Effectiveness of Intensive Cognitive Behavioral Therapy in Treating Adolescent Panic Disorder and Agoraphobia

Panic disorder (PD) in adolescents is a prevalent and chronic anxiety disorder. People with
PD experience unexpected attacks of fear, along with elevated heart rate, dizziness,
faintness, weakness, and increased sweating. During these panic attacks, people may feel
numbness in their hands, flushed or chilled, nauseous, or pain in the chest, and they may
lose touch with reality. PD can lead to substantial social impairment for adolescents,
including avoidance of school, independent activities, and peer involvement. When PD
progresses so far that a person avoids public places where a panic attack might occur, the
person is said to have a condition known as agoraphobia. Weekly sessions of cognitive
behavioral therapy (CBT) appear to be effective in treating panic disorder with agoraphobia
(PDA). However, many adolescents with PDA and their families report the need for a more
immediate relief from the disorder. This study will evaluate the effectiveness of intensive
CBT in treating adolescents with PDA.

Participants in this single blind study will be randomly assigned to one of three
conditions: intensive CBT treatment including family members, intensive CBT treatment
without family members, or a waitlist control group. All participants in the intensive CBT
treatment groups will undergo 8 days of intensive CBT, for a total of 6 sessions. On Days 1
through 3 of treatment, participants will attend daily, 2-hour CBT sessions. The CBT
sessions will include psychoeducation about anxiety, tactics to restructure
anxiety-provoking thoughts, and exposure to bodily sensations that trigger panic. On Days 4
and 5, participants will meet with a therapist to learn ways to approach previously feared
situations. On Days 6 and 7, participants will continue working independently or with family
members to solidify skills. On Day 8, participants will attend a final 2-hour session to
consolidate skills, review the independent weekend activities, and discuss ways to apply
skills to the home environment. Parents of participants in the parental involvement group
will attend the last 30 minutes of sessions, complete homework assignments, learn ways to
coach their children through episodes, and participate in selected exposures. After 6 weeks
of waitlist, participants in the waitlist control group will receive active treatment
following the same procedures as the initial active treatment. All participants will be
assessed at Months 3, 6, and 12 post-treatment.

Inclusion Criteria:

- Meets DSM-IV criteria for principal diagnosis of PD or PDA prior to treatment

- Adolescent must be accompanied by at least one parent or caregiver

- If on medication, there must be a 1-month stabilization period for benzodiazepines or
3-month stabilization period for SSRIs or tricyclics prior to study entry

Exclusion Criteria:

- Positive diagnosis of schizophrenia, pervasive developmental disorder, organic brain
syndrome, mental retardation, or current suicidal ideation

- Unavailability of at least one parent or caregiver

- Refusal of parent to accept random assignment to treatment condition

- Refusal of parent or adolescent to accept stabilization of medication

- Adolescent with parent who has any condition that would limit ability to understand
treatment