Lasting Effect of Therapy for Panic with Agoraphobia

Cognitive behavioral therapy benefits lasted two years after treatment for panic with agoraphobia

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Panic attacks with agoraphobia can have a major impact on daily activities, and while cognitive behavioral therapy (CBT) is an effective treatment, it's not known how long the benefit might last.

Agoraphobia is an intense fear of a place or situation where a person feels that escape might be difficult.

This study looked to see whether the effects of CBT lasted up to two years. They also tried to find any factors that would help predict which patients might benefit from CBT.

The researchers found that most people who benefited from CBT treatment of panic with agoraphobia still felt the therapy was helping them cope with their panic and fear after two years. However, the study team was not able to find anything that would predict which patients might be successfully treated with CBT.

"Work with a therapist to overcome your fears."

This research was conducted by Dr. Andrew T. Gloster, of Technische Universitat Dresden in Germany and University of Basel's Department of Psychology in Switzerland.

The National Institute of Mental Health defines agoraphobia as, "Agoraphobia involves intense fear and anxiety of any place or situation where escape might be difficult, leading to avoidance of situations such as being alone outside of the home; traveling in a car, bus, or airplane; or being in a crowded area." It can be a debilitating condition that keeps the person from participating in many aspects of life. Panic attacks make the agoraphobia worse.

Cognitive behavioral therapy is designed to help patients more fully recognize situations that cause certain reactions and to teach them to respond in a way that is better for them. CBT has been shown to be a very effective treatment for people who have panic disorders with agoraphobia.

Since CBT has been effective for panic disorders with agoraphobia, Dr. Gloster and his team felt that it would be important to learn how many people continue to find relief using CBT, how many get worse, the effect of time on these factors, and whether they could identify which people would need more time to see an effect from CBT.

All patients in this study had completed another study where CBT was used for their panic disorder with agoraphobia.

A total of 198 people were contacted to take part in this study described here and 146 people accepted to participate. This study looked at how well people were doing six and 24 months after treatment. This comparison was made to see if the effects of therapy would last or would change.

CBT was given to the study participants in 12 sessions that were given over six weeks. The therapy involved behavior analysis, education about behavior, analysis of the person’s problems, and exposing the person to their fearful situation (such as being in a mall or elevator). The exposure was either done with a therapist present or without a therapist present. The therapy also included giving the person skills to deal with the situation and teaching them how to prevent feeling the panic and agoraphobia in other situations.

There were many measures of the effect of this treatment. These measures were done with standard psychological testing and surveys. These tests and surveys included the Structured Interview Guide for the Hamilton Anxiety Scale (SIGH-A), which is an interview that assesses anxiety; the Clinical Global Impressions Scale (CGI), which measures how severe a disorder is; Mobility inventory (MI), which measures how much certain situations are avoided on a scale of 1 to 5; and the Panic Agoraphobia Scale (PAS), which is a questionnaire measuring how severe the anxiety and situation avoidance are.

The Acceptance and Action Questionnaire II, the Anxiety Sensitivity Index, and the Beck Depression Inventory were used to help predict the results of the CBT treatment.

Patients showed significant improvement at 24 months compared to before they were treated.

If the results of all the measurements were used, the percentage of people reporting good results at six months who still reported good results from CBT after 24 months ranged from 69.4 percent to 96.4 percent.

The percentage of people who did not benefit from CBT at six months and still had no benefit after 24 months varied from 12.5 percent on the CGI to 73.3 percent on the MI questionnaire.

The researchers saw a difference in the MI test at 24 months when they compared whether a therapist was present or was not during the fear exposure.  In this case, there was a better effect when a therapist was present for the fear exposure. This effect was interpreted as a small to medium effect.

The researchers concluded that cognitive behavioral therapy — including exposure to fearful situations done with or without a therapist — effectively relieved patients’ symptoms and that effect was still maintained after 24 months.

"Cognitive Behavioral Therapy (CBT) can be an incredibly effective treatment for many forms of anxiety disorders, including agoraphobia," Julie Gladnick, MA, LMFT, Licensed Marriage and Family Therapist in private practice in Denver, Colorado, told dailyRx News.

"It's important, however, for clients to feel capable of putting many of the CBT interventions to work; often, anxiety is so high that it is difficult for people to employ the very tools that can help them cope. Immediate skills to help with managing the acute symptoms of anxiety (rapid heart rate, shortness of breath, etc.) can be very beneficial to help clients feel regulated enough to effectively use the CBT skills they have learned. Some of these immediate skills include mindfulness (deep breathing, counting, etc.), listening to relaxing music, and getting up and moving," Gladnick said.

In this study, none of the tests used to predict the result of CBT treatment yielded any signs that could be used to predict whether cognitive behavioral therapy would work for a particular person.

This study was published in the December issue of Behaviour Research and Therapy.

Funding for this research was provided as part of the Mechanisms of Action in CBT (MAC) study, which was funded by the German Federal Ministry of Education and Research, part of the BMBF Psychotherapy Research Funding Initiative. The authors did not disclose any conflicts of interest.

Review Date: 
December 6, 2013
Last Updated:
December 30, 2013