تاثیر اختلالات روحی و شخصیتی همزمان در درمان شناختی-رفتاری اختلال پانیک

The present review examined the effect of comorbid major depressive disorder and personality disorder on the outcome of cognitive-behavioral interventions for panic disorder. Panic disorder patients often present with these comorbid conditions, but for the most part, treatment studies have paid little attention to them. Most studies on the effects of comorbidity on treatment outcome address pharmacological treatment. However, there is a growing literature on the effect of additional disorders on the outcome of cognitive-behavioral interventions for panic disorder. Findings from the studies of comorbidity with depression are equivocal, possibly reflecting inconsistencies in measurement methodology across studies. However, personality psychopathology was found to exert a detrimental effect on the outcome of cognitive-behavioral treatment for panic disorder. Further research is necessary to elucidate the impact of these concurrent conditions on cognitive-behavioral treatment for panic disorder. It is suggested that studies utilizing cognitive-behavioral treatment routinely examine the influence of comorbid conditions on treatment outcome.

OVER THE PAST decade, tremendous strides have been made in the treatment of anxiety disorders. Both pharmacological and cognitive-behavioral therapies have demonstrated efficacy Barlow & Lehman 1996 and Lydiard, Brawman-Mintzer, & Ballenger 1996. Specific intervention strategies for different disorders have increased precision of treatment. This has been particularly evident in the cognitive-behavioral treatment (CBT) of panic disorder, where strategies focus on particular characteristics of the disorder Clum et al. 1993 and Otto and Gould 1996. CBT for panic disorder has been highly successful in reducing frequency of panic attacks, severity of symptoms, and the dysfunction associated with panic disorder. CBT interventions have been shown to be among the most efficacious psychological treatments for panic disorder (Chambless & Gillis, 1993). In addition, CBT has been shown to be as efficacious, if not more efficacious, than pharmacological treatment Clum et al. 1993 and Gould et al. 1995. This is an important issue given the cost-effectiveness of CBT and its avoidance of the risks, side effects, and discontinuation difficulties associated with some pharmacological treatments for panic disorder (Gould et al., 1995). Results of controlled studies of CBT for panic disorder have been promising. Craske (1996), in a review of 14 studies of panic disorder with limited or no agoraphobic avoidance, reported that 71% of patients were panic-free after treatment. Furthermore, 82% were free of panic at a 2-year follow-up. Chambless and Gillis (1993) performed a meta-analysis of 14 studies of CBT for panic disorder. Consistently large effect sizes were reported (range, 1.00–1.73 at follow-up), especially when cognitive restructuring and exposure techniques were integrated. Clum et al. (1993) examined 29 controlled studies of either CBT, medication, or combination treatment for panic disorder. They concluded that CBT, incorporating both exposure and cognitive coping techniques, was the most efficacious treatment strategy, followed by combined CBT and medication treatment. Medication administered as a sole treatment was associated with smaller effect sizes than cognitive-behavioral treatment alone or in combination with medication.

The present review examined the effect of comorbid major depressive disorder and personality disorder on the outcome of cognitive-behavioral interventions for panic disorder. Panic disorder patients often present with these comorbid conditions, but for the most part, treatment studies have paid little attention to them. Most of the literature on the effects of comorbidity on treatment outcome addresses pharmacological treatment, and less is known about the specific effects of other disorders (e.g., anxiety, substance, and medical disorders) on the outcome of CBT for panic disorder. However, CBT studies have now begun to address these issues.