Overcoming resistance to exposure in panic disorder with agoraphobia
Abstract
The issue of panic disorder resistant to treatment (whether pharmacological or psychological) has attracted little research attention, despite its clinical frequency and importance. The aim of this study was to compare three treatment modalities, namely exposure alone (E), exposure associated with imipramine (EI) and cognitive therapy supplementing exposure (EC), in a sample of 21 patients with DSM-IV panic disorder and agoraphobia, who failed to respond to a first standard course of individual behavioural treatment based on exposure in vivo. Treatments were administered according to a cross-over, controlled design (E-EI-EC, EI-EC-E, EC-E-EI). Twelve of the 21 patients achieved remission (panic-free status) during the trial. In 8 cases this occurred after exposure alone (E) and in two cases each after the other treatments (EI and EC). The results revealed a significant effect of the factor time on a number of variables, and the superiority of exposure alone compared to other treatment modalities with regard to some variables. These findings suggest that long-term behavioural treatment based on exposure may be necessary in some patients, and may induce clinical remission. However, patients who do not respond to exposure show poor tolerance of and compliance with pharmacological treatment, and are unlikely to achieve remission with imipramine or cognitive therapy, even though this may occur in individual cases.
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Evidence exists that continued exposure can help in some cases of treatment nonresponse.
“Evidence exists that continued exposure can help in some cases [7] .”
From Treating Treatment-Resistant Patients with Panic Disorder and Agoraphobia Using Psychotherapy: A Randomized Controlled Switching Trial. (2015) · cites this paper as [7]
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- Authors
- Fava, G. A., Savron, G., Zielezny, M., Grandi, S., Rafanelli, C., & Conti, S.
- Affiliations
- University at Buffalo, State University of New York (US)
- University of Bologna (IT)
- Corresponding author
- Fava, G. A.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 1997-04
- Volume
- 95
- Issue
- 4
- Pages
- 306-312
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W2021661943
- Semantic Scholar
- 5a011d18dd1cceb202d5570c321b3728e0f97c3c
- Cited by
- 59
- References
- 26
- Citations by year
- 2025: 1 · 2023: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 3 · 2016: 2 · 2015: 3 · 2014: 3 · 2012: 4
- FWCI
- 9.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- 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 Assessments
- Keywords
- panic disorder with agoraphobia, treatment-resistant anxiety, exposure therapy, in vivo exposure, imipramine, cognitive therapy, treatment remission, medication adherence
- MeSH terms
- Adult, Combined Modality Therapy, Defense Mechanisms, Desensitization, Psychologic, Female, Humans, Imipramine, Male, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome
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