The Effects of Cognitive Behavioral Therapy for Discontinuation of Medication in Panic Disorder / 대한정신약물학회지

OBJECTIVE: The purpose of this study is to determine whether CBT is effective in tapering or discontinuing medication regardless of the type of medication and its maintenance effects after long-term follow up. METHOD: 224 patients meet DSM-IV criteria for panic disorder with or without agoraphobia completed 12 weekly sessions of Panic Control Therapy (PCT;Barlow et al.). 80 patients who were using benzodiazepines alone and 144 patients who were using benzodiazepines and Antidepressants were measured with several screening scales at the pre- and post-treatment. The scales were Beck Depression Inventory (BDI), Spielberg State Anxiety Inventory (STAI-State), Spielberg Trait Anxiety Inventory (STAI-Trait), Body Sensation Questionnaire (BSQ), Agoraphobic Cognition Questionnaire (ACQ), Anxiety Sensitivity Index (ASI), Panic Belief Questionnaire (PBQ). These patients were assessed at 3 months, 6 months, 12 months of follow up and they were also assessed for their medications, panic frequency, and End-State Functioning. RESULTS: After the completion of PCP, both benzodiazepines alone group and benzodiazepines and antidepressants combination group showed significant improvement (p<0.001) in all the results of 7-self reported questionnaires. 54% of patients discontinued their medication and 90.9% of patients were in HES at post-treatment. 70 % of patients were in HES at 3 month, 6 month, and 12 month follow up. The patients who could not discontinue medication also tapered their medication afterwards. The rate of discontinuing medication was significantly higher for the patients using benzodiazepines alone (86.3%) than patients using combination of benzodiazepines and antidepressants (56.3%). CONCLUSION: These findings support cognitive behavioral therapy can replace medication and these effects seem to last long.

Predicting Factors of Discontinuation of medication after Cognitive Behavioral Therapy for Panic Disorder

OBJECTIVE: The authors experienced that cognitive begavioral therapy(CBT) could replace medication for controlling panic attacks and anticipatory anxiety symptoms. The objective of this study was finding out predicting factors of discontinuation of medication after CBT for patients with panic disorder. METHOD: A hundred forty-eight patients who met DSM-IV criteria for panic disorder with or without agoraphobia for at least 3 months had completed 12 weekly sessions of Panic Control Therapy(CT ; Barlow et al). Eighty-one patients who could discontinue medication and sixty-seven patients who could not discontinue medication were measured with several scales as the pre- and post-treatment assessment. The scales were Beck Depression Inventory(BDI), Clinical Global Impression(CGI), Spiellberger State Anxiety Inventory(STAI-state), Anxiety Sensitivity Index(ASI), Body Sensation Questionnaire(BSQ), Panic Belief Questionnaire(PBQ), Agoraphobic Cognition Questionnaire(ACQ), Fear Questionnaire(FG), Toronto Alexithymia Scale(TAS). RESULTS: At the pre-treatment assessment, the scores of BDI, CGI, STAI-state, ACQ, BSQ were higher in the patients who could discontinue medication than in the patients who could not discontinue medication(t=-2.68, t=-4.88, t=-3.07, t=-3.68, t=-3.35, p<0.01). CONCLUSION: Patients with panic disorder who were less depressed, less anxious, less agoraphobic and who had less negative cognitions for the bodily sensation and who had higher scores in the therapist's assessment could discontinue their medications.