The Use of the Panic and Agoraphobia Scale (P & A) in a controlled clinical trial1
Abstract
BACKGROUND: A new 13-item scale has been developed for measuring severity of illness in patients with panic disorder and agoraphobia, the Panic and Agoraphobia Scale (P & A). The scale has five subscales covering the main factors that reduce quality of life in panic disorder patients (panic attacks, avoidance, anticipatory anxiety, disability and worries about health). The application of this scale in a double-blind placebo-controlled panic disorder trial is described. At the same time, the aim of the study was to compare the therapeutic effects of aerobic exercise with a treatment of well-documented efficacy. METHODS: Patients with Panic disorder (DSM-IV) were randomly assigned to three treatment modalities: running (n=45), clomipramine (n=15) or placebo (n=15). Treatment efficacy was measured with the Panic and Agoraphobia Scale (P & A) and other rating scales. RESULTS: According to the P & A and other scales, both exercise and clomipramine led to a significant decrease of symptoms in comparison to placebo treatment. Clomipramine was significantly more effective and improved anxiety symptoms significantly earlier than exercise. The evaluation of the P & A subscales revealed that exercise exerted its effect mainly reducing anticipatory anxiew and panic-related disability. CONCLUSIONS: The new Panic and Agoraphobia Scale was shown to be sensitive to differences between different panic treatments. Analysis of the scales five subscores may help to understand mechanisms of action of panic disorder treatments.
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The Panic and Agoraphobia Scale (PAS) is a 13-item questionnaire divided into five subscales addressing panic attacks, agoraphobic avoidance, anticipatory anxiety, limitations in daily life, and health concerns; it can be evaluated separately or as a total score ranging from 0 to 52, with higher scores indicating higher panic symptoms.
“The PAS is a 13-item questionnaire which is divided into five subscales addressing panic attacks, agoraphobic avoidance, anticipatory anxiety, limitations in daily life, and health concerns (e.g., fear of physical harm or fear of an organic cause). These subscales can be evaluated separately or as a total score, ranging from 0 to 52. Higher scores indicate a higher level of panic symptoms.”
From A mobile application for panic disorder and agoraphobia: Insights from a multi-methods feasibility study (2020) · cites this paper as Bandelow et al., 2000
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Bandelow, B., Zohar, J., Hollander, E., Kasper, S., Möller, H., & WFSBP Task Force on Treatment Guide (2008) · The World Journal of Biological Psychiatry · doi:10.1080/15622970802465807 · Cited by 862 · see citing works
Self-citationTreatment of anxiety disorders
Bandelow, B., Michaelis, S., & Wedekind, D. (2017) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2017.19.2/bbandelow · Cited by 811 · see citing works
Self-citationExercise as Treatment for Anxiety: Systematic Review and Analysis
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“Of note, at least one study indicated that an ITTanalysis was performed but reported primarily an analysis of study completers [67–69].”
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Regulation of the Hypothalamic–Pituitary–Adrenocortical System in Patients with Panic Disorder
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“…the HAM-Ds factorial subscales ‘vegetative depression’ and ‘cognitive depression’ according to Overall and Rhoades (1982), State and Trait Anxiety Inventory scale (Spielberger, 1983), Panic and Agoraphobia scale (Bandelow et al, 2000a), including selfrating and ratings assessed by clinicians.”
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“As observational instruments such as the Panic Disorder Severity Scale (47) and the Panic Agoraphobia Scale (48) are now available in various languages, we advise their use to complement other (self-report) scales to establish treatment efficacy in this population.”
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“[59] The use of observer-rated instruments like the Panic Disorder Severity Scale[60] or the Panic Agoraphobia Scale,[61] might have been more suitable, but neither was available in Dutch translation nor psychometrically tested at the launch of our study.”
