یک کارآزمایی تصادفی کنترل شده بالینی استاندارد، و رفتاردرمانی شناختی گروهی کوتاه برای اختلال پانیک با موقعیت هراسی: دو سال پیگیری

A randomized controlled clinical trial with a wait-list control group was conducted to examine the effectiveness of three modalities (brief, group, and standard) of cognitive-behavioral treatment (CBT) for panic disorder with agoraphobia. A total of 100 participants meeting DSM-IV criteria were randomly assigned to each treatment condition: a 14-session standard CBT (n = 33), a 14-session group CBT (n = 35) and a 7-session brief CBT (n = 32). Participants received a self-study manual and were assigned weekly readings and exercises. The results indicate that regardless of the treatment condition, CBT for moderate to severe PDA is beneficial in medium and long term. To this effect, all three-treatment conditions significantly reduced the intensity of symptoms, increased participants’ quality of life, offered high effect sizes, superior maintenance of gains over time, and lower rates of relapse, compared to the wait-list control.

Cognitive-behavioral therapy (CBT) is considered a first-line treatment for PDA in practice guidelines published by the American Psychiatric Association (1998) and the Canadian Psychiatric Association (Swinson et al., 2006). In fact, substantial research evidence has established CBT as the treatment of choice for PDA over placebo, wait-list control, and other active treatments, such as applied relaxation and pharmacotherapy (Foldes-Busque et al., 2007 and McCabe and Gifford, 2009). Cognitive-behavioral treatments have been shown to offer high effect sizes, superior maintenance of gains over time, and lower rates of relapse compared to pharmacological treatment (Fava et al., 2001, Foldes-Busque et al., 2007, Gould et al., 1995 and White and Barlow, 2001). The CBT approach for PDA utilizes multiple components that are tailored to meet the treatment needs of the individual. These components include psychoeducation, cognitive restructuring, interoceptive exposure, in vivo exposure, relaxation-based strategies, and prevention relapse. The goal of these strategies is to modify an individual's response to panic cues that may be internally or externally based, so that a fearful response is replaced by a non-fearful one. Standard CBT generally involves weekly individual sessions (between 12 and 18) with a therapist, a reality that requires considerable resources from both the therapist and the client. To further the problem, few professionals have received adequate CBT training to effectively treat PDA. This lack of preparation appears to be an obstacle preventing accessibility to effective treatment (Côté et al., 1994 and Walker et al., 1991).