Effectiveness of Cognitive and Behavioral Psychotherapies in the Treatment of Panic Disorder
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https://doi.org/10.5281/zenodo.10616513Keywords:
panic disorder, agoraphobia, cognitive and behavioural therapies, exposure, cognitive restructuring, breathing and relaxation training, meta-analysisAbstract
A panic attack is a state of intense fear or inner distress with physical and cognitive symptoms. Panic disorder is a psychological difficulty characterized by recurrent and unexpected panic attacks. Cognitive and behavioral psychotherapies are the most frequently used psychotherapy approaches in the treatment of panic disorder. The techniques mostly used for panic disorder in cognitive and behavioral psychotherapy are exposure (in vivo or interoceptive), cognitive restructuring, relaxation and breathing training. In this article, the cognitive and behavioral model in panic disorder is discussed and the theoretical underpinnings of cognitive and behavioral methods are mentioned. In addition, by examining 15 meta-analyses investigating the effect of cognitive and behavioral therapies in the treatment of panic disorder using the document analysis method, it was aimed to understand the effect of this treatment and treatment components on recovery. The effects of cognitive and behavioral therapies were compared with other treatments, the effectiveness of treatment components in providing recovery was examined and effective treatment methods were discussed in line with the findings. The results of the meta-analysis, which combines the results of randomized controlled clinical trials using statistical methods, show that cognitive and behavioral therapies are effective treatments for panic disorder. It is also shown that the more effective treatment includes an interoceptive exposure component. It shows that the inclusion of other components, such as cognitive restructuring, has a low impact on treatment outcomes and that the inclusion of muscle relaxation training does not affect the overall effectiveness of the treatment. It is thought that examining which of the treatment components contributes more to recovery both in the short and long term and their cost-effectiveness will be important in terms of choosing the most effective and least costly treatment while providing psychotherapy services to clients.
References
Abelson, J. L., Weg, J. G., Nesse, R. M., & Curtis, G. C. (2001). Persistent respiratory irregularity in patients with panic disorder. Biological Psychiatry, 49(7), 588-595.
Addis, M. E., Hatgis, C., Krasnow, A. D., Jacob, K., Bourne, L., & Mansfield, A. K. (2004). Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting. Journal of Consulting and Clinical Psychology, 72(4), 625-635.
Amerikan Psikiyatri Birliği (2013). Ruhsal Bozuklukların Tanısal ve Sayımsal El Kitabı: Beşinci Baskı (DSM-5). (E. Köroğlu, Çev.) Hekimler Yayın Birliği.
Asmundson, G. and Taylor, S. (1996). Role of anxiety sensitivity in pain-related fear and avoidance. Journal of Behavioral Medicine, 19(6), 577-586.
Baker, H. J., Hollywood, A., & Waite, P. (2022). Adolescents’ lived experience of panic disorder: an interpretative phenomenological analysis. BMC Psychology, 10(1), 1-13.
Bandelow, B., Seidler-Brandler, U., Becker, A., Wedekind, D., & Rüther, E. (2007). Meta-analysis of randomized controlled comparisons of psychopharmacological and psychological treatments for anxiety disorders. The World Journal of Biological Psychiatry, 8(3), 175-187.
Barber, J., Milrod, B., Gallop, R., Solomonov, N., Rudden, M., McCarthy, K., & Chambless, D. (2020). Processes of therapeutic change: results from the cornell-penn study of psychotherapies for panic disorder. Journal of Counseling Psychology, 67(2), 222-231.
Barlow, D. H., Brown, T. A., & Craske, M. G. (1994). Definitions of panic attacks and panic disorder in the dsm-iv: implications for research. Journal of Abnormal Psychology, 103(3), 553-564.
Barlow, D. H., & Craske, M. G. (2006). Mastery of your anxiety and panic. Oxford University Press.
Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford press.
Bevins, R. A. and Besheer, J. (2014). Interoception and learning: import to understanding and treating diseases and psychopathologies. ACS Chemical Neuroscience, 5(8), 624-631.
Booth, J. N., Boyle, J., Kelly, S. W. (2010). Do tasks make a difference? accounting for heterogeneity of performance of children with reading difficulties on tasks of executive function: findings from a meta‐analysis. British Journal of Developmental Psychology, 28(1), 133-176.
Bouton, M. E., Mineka, S., Barlow, D. H. (2001). A modern learning theory perspective on the etiology of panic disorder. Psychological Review, 108(1), 4.
Bouton, M. E., Todd, T. P., Vurbic, D., & Winterbauer, N. E. (2011). Renewal after the extinction of free operant behavior. Learning & Behavior, 39(1), 57-67.
Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative Research Journal, 9(2), 27-40.
