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A Meta-Analysis of the Treatment of Panic Disorder with or without Agoraphobia: A Comparison of Psychopharmacological, Cognitive-Behavioral, and Combination Treatments
Abstract
To compare short-term efficacy of benzodiazepines, antidepressants, psychological panic management, exposure in vivo, and combination treatments in panic disorder with or without agoraphobia (PA), a meta-analysis was conducted. Included were 106 studies, pertaining to 222 treatment conditions, 5,011 patients at pretest and 4,016 at posttest. Pre/post effect sizes Cohen's d were calculated within the treatment conditions for four clinical variables: panic, agoraphobia, depression, and general anxiety. Seven large treatment conditions were used in the main analyses: high-potency benzodiazepines, antidepressants, psychological panic management, exposure in vivo, pill-placebo combined with exposure, antidepressants combined with exposure, and psychological panic management combined with exposure in vivo. First, these treatments were compared with a control condition, consisting of pill-placebo, attention placebo, and waiting list. Next, a comparison was made between the treatments. Antidepressants, psychological panic management, high-potency benzodiazepines, and antidepressants combined with exposure in vivo were superior to the control condition for panic attacks. Exposure in vivo alone was not effective for panic attacks. With regard to agoraphobic avoidance, all seven treatments were superior to the control condition. When comparing the various treatment conditions, no differences concerning panic attacks were found. For agoraphobic avoidance, the combination of antidepressants with exposure in vivo was superior to the other conditions. The combination of antidepressants with exposure in vivo is the most potent short-term treatment of PA.
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“All outcome measures have good psychometric properties.”
From Early intervention in panic: Pragmatic randomised controlled trial (2010) · cites this paper as [25]
In the citing paper
“Meta-analyses have demonstrated the efficacy of psychological treatments in group and individual formats in patients with panic disorder [54-56], specific phobia [57], SAD [58,59], OCD [60-63], GAD [55,64,65], or PTSD [66-69]”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [54]
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Knowledge Transfer and Improvement of Primary and Ambulatory Care for Patients with Anxiety
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“Anxiety responds to pharmacological and cognitive-behavioural treatments, both alone and in combination.(2) In most countries, evidence-based guidelines for the management of anxiety are available for general practice and specialist mental health care.”
BackgroundHow to grade categories of evidence
Bandelow, B., Zohar, J., Kasper, S. F., & Möller, H. (2008) · The World Journal of Biological Psychiatry · doi:10.1080/15622970802456590 · Cited by 26
Tolin, D. F. (2017) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2017.08.007 · Cited by 25
The Utilization of Antidepressants and Benzodiazepines among People with Major Depression in Canada
Sanyal, C., Asbridge, M., Kisely, S. R., SKETRIS, I. S., & Andreou, P. (2011) · The Canadian Journal of Psychiatry · doi:10.1177/070674371105601105 · Cited by 25
Lonsdorf, T. B., Haaker, J., Fadai, T., & Kalisch, R. (2013) · Psychopharmacology · doi:10.1007/s00213-013-3338-8 · Cited by 27
The role of psychosocial factors in gastrointestinal disorders: Table 1
Wilhelmsen, I. (2000) · Gut · doi:10.1136/gut.47.suppl_4.iv73 · Cited by 24
Outcome of cognitive‐behavioural therapy in training practice with anxiety disorder patients
Bados, A., Fort, G. B., & Saldaña, C. (2007) · British Journal of Clinical Psychology · doi:10.1348/014466507x209961 · Cited by 23
Early intervention in panic: randomized controlled trial and cost-effectiveness analysis
Meulenbeek, P. A. M., Willemse, G., Smit, F., van Balkom, A. V., Spinhoven, P., & Cuijpers, P. (2008) · Trials · doi:10.1186/1745-6215-9-67 · Cited by 24
“The course is based on cognitive-behavioural principles and makes use of interventions that have appeared effective in the treatment of the full-blown disorder [27-29].”
