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Cited by 13Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and AssessmentsPsychotherapy Techniques and Applications

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: Research Article: Second-Stage Treatments for Panic Disorder

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Payne, Laura A., White, Kamila S., Gallagher, Matthew W., Woods, Scott W., Shear, M. Katherine, Gorman, Jack M., Farchione, Todd J., Barlow, David H.·2016·Depression and Anxiety
DOI 10.1002/da.22457
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Abstract

BACKGROUND: Cognitive behavioral therapy (CBT) and pharmacotherapy are efficacious for the short-term treatment of panic disorder. Less is known about the efficacy of these therapies for individuals who do not respond fully to short-term CBT. METHOD: The current trial is a second-step stratified randomized design comparing two treatment conditions-selective serotonin reuptake inhibitor (SSRI; paroxetine or citalopram; n = 34) and continued CBT (n = 24)-in a sample of individuals classified as treatment nonresponders to an initial course of CBT for panic disorder. Participants were randomized to 3 months of treatment and then followed for an additional 9 months. Only treatment responders after 3 months were maintained on the treatment until 12-month follow-up. Data analysis focused on panic disorder symptoms and achievement of response status across the first 3 months of treatment. Final follow-up data are presented descriptively. RESULTS: Participants in the SSRI condition showed significantly lower panic disorder symptoms as compared to continued CBT at 3 months. Results were similar when excluding individuals with comorbid major depression or analyzing the entire intent-to-treat sample. Group differences disappeared during 9-month naturalistic follow-up, although there was significant attrition and use of nonstudy therapies in both arms. CONCLUSIONS: These data suggest greater improvement in panic disorder symptoms when switching to SSRI after failure to fully respond to an initial course of CBT. Future studies should further investigate relapse following treatment discontinuation for nonresponders who became responders. Clinicaltrials.gov Identifier: NCT00000368; https://clinicaltrials.gov/show/NCT00000368.

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  • In a 3-month second-step randomized controlled trial, panic disorder patients who had not responded to 12 individual cognitive behavioral therapy sessions and switched to paroxetine or citalopram reported significantly lower panic symptoms than those who continued cognitive behavioral therapy.

    “At the end of the treatment period, the participants who took SSRIs reported significantly lower panic symptoms in comparison to those who continued CBT.”

    From Management of Treatment-Resistant Panic Disorder (2017) · cites this paper as [34]

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  1. [18]18. Mavissakalian MR, Prien RF, editors. Long-Term Treatment of Anxiety Disorders. Washington, DC: American Psychiatric Press, Inc.; 1996.
  2. [20]20. Depression and Anxiety 15206394, 2016, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/da.22457 by Mount Vernon Nazarene University, Wiley Online Library on [28/08/2026]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

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Authors
Payne, L. A., White, K. S., Gallagher, M. W., Woods, S. W., Shear, M. K., Gorman, J. M., Farchione, T. J., & Barlow, D. H.
Affiliations
  • University of California, Los Angeles (US)
  • University of Missouri–St. Louis (US)
  • University of Houston (US)
  • Yale University (US)
  • Columbia University (US)
  • Franklin Behavioral Health Consultants; New York New York
  • Boston University (US)
Corresponding author
Barlow, David H.
ORCID
Venue
Depression and Anxiety
Publisher
Wiley
Published
2015-12-10
Volume
33
Issue
5
Pages
392-399
ISSN
1091-4269 (ISSN-L)
DOI
10.1002/da.22457
OpenAlex
W2192402372
Cited by
13
References
34
Citations by year
2025: 1 · 2023: 1 · 2021: 2 · 2018: 2 · 2017: 3 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 1
FWCI
3.48
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health grants (R01MH45963, MH45964, MH45965, MH45966)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
panic disorder, agoraphobia, cognitive behavioral therapy, treatment non-responders, selective serotonin reuptake inhibitors, paroxetine, citalopram, relapse after treatment discontinuation
MeSH terms
Adult, Agoraphobia, Combined Modality Therapy, Female, Humans, Male, Citalopram, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Paroxetine

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