Cognitive-Behavioral Therapy, Imipramine, or Their Combination for Panic Disorder

Abstract

Panic disorder (PD) is a chronic condition associated with substantial reduction in quality of life, and lifetime prevalence rates are approximately 3%. Cognitive-behavioral therapy (CBT) for PD, developed at the Boston site, combines interoceptive exposure, cognitive restructuring, and breathing retraining. The combined treatment conditions were administered according to a manual essentially consisting of the CBT and the imipramine manuals. Both the imipramine and placebo arms included a medical management component, specified in the manual. Acute coadministration of imipramine and CBT resulted in limited benefit over monotherapy. Therapists providing CBT were doctoral-level clinicians who underwent extensive training and certification supervised by the Boston site prior to treating study patients. All CBT therapists and pharmaco-therapists received ongoing supervision of their cases from the responsible site during biweekly telephone calls, and adherence and competence ratings were routinely collected after listening to a sample of audiotaped sessions.

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