Cognitive-behavioral therapy helps prevent relapse and recurrence of panic disorder following Alprazolam discontinuation: A long-term follow-up of the Peoria and Dartmouth studies

Department of Psychiatry and Behavioral Medicine, University of Illinois College of Medicine at Peoria 61614, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 03/1999; 67(1):151-6. DOI: 10.1037/0022-006X.67.1.151
Source: PubMed


The present research evaluated patients from 2 previous studies (1 conducted in Peoria, the other at Dartmouth) during a 2- to 5-year posttreatment period. Results showed that 75% of the Peoria sample and 76% of the Dartmouth sample were able to discontinue alprazolam therapy, remain abstinent of any type of treatment for panic disorder, and maintain their acute-treatment clinical gains over this follow-up period. The degree to which patients' anxiety sensitivity declined during treatment predicted relapse versus survival during the 1st 6 months of follow-up, when most relapses occurred. Implications of these findings for benzodiazepine discontinuation, combined pharmacotherapy and psychotherapy, and relapse prevention in panic disorder are discussed.

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Available from: Timothy J Bruce, Aug 25, 2014
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    • "Clearly if a patient refuses to engage in the exposures without medication, clinicians may choose to utilize concurrent medication and then taper the medication during treatment. Studies have found beneficial effects of discontinuing benzodiazepines during cognitive-behavioral treatment (CBT) for individuals with PDA (Bruce et al. 1999; Otto et al. 1993; Spiegel et al. 1994 "
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    ABSTRACT: State dependent learning (SDL) occurs when learning acquired in one context is not retrievable in a different context. Although traditionally SDL is thought of in the context of substance use, the role of SDL should be considered during combined medication and exposure treatment for anxiety disorders. Data are presented from a within-subjects, case-series design of four participants with social anxiety disorder. Participants engaged in a series of situational exposures while taking either alprazolam (0.75mg), propranolol (40mg), placebo or no medication. They returned 48h later and engaged in the same situational exposure in an unmedicated state to determine retention of learning following the shift in drug context. Results suggest that SDL effects are possible when combining pharmacotherapy (alprazolam) with exposure therapy. Future research is needed determine the conditions under which SDL is most likely to occur and ways to facilitate transfer of learning across different contexts.
    Journal of Psychopathology and Behavioral Assessment 09/2008; 30(3):211-219. DOI:10.1007/s10862-007-9061-1 · 1.55 Impact Factor
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    • "Por otra parte, también se han planteado líneas de acción interesantes que merecen seguir siendo investigadas. Se ha sometido a prueba la posible ayuda de los tratamientos cognitivos comportamentales (una variación de TCP) para ayudar en el proceso de abandono de las benzodiacepinas con buenos resultados (Bruce, Spiegel y Hegel, 1999; Otto et al., 1993; Spiegel, Bruce, Gregg y Nuzzarello, 1994). En opinión de Barlow et al. (1998), estos datos sugieren la posibilidad de dar alprazolam inicialmente a aquellos pacientes que necesitan alivio inmediato o desean medicación y, posteriormente, dar tratamiento cognitivo comportamental para el pánico. "
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    ABSTRACT: Se lleva a cabo una revisión de los tratamientos psicológicos empíricamente validados para el Trastorno de Pánico, para ello se atiende a los criterios establecidos por la American Psychological Association (Task Force on Promotion and Dissemination of Psychological Procedures, 1995), teniendo en cuenta las revisiones y las recomendaciones posteriores (Chambles et al., 1996; 1998; Chambles, y Hollon, 1998; Natahn y Gorman, 1998) respecto a las exigencias metodológicas que tienen que tener los trabajos de investigación. Además, se presta atención tanto a los resultados obtenidos respecto al Eje I (eficacia o validez interna) como al Eje II (efectividad, validez externa o utilidad clínica) de la Guía (Template for Developing Guidelines: Interventions for Mental Disorders and Psychosocial Aspects of Physical Disorders) elaborada por este mismo organismo para desarrollar las directrices prácticas que puedan guiar las intervenciones. Por tanto, se analiza la evidencia empírica disponible sobre este tema con la meta de estudiar la eficacia de cualquier intervención dada y analizar la aplicabilidad y posibilidad de la intervención en el contexto concreto en el que tenga que ofrecerse
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    ABSTRACT: Efficacious psychological treatments for agoraphobia. In vivo exposure and cognitive-behavioral the - rapy have demonstrated their efficacy f or ag oraphobic anxiety and avoidance; however, the ef fects of cognitive-behavioral ther apy might be smaller if time g iven to in vivo exposure is r educed. Cogniti- ve-behavioral ther ap y is also a probably ef ficacious treatment f or other aspects of agoraphobia (fre- quency of panic, worry about panic, interference) and associated problems (general anxiety, depressed mood). Furthermore, cognitive-behavior al therapy is effective and efficient, and , in comparison with in vivo exposure, is associa ted with fewer dropouts of tr eatment and fewer r elapses in panic attacks. No- netheless, their shor t-term and mid-term effects in fr equency of panic attacks, worry a bout panic, in- terf erence, gener al anxiety and depressed mood have not been established in a consistent way in com- parison with placebo or other treatments; moreover, measures as fear of fear or anxiety sensiti vity ha- ve not been consider ed in that r espect. Finally, results about predictors of treatment outcome have be- en gener ally inconsistent.
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