD, few studies have evaluated its effectiveness in group format. This is important because of the advantages in terms of cost/ benefit offered by group therapy compared to the individual.

Main part

The initial sample was made up of 62 patients recruited consecutively in the Anxiety Unit of the Hospital del Mar. The subjects were offered to participate in a CBT program with a group format.

All the study patients fulfilled the following inclusion/ exclusion criteria: (I) primary diagnosis of panic disorder with or without agoraphobia or agoraphobia with no history of panic disorder according to DSM-IV criteria; (II) absence of major depressive disorder, psychotic disorder or comorbid bipolar disorder; (III) not having undergone changes in drug treatment (if they had received it) in the month prior to the onset of the treatment and (IV) absence of a medical disease that would determine the psychological treatment. Of the 62 patients who were offered treatment, 56 initiated the program. Data were available for 46 patients at the end of treatment, 31 at one month and 28 at three months of follow-up.

Methods

The patients completed the treatment protocol based on the Barlow and Craske Manual for Panic Disorder following a modified manual for group treatment and adapted to our context (Fullana et al., unpublished data).

The treatment consisted of an initial presentation and evaluation session followed by 9 weekly 1-hour long sessions with the following contents: (I) psychoeducation (sessions 2 to 4), (II) interoceptive exposure (sessions 5 and 6) and (III) situational exposure (sessions 7 to 10). The tasks to be performed at home included reading psychoeducation material, daily registers of symptoms and individualized practice of the interoceptive exposure exercises (initially practiced in the group) and situational exposure.

Results

There were significant reductions in panic/ agoraphobia symptoms and related variables between baseline and post-treatment, and these reductions were maintained in three-month follow-up. No differences were observed between those patients who received only CBT and those who received pharmacological treatment as well as CBT. Only initial panic/agoraphobia symptoms were significant predictors of treatment response at the end of treatment (a greater severity was associated with a worse response to CBT).

Conclusions

The use of a group format for panic disorder treatment makes it possible for the therapist to treat more patients. The authors conclude that group CBT is effective for people with panic disorder in a specialized unit. They note two limitations: this was an open study with no control group, and the sample was small, especially for comparing patients with and without medication.

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