Abstract

This is one of four identical applications for a multi-center study of long-term treatment strategies for panic disorder (PD). The study builds upon the findings of our original multi-center study comparing imipramine, placebo, cognitive behavior therapy (CBT), and their combination in the treatment of PD patients with no more than mild agoraphobia. That study found response rates were as high with CBT or imipramine alone as with their combination. Given the added cost of combined treatments, it therefore seems reasonable to begin with monotherapy. Further, following general principles of medical practice, it would be reasonable to initiate treatment with the less invasive behavioral intervention. It is then important to learn what should be done following initial treatment. The proposed grant addresses this subject. In the proposed study, all subjects initially receive CBT alone. Subjects are then randomized in one of two postacute studies, depending on response status. These studies address two questions: (1) among patients who respond to an initial course of CBT, is maintenance therapy required to maintain response?; and (2) among those who fail to respond substantially to an initial course of CBT, will the addition of pharmacotherapy improve response? A total of 336 subjects will be enrolled from 4 sites over a 3 year period. Responders will be randomized to a maintenance study comparing no maintenance with 9 months of continued CBT. Non-responders will be randomized to a study comparing paroxetine with continued CBT. In addition to the main questions, possible predictors of response and relapse will be examined as well as possible mediators of response. Central to this proposal is the continuation of a well-functioning and productive collaboration among the sites conducting the current study. These sites already have in place the trained and certified assessment and treatment personnel and rigorous monitoring procedures that are essential for the conduct of a study such as the one we propose.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH045965-13
Application #
6629201
Study Section
Treatment Assessment Review Committee (TA)
Program Officer
Rudorfer, Matthew V
Project Start
1999-02-01
Project End
2005-06-30
Budget Start
2003-02-01
Budget End
2005-06-30
Support Year
13
Fiscal Year
2003
Total Cost
$165,861
Indirect Cost

  Institution

Name
Boston University
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
049435266
City
Boston
State
MA
Country
United States
Zip Code
02215

  Publications

Payne, Laura A; White, Kamila S; Gallagher, Matthew W et al. (2016) SECOND-STAGE TREATMENTS FOR RELATIVE NONRESPONDERS TO COGNITIVE BEHAVIORAL THERAPY (CBT) FOR PANIC DISORDER WITH OR WITHOUT AGORAPHOBIA-CONTINUED CBT VERSUS SSRI: A RANDOMIZED CONTROLLED TRIAL. Depress Anxiety 33:392-9
Cassiello-Robbins, Clair; Conklin, Laren R; Anakwenze, Ujunwa et al. (2015) The effects of aggression on symptom severity and treatment response in a trial of cognitive behavioral therapy for panic disorder. Compr Psychiatry 60:1-8
Huppert, Jonathan D; Kivity, Yogev; Barlow, David H et al. (2014) Therapist effects and the outcome-alliance correlation in cognitive behavioral therapy for panic disorder with agoraphobia. Behav Res Ther 52:26-34
Lutz, Wolfgang; Hofmann, Stefan G; Rubel, Julian et al. (2014) Patterns of early change and their relationship to outcome and early treatment termination in patients with panic disorder. J Consult Clin Psychol 82:287-97
White, Kamila S; Payne, Laura A; Gorman, Jack M et al. (2013) Does maintenance CBT contribute to long-term treatment response of panic disorder with or without agoraphobia? A randomized controlled clinical trial. J Consult Clin Psychol 81:47-57
Gallagher, Matthew W; Payne, Laura A; White, Kamila S et al. (2013) Mechanisms of change in cognitive behavioral therapy for panic disorder: the unique effects of self-efficacy and anxiety sensitivity. Behav Res Ther 51:767-77
Boswell, James F; Gallagher, Matthew W; Sauer-Zavala, Shannon E et al. (2013) Patient characteristics and variability in adherence and competence in cognitive-behavioral therapy for panic disorder. J Consult Clin Psychol 81:443-54
White, Kamila S; Allen, Laura B; Barlow, David H et al. (2010) Attrition in a multicenter clinical trial for panic disorder. J Nerv Ment Dis 198:665-71
Allen, Laura B; White, Kamila S; Barlow, David H et al. (2010) Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome. J Psychopathol Behav Assess 32:185-192
Furukawa, Toshi A; Katherine Shear, M; Barlow, David H et al. (2009) Evidence-based guidelines for interpretation of the Panic Disorder Severity Scale. Depress Anxiety 26:922-9

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