Elsevier

Journal of Anxiety Disorders

Volume 12, Issue 4, July–August 1998, Pages 357-371
Journal of Anxiety Disorders

The Effects of Cognitive-Behavior Therapy for Panic Disorder on Comorbid Conditions

https://doi.org/10.1016/S0887-6185(98)00020-6Get rights and content

Abstract

In a replication and extension of prior research (Brown, Antony, & Barlow, 1995) examining the impact of treatment on additional diagnoses, our study investigated the effects of cognitive-behavioral treatment for panic disorder on frequency and severity of comorbid conditions in 33 principal panic disorder patients. Patients were diagnosed using the Anxiety Disorders Interview Schedule-Revised (ADIS-R; Di Nardo & Barlow, 1988) and assigned severity ratings indicating degree of distress and/or impairment for both principal panic disorder and comorbid conditions. A high rate of comorbidity (63.6%) was found at pretreatment. Following cognitive-behavioral treatment, there was a significant reduction in the number of patients with at least one additional diagnosis (p < .01); the greatest declines were found in comorbid social phobia and generalized anxiety disorder. Severity ratings also declined significantly from pre- to posttreatment for comorbid social phobia, generalized anxiety disorder, and posttraumatic stress disorder (p < .01) and were marginally significant for depression. There was a trend for comorbidity to reduce likelihood of achieving high improvement in panic at posttreatment. Implications of these findings for classification and treatment mechanisms are discussed.

Section snippets

Participants

Patients with principal panic disorder and agoraphobia (PDA) were enrolled in a treatment outcome study comparing two different CBT packages for PDA. Participants were self-referred or referred by local mental health professionals to the UCLA Anxiety Disorders Behavioral Program. An initial diagnostic evaluation was scheduled for participants who met the following criteria: (a) reported panic attacks and/or panic apprehension and agoraphobic avoidance, (b) aged between 18 and 60 years, (c) not

Analytic Approach

Overall, both treatment packages for panic, CIE and CBE, led to significant reductions in ADIS-R-rated panic disorder severity, F1, 32 = 154.07, p < .001, although CIE resulted in more improvement than CBE on measures of panic frequency and severity. Because the focus of the current study was to examine whether successful treatment for panic disorder influences comorbid conditions, and due to the relatively small sample size that prohibits testing of Treatment Group &times; Comorbidity

Discussion

The present study found that CBT treatment for principal panic disorder was effective in reducing both frequency and severity of comorbid conditions that were not the focus of treatment. In terms of frequency, there was a significant decline in number of patients with comorbid diagnoses of clinical severity following panic treatment. Whereas 21 (63.6%) patients presented with at least one additional diagnosis at pretreatment, only 9 (27.3%) continued to have a clinically severe comorbid

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