Chen, W. C., Chu, H., Lu, R. B., Chou, Y. H., Chen, C. H., Chang, Y. C., & Chou, K. R. (2009). Efficacy of progressive muscle relaxation training in reducing anxiety in patients with acute schizophrenia. Journal of Clinical Nursing, 18(15), 2187-2196.
Clark, D. A., Beck, A. T. (2011). Cognitive Therapy of Anxiety Disorders: Science and Practice. Guilford Press. Chapter 8.
Clark, D.M. (1986) A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461–470.
Clark, D. M., Salkovskis, P. M., Chalkley, A. J. (1985). Respiratory control as a treatment for panic attacks. Journal of Behavior Therapy and Experimental Psychiatry, 16(1), 23-30.
Clum, G. A., Clum, G. A., & Surls, R. (1993). A meta-analysis of treatments for panic disorder. Journal of consulting and clinical psychology, 61(2), 317.
Cox, B. J., Endler, N. S., Lee, P. S., & Swinson, R. P. (1992). A meta-analysis of treatments for panic disorder with agoraphobia: Imipramine, alprazolam and in vivo exposure. Journal of Behaviour Therapy and Experimental Psychiatry, 23(3), 175–182.
Craske, M. G., Barlow, D. H., (2008). Panic Disorder and Agoraphobia. In Barlow, D. H. (Ed.) Clinical Handbook of Psychological Disorders: A Step-by-step Treatment Manual. The Guilford Press, 1-64.
Craske, M. G., Glover, D., DeCola, J. (1995). Predicted versus unpredicted panic attacks: Acute versus general distress. Journal of Abnormal Psychology, 104(1), 214–223.
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.
Cuijpers, P., Gentili, C., Baños, R., Campayo, J. G., Botella, C., & Cristea, I. A. (2016). Relative effects of cognitive and behavioral therapies on generalized anxiety disorder, social anxiety disorder and panic disorder: a meta-analysis. Journal of Anxiety Disorders, 43, 79-89.
Davies, S., Nash, J., Nutt, D. (2017). Management of panic disorder in primary care. Prescriber, 28(1), 19-26.
Farmer, R.F., Chapman, A.L. (2016). Behavioral Interventions in Cognitive Behavior Therapy. Washington DC: Americal Psychological Association. Chapter 9.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: exposure to corrective information. Psychological Bulletin, 99(1), 20.
Galassi, F., Quercioli, S., Charismas, D., Niccolai, V., & Barciulli, E. (2007). Cognitive‐behavioral group treatment for panic disorder with agoraphobia. Journal of Clinical Psychology, 63(4), 409-416.
Gelder, M. (1986). Panic attacks: new approaches to an old problem. The British Journal of Psychiatry, 149(3), 346-352.
Gould, R. A., Otto, M. W., Pollack, M. H. (1995). A meta-analysis of treatment outcome for panic disorder. Clinical Psychology Review, 15(8), 819–844.
Groves, P. M. and Thompson, R. F. (1970). Habituation: a dual-process theory. Psychological Review, 77(5), 419-450.
Guo, R. (2021, December). Exposure Therapy for Phobia Treatment. In 2021 3rd International Conference on Economic Management and Cultural Industry (ICEMCI 2021) (pp. 1563-1566). Atlantis Press.
Hewitt, O., Tomlin, A., Waite, P. (2021). The experience of panic attacks in adolescents: an interpretative phenomenological analysis study. Emotional and Behavioural Difficulties, 26(3), 240-253.
Holloway, W. & McNally, R. (1987). Effects of anxiety sensitivity on the response to hyperventilation. Journal of Abnormal Psychology, 96(4), 330-334.
Jacoby, R. J. and Abramowitz, J. S. (2016). Inhibitory learning approaches to exposure therapy: a critical review and translation to obsessive-compulsive disorder. Clinical Psychology Review, 49, 28-40.
Johnco, C., Wuthrich, V., & Rapee, R. (2015). The impact of late-life anxiety and depression on cognitive flexibility and cognitive restructuring skill acquisition. Depression and Anxiety, 32(10), 754-762.
Judd, F., Burrows, G. D., Marriott, P., P, F., Blair-West, S., & Norman, T. R. (1991). A short‐term open trial of clomipramine in the treatment of patients with panic attacks. Human Psychopharmacology: Clinical and Experimental, 6(1), 53-60.
Kessler, R. C., Chiu, W. T., Jin, R., Ruscio, A. M., Shear, K., & Walters, E. E. (2006). The epidemiology of panic attacks, panic disorder, and agoraphobia in the national comorbidity survey replication. Archives of General Psychiatry, 63(4), 415.
