Psychological Medicine

Original Articles

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

D. Koszyckia1a2 c1, M. Taljaarda3a4, Z. Segala5 and J. Bradwejna2

a1 Faculty of Education, University of Ottawa, ON, Canada

a2 Department of Psychiatry, University of Ottawa, ON, Canada

a3 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

a4 Department of Epidemiology and Community Medicine, University of Ottawa, ON, Canada

a5 Departments of Psychiatry and Psychology, University of Toronto and Centre for Addiction and Mental Health, Toronto, ON, Canada


Background 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.

Method 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.

Results 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.

Conclusions 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.

(Received May 13 2009)

(Revised March 23 2010)

(Accepted March 29 2010)

(Online publication May 13 2010)


c1 Address for correspondence: D. Koszycki. Ph.D., C.Psych., Faculty of Education, University of Ottawa, 145 Jean-Jacques Lussier, Ottawa, Ontario, K1N 6N5, Canada. (Email: