A randomized trial of sertraline, self-administered cognitive behavior therapy, and their combination for panic disorder

• Published in: Psychological medicine Vol. 41; no. 2; pp. 373 - 383
• Main Authors: Koszycki, D., Taljaard, M., Segal, Z., Bradwejn, J.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.02.2011
• Subjects: Adult; Associated treatments; Behavior therapy. Cognitive therapy; Biological and medical sciences; Bodily sensations; Clinical outcomes; Clinical trials; Cognition; Cognitive behaviour therapy; Cognitive psychology; Cognitive Therapy; Combined Modality Therapy; Double-Blind Method; Drug therapy; Efficacy; Female; Humans; Likelihood Functions; Linear Models; Male; Medical sciences; Neuropharmacology; Panic attacks; Panic Disorder - therapy; Panic disorders; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Psychotropic drugs; Self Care; Serotonin Uptake Inhibitors - therapeutic use; Sertraline; Sertraline - therapeutic use; Treatments; SSRI; Cognitive behavior therapy (CBT); combination treatment; self-help interventions; panic disorder; Panic; Psychotropic; Anxiety disorder; Pharmacotherapy; Self administration; Reuptake inhibitor; Selective serotonin reuptake inhibitor; Selfcare; Antidepressant agent; Behavior therapy; Human; Cognitive therapy; Serotonin; Treatment efficiency; Controlled therapeutic trial; Sertraline; Naphthylamine derivatives; Treatment; Follow up study; Neurotransmitter; Combined treatment; Comparative study
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291710000930

Self-administered cognitive behavior therapy (SCBT) has been shown to be an effective alternative to therapist-delivered treatment for panic disorder (PD). However, it is unknown whether combining SCBT and antidepressants can improve treatment. This trial evaluated the efficacy of SCBT and sertraline, alone or in combination, in PD. Patients (n=251) were randomized to 12 weeks of either placebo drug, placebo drug plus SCBT, sertraline, or sertraline plus SCBT. Those who improved after 12 weeks of acute treatment received treatment for an additional 12 weeks. Outcome measures included core PD symptoms (panic attacks, anticipatory anxiety, agoraphobic avoidance), dysfunctional cognitions (fear of bodily sensations, agoraphobic cognitions), disability, and clinical global impression of severity and improvement. Efficacy data were analyzed using general and generalized linear mixed models. Primary analyses of trends over time revealed that sertraline/SCBT produced a significantly greater rate of decline in fear of bodily sensations compared to sertraline, placebo/SCBT and placebo. Trends in other outcomes were not significantly different over time. Secondary analyses of mean scores at week 12 revealed that sertraline/SCBT fared better on several outcomes than placebo, with improvement being maintained at the end of continuation treatment. Outcome did not differ between placebo and either sertraline monotherapy or placebo/SCBT. Moreover, few differences emerged between the active interventions. This trial suggests that sertraline combined with SCBT may be an effective treatment for PD. The study could not confirm the efficacy of sertraline monotherapy or SCBT without concomitant medication or therapist assistance in the treatment of PD.