A randomized trial of sertraline, self-administered cognitive behavior therapy,
and their combination for panic disorder.
Author(s): Koszycki D, Taljaard M, Segal Z, Bradwejn J.
Affiliation(s): Faculty of Education, University of Ottawa, ON, Canada. dkoszyck@uottawa.ca
Publication date & source: 2011, Psychol Med. , 41(2):373-83
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.
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