Comparison of Psychotherapy Programs to Treat Panic Disorder

Panic disorder (PD) is a debilitating anxiety disorder. It is characterized by unexpected and
repeated episodes of intense fear, accompanied by serious physical symptoms, such as chest
pain, heart palpitations, shortness of breath, dizziness, or abdominal stress. Available
treatments for PD include medication therapy and cognitive behavioral therapy (CBT), a type
of psychotherapy that teaches people how to view panic attacks differently and how to reduce
anxiety. Approximately 30% of patients refuse medication, however, and nearly 50% do not
achieve remission with CBT alone. Therefore, there is a pressing need for additional
non-pharmacologic treatment methods. Panic-focused psychodynamic psychotherapy (PFPP) and
applied relaxation training (ART) are among some of the other available treatments for PD.
During ART, individuals are taught to relax their muscles while being exposed to increasingly
frightening situations. PFPP combines elements of CBT with other, more extensive approaches
aimed at determining the anxiety's origin and at finding ways to reduce it. This study will
compare the effectiveness of PFPP, CBT, and ART in treating PD.

Participants in this single blind study will be randomly assigned to receive PFPP, CBT, or
ART for 12 weeks. All participants will attend between 19 and 24 treatment sessions over the
course of the study. Upon completing the study, participants will attend monthly follow-up
visits for an additional 12 months. Participants assigned to ART who have not responded by
the end of treatment may opt to receive PFPP or CBT. Outcomes will be assessed using a
variety of scales to determine depression and anxiety symptoms.

Inclusion Criteria:

- Meets DSM-IV diagnosis criteria for primary PD with or without agoraphobia

- History of at least one spontaneous panic attack per week within the month prior to
study entry

Exclusion Criteria:

- Active substance dependence within 6 months prior to study entry

- Lifetime history of any psychotic disorder, including bipolar disorder

- Acutely suicidal