ABSTRACT
Background: Panic disorder is the most prevalent among anxiety disorders in psychiatry clinics. Randomized controlled trials and open studies in research settings and studies from naturalistic settings have proved the efficacy and effectiveness of cognitive behavior therapy (CBT) for panic disorder (PD). Panic disorder responds in only a few CBT sessions. In India studies in this regard are practically non-existent. Materials and methods: This study was a part of study titled “The utilization pattern and effectiveness of Cognitive Behavior Therapy for anxiety disorders in adults: A naturalistic study from a medical college hospital”. Out of 80 anxiety disorder patients taken for study, 26 PD patients attended at least one CBT session. In these 26 patients‟ pre and post CBT scores on Panic Disorder Severity Scale (PDSS) were assessed and analyzed for clinically significant change (CSC) and response rate. Effect size, refusal and dropout rates were assessed. Results: Pre and post PDSS score reduction was statistically significant at P<0.5. Large effect size of 1.78 was noted. Though 30% of patients were on medication, they were stably on same medication throughout the evaluation. CSC, as defined by twin criteria proposed by Jacobson and Truax, was noted in 57% of patients. In the intent to treat analysis number needed to treat to achieve CSC/recovery was about four. Response (defined as 40% reduction in PDSS rating) rate was 88%. There was about 50% CBT refusal rate. Conclusions: This open prospective naturalistic study shows that CBT of panic disorder can be effective, when it is conducted by a psychiatrist who has not received rigorous training from certified Sylvester Satish Romero, Sudhir Hebbar. Effectiveness of Cognitive behavior therapy of panic disorder in adults: A naturalistic study from a Medical College Hospital. IAIM, 2018; 5(10): 44-49. Page 45 training centers. Effect size is comparable to that observed in other settings. CBT can be integrated along with medications for PD in general hospital psychiatry setting. Response and recovery can be obtained in as few as 5 sessions. More than half of treatment seeking panic disorder patients refused to take cognitive behavior therapy reducing its effectiveness.
ABSTRACT
Background: Cognitive Behavior Therapy (CBT) for anxiety disorders is proved to be equally efficacious to medications in research settings. Is CBT effective in naturalistic settings? Studies in naturalistic setting are recently surfacing world over. Indian studies in this area are almost nonexistent. Material and methods: Eighty adult patients satisfying criteria for an anxiety disorders as per Diagnostic and Statistical Manual of Mental disorders, 5th edition (DSM-5) were evaluated using appropriate rating scale and treated with medication only, CBT only or a combination. Sociodemographic variables between CBT (n=33) and no CBT (n=47) were compared. Various utilization parameters were evaluated. Results analyzed using statistical tests. Results: Education, economic status, closeness to hospital, younger age and male gender was associated with taking up psychotherapy. Panic disorder was 4 times prevalent than all other anxiety disorders. There was 59% primary dropout/refusal, 37% premature termination of CBT. Both refusal of 59% and premature termination of 14% of total sample add up to 73%. This indicated intent to treat number was 4. In this panic disorder dominant sample mean number of CBT sessions were 3.2 Conclusion: Treatment refusal and dropout from CBT is a significant problem among patients with anxiety in the general hospital psychiatry setup. At its darkest light, in this study intent to treat number is roughly 4. Still the silver line is that there are patients who utilize CBT and improve in this setup.