Comparison of Psychotherapy Programs to Treat Panic Disorder

• Sheehan Disability Scale [ Time Frame: Measured at Month 12 post-treatment ] [ Designated as safety issue: No ]
• Clinical Global Impressions Scale [ Time Frame: Measured at Month 12 post-treatment ] [ Designated as safety issue: No ]
• Hamilton Depression Rating Scale [ Time Frame: Measured at Month 12 post-treatment ] [ Designated as safety issue: Yes ]
• Hamilton Anxiety Rating Scale [ Time Frame: Measured at Month 12 post-treatment ] [ Designated as safety issue: No ]
• Anxiety Disorder Sensitivity Index [ Time Frame: Measured at Month 12 post-treatment ] [ Designated as safety issue: No ]
• Brief Body Sensitivity Interpretation Questionnaire [ Time Frame: Measured at Month 12 post-treatment ] [ Designated as safety issue: No ]
• Panic-Specific Reflective Function [ Time Frame: Measured at Month 12 post-treatment ] [ Designated as safety issue: No ]

• Sheehan Disability Scale
• Adolescent Drug Involvement Scale-Superlite
• Clinical Global Impressions Scale
• Hamilton Depression Rating Scale
• Hamilton Anxiety Rating Scale
• Anxiety Disorder Sensitivity Index
• Brief Body Sensitivity Interpretation Questionnaire
• Panic-Specific Reflective (all measured 12 months following the end of treatment)

This study will determine the relative effectiveness of three psychotherapies in treating people with a panic disorder.

Panic disorder (PD) is a debilitating anxiety disorder. It is characterized by unexpected and repeated episodes of intense fear, accompanied by serious physical symptoms, such as chest pain, heart palpitations, shortness of breath, dizziness, or abdominal stress. Available treatments for PD include medication therapy and cognitive behavioral therapy (CBT), a type of psychotherapy that teaches people how to view panic attacks differently and how to reduce anxiety. Approximately 30% of patients refuse medication, however, and nearly 50% do not achieve remission with CBT alone. Therefore, there is a pressing need for additional non-pharmacologic treatment methods. Panic-focused psychodynamic psychotherapy (PFPP) and applied relaxation training (ART) are among some of the other available treatments for PD. During ART, individuals are taught to relax their muscles while being exposed to increasingly frightening situations. PFPP combines elements of CBT with other, more extensive approaches aimed at determining the anxiety's origin and at finding ways to reduce it. This study will compare the effectiveness of PFPP, CBT, and ART in treating PD.

Participants in this single blind study will be randomly assigned to receive PFPP, CBT, or ART for 12 weeks. All participants will attend between 19 and 24 treatment sessions over the course of the study. Upon completing the study, participants will attend monthly follow-up visits for an additional 12 months. Participants assigned to ART who have not responded by the end of treatment may opt to receive PFPP or CBT. Outcomes will be assessed using a variety of scales to determine depression and anxiety symptoms.

• Anxiety Disorders
• Panic Disorder
• Agoraphobia

• Behavioral: Cognitive behavioral therapy
  CBT for panic disorder will include 19 to 24 sessions over 12 weeks.
  Other Name: Panic control treatment
• Behavioral: Applied relaxation training (ART)
  ART with exposure protocol will include 19 to 24 sessions over 12 weeks.
  Other Name: ART
• Behavioral: Panic focused psychodynamic psychotherapy (PFPP)
  PFPP will include 19 to 24 sessions over 12 weeks.

• Experimental: 1
  Participants will receive panic focused psychodynamic psychotherapy for 12 weeks
  Intervention: Behavioral: Panic focused psychodynamic psychotherapy (PFPP)
• Active Comparator: 2
  Participants will receive cognitive behavioral therapy-panic control treatment for 12 weeks
  Intervention: Behavioral: Cognitive behavioral therapy
• Active Comparator: 3
  Participants will receive applied relaxation training for 12 weeks
  Intervention: Behavioral: Applied relaxation training (ART)

• Milrod B, Leon AC, Busch F, Rudden M, Schwalberg M, Clarkin J, Aronson A, Singer M, Turchin W, Klass ET, Graf E, Teres JJ, Shear MK. A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. Am J Psychiatry. 2007 Feb;164(2):265-72. Erratum in: Am J Psychiatry. 2007 Jul;164(7):1123. Am J Psychiatry. 2007 Mar;164(3):529.
• Milrod BL, Leon AC, Barber JP, Markowitz JC, Graf E. Do comorbid personality disorders moderate panic-focused psychotherapy? An exploratory examination of the American Psychiatric Association practice guideline. J Clin Psychiatry. 2007 Jun;68(6):885-91.

Inclusion Criteria:

• Meets DSM-IV diagnosis criteria for primary PD with or without agoraphobia
• History of at least one spontaneous panic attack per week within the month prior to study entry

Exclusion Criteria:

• Active substance dependence within 6 months prior to study entry
• Lifetime history of any psychotic disorder, including bipolar disorder
• Acutely suicidal