Self-citationCognitive neuropsychiatry: Conceptual, methodological and philosophical perspectives
Hohwy, J., & Rosenberg, R. (2005) · The World Journal of Biological Psychiatry · doi:10.1080/15622970510029867 · Cited by 18
Anxiety Disorders: Treatable regardless of the Severity of Comorbid Alcohol Dependence
Schadé, A., Marquenie, L. A., van Balkom, A. J. L. M., Koeter, M. W. J., de Beurs, E., van Dyck, R., & van den Brink, W. (2007) · European Addiction Research · doi:10.1159/000097941 · Cited by 18
Generalized Anxiety Disorders, Panic Disorders, and Phobias
Rapee, R. M., & Barlow, D. H. (2005) · Kluwer Academic Publishers eBooks · doi:10.1007/0-306-47377-1_6 · Cited by 19
Meulenbeek, P. A. M., Willemse, G., Smit, F., Smits, N., van Balkom, A. V., Spinhoven, P., & Cuijpers, P. (2009) · BMC Research Notes · doi:10.1186/1756-0500-2-4 · Cited by 24
“The course is based on cognitive-behavioural principles and makes use of interventions that have appeared effective in the treatment of PD before [12,13].”
BackgroundSelf-citationHam, P. S., Waters, D. B., & Oliver, M. N. (2009) · doi:10.1093/oso/9780199574698.003.0006 · Cited by 17
Hendriks, G., Janssen, N., Robertson, L., van Balkom, A. J. L. M., van Zelst, W. H., Wolfe, S., Voshaar, R. C. O., & Uphoff, E. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007674.pub3 · Cited by 22
Zwanzger, P., Diemer, J., & Jabs, B. E. (2008) · Journal of Neural Transmission · doi:10.1007/s00702-008-0116-6 · Cited by 16
Nonpharmacological treatments for anxiety disorders
Cottraux, J. A. (2002) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2002.4.3/jcottraux · Cited by 16
The psychological development of panic disorder: implications for neurobiology and treatment
Cosci, F. (2012) · Brazilian Journal of Psychiatry · doi:10.1590/s1516-44462012000500003 · Cited by 15
Psychotherapy Plus Antidepressant for Panic Disorder With or Without Agoraphobia: Systematic Review
Furukawa, T. A., Watanabe, N., & Churchill, R. C. (2008) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/foc.6.4.foc528 · Cited by 15
Relevance of Assessment of Cognitions during Panic Attacks in the Treatment of Panic Disorder
Bakker, A., Spinhoven, P., van Balkom, A. J. L. M., & van Dyck, R. (2002) · Psychotherapy and Psychosomatics · doi:10.1159/000056283 · Cited by 15
Self-citationTelch, M. J., Cobb, A. R., & Lancaster, C. L. (2014) · Wiley eBooks · doi:10.1002/9781118775349.ch35 · Cited by 14
The potential role of atypical antipsychotics in the treatment of panic disorder
Wang, H. R., Woo, Y. S., & Bahk, W. (2014) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.2419 · Cited by 13
“However, for relapse prevention, cognitive behavioral therapy seems to have superior efficacy compared with tricyclic antidepressants (van Balkom et al., 1997).”
Background
Metadata
- Authors
- VAN BALKOM, A. J. L. M., BAKKER, A., SPINHOVEN, P., BLAAUW, B. M. J. W., SMEENK, S., & RUESINK, B.
- Affiliations
- Vrije Universiteit Amsterdam (NL)
- Leiden University (NL)
- ORCID
- SPINHOVEN, PHILIP
- Venue
- The Journal of Nervous & Mental Disease
- Published
- 1997-08
- Volume
- 185
- Issue
- 8
- Pages
- 510-516
- ISSN
- 0022-3018 (ISSN-L)
- OpenAlex
- W2064623716
- Cited by
- 211
- References
- 9
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2021: 6 · 2020: 2 · 2019: 3 · 2018: 2 · 2017: 7 · 2016: 5 · 2015: 8 · 2014: 10 · 2013: 5 · 2012: 8
- FWCI
- 2.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- benzodiazepines, antidepressants, in vivo exposure, cognitive behavioral therapy, combination therapy, agoraphobic avoidance, panic attacks, depression, general anxiety, short-term treatment efficacy
- MeSH terms
- Adult, Agoraphobia, Antidepressive Agents, Benzodiazepines, Combined Modality Therapy, Female, Humans, Male, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome
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