Khawaja, N. and Oei, T. (1999). The psychobiological correlates of panic attacks during in vivo exposure. Behavioural and Cognitive Psychotherapy, 27(4), 353-367.
Killeen, T. K., Back, S. E., & Brady, K. T. (2011). The use of exposure-based treatment among individuals with ptsd and co-occurring substance use disorders: clinical considerations. Journal of Dual Diagnosis, 7(4), 194-206.
Lee, K., Noda, Y., Nakano, Y., Ogawa, S., Kinoshita, Y., Funayama, T., & Furukawa, T. A. (2006). Interoceptive hypersensitivity and interoceptive exposure in patients with panic disorder: specificity and effectiveness. BMC Psychiatry, 6(1), 1-9.
Luermans, J., Cort, K. D., Schruers, K., & Griez, E. (2004). New insights in cognitive behavioural therapy as treatment of panic disorder: a brief overview. Acta Neuropsychiatrica, 16(2), 110-112.
Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2018). Dissociation in psychiatric disorders: a meta-analysis of studies using the dissociative experiences scale. American Journal of Psychiatry, 175(1), 37-46.
Manzoni, G., Pagnini, F., Castelnuovo, G., & Molinari, E. (2008). Relaxation training for anxiety: a ten-years systematic review with meta-analysis. BMC Psychiatry, 8(1), 1-12.
Marchione, K. E., Michelson, L., Greenwald, M., & Dancu, C. (1987). Cognitive behavioral treatment of agoraphobia. Behaviour Research and Therapy, 25(5), 319-328.
Marzol, P., & Pollack, M. (2000). New developments in panic disorder. Current Psychiatry Reports, 2(4), 353-357.
Marten, P. A., & Barlow, D. H. (1993). Implications of clinical research for psychotherapy integration in the treatment of the anxiety disorders. Journal of Psychotherapy Integration, 3(4), 297-311.
Mineka, S., Cook, M., & Miller, S. (1984). Fear conditioned with escapable and inescapable shock: The effects of a feedback stimulus. Journal of Experimental Psychology: Animal Behavior Processes, 10(3), 307– 323.
Mitte, K. (2005). A meta-analysis of the efficacy of psycho-and pharmacotherapy in panic disorder with and without agoraphobia. Journal of Affective Disorders, 88(1), 27-45.
Montero-Marin, J., Garcia-Campayo, J., López-Montoyo, A., Zabaleta-del-Olmo, E., & Cuijpers, P. (2018). Is cognitive–behavioural therapy more effective than relaxation therapy in the treatment of anxiety disorders? A meta-analysis. Psychological medicine, 48(9), 1427-1436.
Morissette, S. B., Tull, M. T., Gulliver, S. B., Kamholz, B. W., & Zimering, R. T. (2007). Anxiety, anxiety disorders, tobacco use, and nicotine: a critical review of interrelationships. Psychological Bulletin, 133(2), 245-272.
Mott, J. M., Sutherland, R. J., Williams, W., Lanier, S. H., Ready, D. J., & Teng, E. J. (2013). Patient perspectives on the effectiveness and tolerability of group-based exposure therapy for posttraumatic stress disorder: preliminary self-report findings from 20 veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 5(5), 453-461.
Mowrer, O. H. (1960). Learning theory and behavior. John Wiley & Sons Inc.
Myers, K. M. and Davis, M. (2006). Mechanisms of fear extinction. Molecular Psychiatry, 12(2), 120-150.
Noda, Y., Nakano, Y., Lee, K., Ogawa, S., Kinoshita, Y., Funayama, T., … & Furukawa, T. A. (2007). Sensitization of catastrophic cognition in cognitive-behavioral therapy for panic disorder. BMC Psychiatry, 7(1), 1-9.
Ohst, B. and Tuschen-Caffier, B. (2018). Catastrophic misinterpretation of bodily sensations and external events in panic disorder, other anxiety disorders, and healthy subjects: a systematic review and meta-analysis. Plos One, 13(3), e0194493.
Ougrin, D. (2011). Efficacy of exposure versus cognitive therapy in anxiety disorders: systematic review and meta-analysis. BMC psychiatry, 11(1), 1-13.
Peterson, A. L., Hatch, J. P., Hryshko-Mullen, A. S., & Cigrang, J. A. (2011). Relaxation training with and without muscle contraction in subjects with psychophysiological disorders. Journal of Applied Biobehavioral Research, 16(3-4), 138-147.
Pfaltz, M. C., Michael, T., Meyer, A. H., & Wilhelm, F. H. (2013). Reexperiencing symptoms, dissociation, and avoidance behaviors in daily life of patients with PTSD and patients with panic disorder with agoraphobia. Journal of Traumatic Stress, 26(4), 443-450.
