Psychological Medicine

Original Article

Does the addition of cognitive behavioral therapy improve panic disorder treatment outcome relative to medication alone in the primary-care setting?

a1 Departments of Psychology and Psychiatry & Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
a2 The RAND Corporation, Santa Monica, CA, USA
a3 Departments of Psychiatry and Family & Preventive Medicine, University of California, San Diego (UCSD), CA, USA
a4 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine at Harborview Medical Center, Seattle, WA
a5 Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA

Article author query
craske mg   [PubMed][Google Scholar] 
golinelli d   [PubMed][Google Scholar] 
stein mb   [PubMed][Google Scholar] 
roy-byrne p   [PubMed][Google Scholar] 
bystritsky a   [PubMed][Google Scholar] 
sherbourne c   [PubMed][Google Scholar] 


Background.Randomized clinical trials indicate a benefit from combining medications with cognitive behavioral therapy (CBT) relative to medication alone for panic disorder. Using an as-treated analysis, we evaluated whether the addition of CBT enhanced outcomes for panic disorder relative to medications alone in the primary-care setting.

Method.Primary-care patients with panic disorder reported on their receipt of CBT and medications over the 3 months following baseline assessment. The degree to which outcomes for those who used anti-panic medications were enhanced by the receipt of at least one component of CBT was analyzed using a propensity score model that took into account observable baseline patient characteristics influencing both treatment selection and outcomes.

Results.The addition of CBT resulted in statistically and clinically significant improvements at 3 months on anxiety sensitivity, social avoidance, and disability. Also, patients receiving CBT in the first 3 months of the study were more improved at 12 months than patients who took medications only during the first 3 months of the study.

Conclusions.The clinical utility of the findings are discussed in terms of the importance of primary-care physicians encouraging their panic disorder patients to receive CBT as well as medications.

(Published Online July 15 2005)

c1 Departments of Psychology and Psychiatry & Biobehavioral Sciences, UCLA, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA. (Email: