Cognitive-behavior therapy for discontinuation of SSRI treatment of panic disorder: a case series.

In this report we describe the outcome of eight outpatients with panic disorder and agoraphobia who discontinued their treatment with a selective serotonin reuptake inhibitor (SSRI) in the context of a structured, group program of cognitive-behavior therapy. All patients successfully discontinued their SSRI medication while demonstrating clinical improvement. These results were maintained at 3-month follow-up. This case series suggests that manualized CBT for discontinuation of benzodiazepine treatment for panic disorder may be successfully applied to SSRI discontinuation as well.

Cognitive versus behavior therapy in the group treatment of obsessive-compulsive disorder.

This study examined the effects of cognitive-behavior therapy (CBT) compared with traditional behavior therapy (exposure and response prevention [ERP]) in the group treatment of obsessive-compulsive disorder. Of the 76 participants who started treatment, 38 were wait-listed for 3 months before treatment to assess possible course effects. Both treatments were superior to the control condition in symptom reduction, with ERP being marginally more effective than CBT by end of treatment and again at 3-month follow-up. In terms of clinically significant improvement, treatment groups were equivalent on the conclusion of treatment, but 3 months later significantly more ERP participants met criteria for recovered status. Only 1 of 7 belief measures changed with treatment improvement, and the extent of this cognitive change was similar between CBT and ERP groups. Discussion includes consideration of optimal formats for the delivery of different types of treatment.

Anxiety sensitivity and response to hyperventilation challenge: physiologic arousal, interoceptive acuity, and subjective distress.

Twenty-four female undergraduates, 12 high on anxiety sensitivity and 12 low on anxiety sensitivity, were subjected to a hyperventilation challenge task. Physiologic and subjective measures of arousal and distress were obtained before, during, and after the hyperventilation challenge. Alternating between the eight 15-second intervals of hyperventilation, participants engaged in a heartbeat-tracking task for eight 10-second intervals to assess interoceptive acuity. Although the hyperventilation challenge produced phase main effects for physiologic arousal, and group and time main effects for subjective distress, there were no significant interaction effects. Results revealed no significant interoceptive acuity differences across the low and high anxiety sensitivity groups. However, subjective ratings of physiological sensations during hyperventilation were significantly greater for the high anxiety sensitivity group. Hierarchical multiple regression analyses revealed that anxiety sensitivity accounted for additional variance beyond trait anxiety in explaining subjective ratings of arousal and distress in this nonclinical sample in response to a hyperventilation challenge.

The impact of panic expectancy and social demand on agoraphobic avoidance.

The relationship between panic expectancy, social demand and agoraphobic avoidance was investigated in a group of 48 panic disorder subjects. Subjects were observed surreptitiously while completing a naturalistic behavioral avoidance task (BAT) involving either a high or low social challenge task. Subjects in the high social challenge task avoided more compared to subjects in the low social challenge task. Prediction of panic made before entering the situation and type of social challenge condition (high/low) were the only variables that accounted for significant amounts of unique variance in prediction of BAT score. The results confirm previous findings regarding the relationship between panic expectancy and avoidance and suggest that social interaction and scrutiny is a factor in avoidance.

Cognitive-behavior therapy and the longitudinal course of panic disorder.

This article examines the nature and course of panic disorder as understood from a cognitive-behavioral perspective. A model of the causes and maintenance of panic disorder is presented, and is followed by a discussion of the elements and efficacy of cognitive-behavioral treatment. Treatment effects and factors associated with relapse are considered within the context of evidence for a differential course of panic disorder for patients treated with cognitive-behavioral therapy relative to those treated with pharmacotherapy. Issues of combined treatment, maintenance of treatment gains, and preventive interventions are discussed.

Physiological, subjective and behavioral responses to hyperventilation in clinical and infrequent panic.

This study investigated the physiological, subjective and behavioral responses to hyperventilation of four groups of Ss with: (1) clinical panic disorder (n = 13); (2) infrequent panic (n = 16); (3) no panic and high trait anxiety (n = 16); and (4) no panic and low trait anxiety. After completing a number of anxiety-related questionnaires, Ss participated in 2 min of hyperventilation during which heart rate and electrodermal activity were recorded continuously. Subjective sensations and cognitions during hyperventilation were assessed immediately following the task. After recovery, Ss could participate in a second, optional hyperventilation from which they could escape at any time. Analyses revealed no group differences in physiological responses to the hyperventilation, although group differences in subjective sensations and cognitions were found. Data are discussed with regards to the role of physiological processes vs subjective responses to anxiety-provoking stimuli in the psychopathology of clinical panic disorder.

Infrequent panic: physiological and subjective reactions to hyperventilation.

Forty-eight females were evaluated to detect differences in panic-related symptomatology and physiological responses to 2 min of hyperventilation. Ss were divided into 3 groups: infrequent panickers; no panic/high trait anxiety; and no panic/low trait anxiety. The low trait anxiety group scored significantly lower on various self-report measures of anxiety-related symptomatology compared to Ss with infrequent panic and high trait anxiety. Hyperventilation produced no significant group differences in physiological reactivity or recovery. However, Ss with low trait anxiety reported significantly less severe sensations and a significantly lower incidence of panic during hyperventilation than the infrequent panickers and the high trait anxiety group. Ss who panicked during hyperventilation reported more intense sensations and negative cognitions than those who did not panic. Thus, Ss were distinguished by their subjective, but not their physiological responses.

The effect of an aversive event on the return of fear.

An experiment on the return-of-fear (ROF) was carried out on 40 snake- or spider-phobic subjects in order to determine whether an arousing event that occurs shortly before retest influences the magnitude of the ROF. Additionally, we attempted to produce a reinstatement of fear by introducing an unrelated aversive event (shock) after the fear had been reduced. The arousal manipulation successfully increased subjective arousal but not heartrate responsiveness. The increases in subjective arousal were not followed by increases in ROF, and the attempt to produce a reinstatement of fear did not succeed. A significant correlation between speed of fear-reduction and ROF was obtained.

Fast, slow and sudden reductions in fear.

An experiment was carried out on 30 spider-fearful and 30 snake-fearful subjects in an attempt to replicate the finding of a correlation between the rapid reduction of fear and the reduced likelihood of significant fear returning after an interval (low return of fear). It was also hoped to observe and closely examine the occurrence of sudden and enduring reductions in fear. The results from the two groups of fearful subjects were reassuringly similar. The fears of both groups were significantly reduced in a relatively brief session, and small but significant returns of fear were observed after a 2 week interval, with the slow responders reporting a higher return of fear than fast responders. The time taken to reduce the fear correlated 0.36 with the return of fear. A minority of subjects did experience a subjectively important, abrupt change in their fears, these 'glass-jar' experiences were associated with faster (overall) reductions in fear, a lower return of fear, and subjective estimates of permanent and generalized reductions of the fear.