MethodRufer, M., Albrecht, R., Zaum, J., Schnyder, U., Mueller-Pfeiffer, C., Hand, I., & Schmidt, O. (2010) · Psychopathology · doi:10.1159/000288639 · Cited by 78 · see citing works
Antidepressants versus placebo for panic disorder in adults
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Treatment-Resistant Panic Disorder
Bandelow, B., & Rüther, E. (2004) · CNS Spectrums · doi:10.1017/s1092852900022379 · Cited by 57 · see citing works
Self-citationWCA Recommendations for the Long-Term Treatment of Panic Disorder
Pollack, M. H., Allgulander, C., Bandelow, B., Cassano, G. B., Greist, J. H., Hollander, E., Nutt, D., Okasha, A., & Swinson, R. P. (2003) · CNS Spectrums · doi:10.1017/s109285290000691x · Cited by 55 · see citing works
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“The scale has been shown to be sensitive to change due to treatment in 2 clinical trials [31,32].”
MethodThe Medical Treatment of Obsessive-Compulsive Disorder and Anxiety
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“Physical sensation self-monitoring scale[5] Assesses for intensity and anxiety regarding physical sensations to provide information on interoceptive triggers Severity Measure for Panic Disorder-Adult[6] Severity of panic disorder Panic disorder severity scale[7] 7 items on 5-point scale (0-4) to assess severity of pan…”
MethodTranstornos de ansiedade e exercício físico
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“from an HRV-BF intervention on the severity of panic-related symptoms comparedwith psychotherapy (60,61) or pharmacotherapy (62).”
BackgroundPharmacological treatments in panic disorder in adults: a network meta-analysis
Guaiana, G., Meader, N., Barbui, C., Davies, S., Furukawa, T. A., Imai, H., Dias, S., Caldwell, D. M., Koesters, M., Tajika, A., et al. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012729.pub3 · Cited by 32 · see citing works
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“[18] submitted the patients to three treatment conditions: clomipramine, placebo and aerobic exercise (walking or running).”
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Bandelow, B., Baldwin, D. S., & Zwanzger, P. (2013) · Modern trends in psychiatry · doi:10.1159/000351953 · Cited by 27 · see citing works
Self-citationChanges in quality of life following cognitive-behavioral group therapy for panic disorder
Rufer, M., Albrecht, R., Schmidt, O., Zaum, J., Schnyder, U., Hand, I., & Mueller‐Pfeiffer, C. (2009) · European Psychiatry · doi:10.1016/j.eurpsy.2009.05.003 · Cited by 24 · see citing works
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“The primary outcome will be the severity of panic and agoraphobia symptoms as assessed by the total PAS score [34,35,48].”
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“Previous studies have demonstrated its reliability and validity and that the PAS is appropriate for use in a variety of clinical and research environments [48–50].”
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“The Panic and Agoraphobia Scale (PAS),[28] which assesses the severity of the worst experienced period of panic symptoms, was used for quantitative trait association analysis in a patient sample consisting of 478 individuals.”
MethodPanic disorder patients have reduced cyclic AMP in platelets
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“As expected, our results support the effectiveness of clomipramine for treatment of panic disorder (Gentil et al., 1993; Caillard et al., 1999; Marcourakis et al., 1999; Bandelow et al., 2000).”
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- Authors
- Bandelow, B., Broocks, A., Pekrun, G., George, A., Meyer, T., Pralle, L., Bartmann, U., Hillmer-Vogel, U., & Rüther, E.
- Affiliations
- University of Göttingen (DE)
- Saarland University (DE)
- Pennsylvania State University (US)
- Venue
- Pharmacopsychiatry
- Publisher
- Georg Thieme Verlag KG
- Published
- 2000-09
- Volume
- 33
- Issue
- 5
- Pages
- 174-181
- ISSN
- 0176-3679 (ISSN-L)
- 1439-0795
- OpenAlex
- W1987094059
- Cited by
- 53
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 4 · 2016: 3 · 2015: 2 · 2014: 5 · 2013: 3
- FWCI
- 3.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pharmacopsychiatry (publishedVersion)
- PubMed (publishedVersion)
- GRO (submittedVersion)
- Funders
- Volkswagen Foundation
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- panic disorder, agoraphobia, clomipramine, aerobic exercise, running, anticipatory anxiety, treatment efficacy comparison
- MeSH terms
- Agoraphobia, Antidepressive Agents, Tricyclic, Clomipramine, Combined Modality Therapy, Double-Blind Method, Exercise Therapy, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Running, Panic Disorder
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