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

ABSTRACT 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.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The long-term use of Benzodiazepines (BZs) is currently a source of growing concern, owing to increasing doubts about their efficacy, and evidence of important adverse effects, including physical dependence and neuropsychologi- cal impairment. The long-term use of BZs in patients with anxiety and mood disorders calls for special concern; in these patients, in fact, interepisodic chronicity and residual symptoms often appear to be related to inappropriate long-term use of BZs. The problem of dependence on benzodiazepines has been aggravated by iatrogenic physiological dependence on these medications and by polysubstance-abusing patients using them in addition to other agents, in particu- lar opioids or cocaine. A safe, rapid, and effective way to detoxify patients from benzodiazepines is of prime importance in facilitating further treatment of their psychiatric or substance use disorder. Correct withdrawal strategies should combine gradual dosage reduction, psychological support and adjuvant medica- tions in selected patients. The tapering schedule should be individually titrated and adjusted according to the patient's reactions; substitution with a long-acting BZ is often useful. Psychological support should include information about BZ withdrawal, general encouragement and the correction of misconceptions about discontinuing medicines; it should be available both during tapering and after withdrawal. Some antiepileptics and sedative antidepressants may be useful to mitigate withdrawal phenomena. Adequate dosages of antidepressants should be used to treat the re-emergence of an underlying mood or anxiety disorder. Success rates of withdrawal are high (54-92%); the follow-up studies, however, indicate that long-term discontinuation of BZ is a slow process, taking many weeks or months - in some cases years - with a protracted clinical course after drug cessation.
  • [Show abstract] [Hide abstract]
    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.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated.
    BMC Psychiatry 07/2014; 14(Suppl 1):S1. DOI:10.1186/1471-244X-14-S1-S1 · 2.24 Impact Factor

Full-text (2 Sources)

Available from
Aug 25, 2014