Pollack, M., Allgulander, C., Bandelow, B., Cassano, G., Greist, J., Hollander, E., & Swinson, R. (2003). Wca recommendations for the long-term treatment of panic disorder. CNS Spectrums, 8(S1), 17-30.
Pompoli, A., Furukawa, T. A., Efthimiou, O., Imai, H., Tajika, A., Salanti, G. (2018). Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychological Medicine, 48(12), 1945-1953.
Razran, G. (1961). The observable and the inferable conscious in current Soviet psychophysiology: Interoceptive conditioning, semantic conditioning, and the orienting reflex. Psychological Review, 68(2), 81.
Reiss, S. (1980). Pavlovian conditioning and human fear: An expectancy model. Behavior Therapy, 11(3), 380-396.
Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11(2), 141-153.
Richards, J., Richardson, V., & Pier, C. (2002). The relative contributions of negative cognitions and self-efficacy to severity of panic attacks in panic disorder. Behaviour Change, 19(2), 102-111.
Riley, R. D., Higgins, J. P., & Deeks, J. J. (2011). Interpretation of random effects meta-analyses. Bmj, 342, 964-967.
Robleto, K., Poulos, A. M., & Thompson, R. F. (2004). Brain mechanisms of extinction of the classically conditioned eyeblink response. Learning & Memory, 11(5), 517-524.
Sánchez-Meca, J., Rosa-Alcázar, A. I., Marín-Martínez, F., Gómez-Conesa, A. (2010). Psychological treatment of panic disorder with or without agoraphobia: a meta-analysis. Clinical Psychology Review, 30(1), 37-50.
Schmidt, N. B., Woolaway-Bickel, K., Trakowski, J., Santiago, H., Storey, J., Koselka, M., Cook, J. (2000). Dismantling cognitive–behavioral treatment for panic disorder: questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology, 68(3), 417-424.
Siev, J., Chambless, D. L. (2007). Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders. Journal of Consulting and Clinical Psychology, 75(4), 513.
Stappenbeck, C. A., Luterek, J. A., Kaysen, D., Rosenthal, C. F., Gurrad, B., & Simpson, T. L. (2015). A controlled examination of two coping skills for daily alcohol use and ptsd symptom severity among dually diagnosed individuals. Behaviour Research and Therapy, 66, 8-17.
Stewart, R. E., & Chambless, D. L. (2009). Cognitive–behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of consulting and clinical psychology, 77(4), 595-606.
Stewart, S. H. and Watt, M. C. (2008). Introduction to the special issue on interoceptive exposure in the treatment of anxiety and related disorders: novel applications and mechanisms of action. Journal of Cognitive Psychotherapy, 22(4), 291-302.
Trull, T. J., Nietzel, M. T., & Main, A. (1988). The use of meta-analysis to assess the clinical significance of behavior therapy for agoraphobia. Behavior Therapy, 19(4), 527–538.
Van Balkom, A. J., Bakker, A., Spinhoven, P., Blaauw, B. M., Smeenk, S., & Ruesink, B. (1997). A meta-analysis of the treatment of panic disorder with or without agoraphobia: a comparison of psychopharmacological, cognitive-behavioral, and combination treatments. The Journal of nervous and mental disease, 185(8), 510-516.
Watson, D., Clark, L. A. (1984). Negative affectivity: the disposition to experience aversive emotional states. Psychological Bulletin, 96(3), 465-490.
Wenzel, A., Sharp, I. R., Sokol, L., & Beck, A. T. (2006). Attentional fixation in panic disorder. Cognitive Behaviour Therapy, 35(2), 65-73.
Wiener, C., Perloe, A., Whitton, S., & Pincus, D. (2011). Attentional bias in adolescents with panic disorder: changes over an 8-day intensive treatment program. Behavioural and Cognitive Psychotherapy, 40(2), 193-204.
Wittchen, H., Gloster, A., Beesdo-Baum, K., Fava, G., & Craske, M. (2010). agoraphobia: a review of the diagnostic classificatory position and criteria. Depression and Anxiety, 27(2), 113-133.
Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford University Press.
Yamada, T., Inoue, A., Mafune, K., Hiro, H., & Shoji, N. (2017). Recovery of percent vital capacity by breathing training in patients with panic disorder and impaired diaphragmatic breathing. Behavior Modification, 41(5), 665-682.
Yonkers, K. A., Zlotnick, C., Allsworth, J. E., Warshaw, M. G., Shea, M. T., & Keller, M. B. (1998). Is the course of panic disorder the same in women and men?. American Journal of Psychiatry, 155(5), 596-602.
Zemore, R. (1975). Systematic desensitization as a method of teaching a general anxiety-reducing skill. Journal of Consulting and Clinical Psychology, 43(2), 157-161.
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