Dr. Barbara Milrod
Cognitive behavioral therapy, a structured, results-based psychotherapy that targets negative thoughts and how they impact behavior, is the most consistently effective way to manage symptoms tied to panic disorder, though another less-structured treatment also shows promise, researchers from Weill Cornell Medical College and the University of Pennsylvania found in a new study, published June 9 in the Journal of Clinical Psychiatry.
These findings, which incorporated earlier research that showed panic disorder patients prefer talk therapy over taking an anti-anxiety medication, could help therapists personalize treatment plans their patients and dictate what type of therapy they try as a first line of defense.
"Panic disorder is really debilitating — it causes terrible healthcare costs and interference with functioning," said lead author Dr. Barbara Milrod, a professor of psychiatry at Weill Cornell Medical College. "We conducted this first ever large panic disorder study to compare therapy types and see if one type of therapy is preferable over another."
To determine which type of talk therapy best mitigated symptoms, like anxiety, panic attacks, or fear of public spaces and situations — a condition known as agoraphobia — researchers compared three well-known psychotherapies across about 200 patients with panic disorder. The therapies included CBT, which requires patients to complete homework assignments and mimic bodily sensations experienced during panic attacks; panic-focused psychodynamic psychotherapy (PFPP), a less-structured treatment that helps patients discover unconscious conflicts and emotions behind their symptoms to gain relief; and applied relaxation training (ART), a control treatment that focuses on relaxation techniques practiced twice daily at home to alleviate panic symptoms.
The patients were randomly assigned to one of the three treatment groups at two sites: Weill Cornell and Penn. Each group corresponded to a specific type of therapy, and each subject received two 45- to 50-minute individual therapy sessions per week for 12 to 16 weeks, for a total 19 to 24 sessions.
Results showed that patients at both sites dropped out of ART more often than CBT and PFPP — 41 percent compared to 25 and 22 percent, respectively. In patients with the most severe symptoms, "ART just didn't help them enough to keep them in the treatment," Dr. Milrod said. Panic disorder patients at Weill Cornell also showed greater response rates when undergoing CBT and PFPP therapies compared to ART, which validated the researchers' hypothesis that CBT and PFPP patients would show greater improvement after treatment than ART patients.
But results differed at the Penn site, where CBT and ART showed greater improvement over PFPP patients after therapy was complete, illustrating how different treatment deliveries can affect patient outcomes.
No matter which treatment patients participated in, those who didn't drop out and fully completed treatment showed improvement from before to after the psychotherapy term.
"If patients stick it out and continue with therapy rather than drop out," Dr. Milrod said, "they have a far greater chance of seeing positive results or getting better."