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Agoraphobia Treatment May Not Necessary In Patients Treated For Panic Disorder

In patients diagnosed with panic disorder and agoraphobia, a reduction in panic frequency appears to predict a reduction in symptoms of agoraphobia; therefore, targeted treatment for agoraphobia may not be necessary when patients are being treated for panic disorder.

Previous studies have demonstrated a strong association between the occurrence of panic attacks and agoraphobia. Michelle G. Craske, PhD, with the University of California Los Angeles, and colleagues evaluated whether treatment for panic attacks alone may be sufficient for improving symptoms of agoraphobia.

The researchers evaluated 68 individuals, 18 to 55 years of age, who met the diagnosis for panic disorder with agoraphobia. Participants were randomly assigned to treatment with 90-minute weekly sessions of either panic control therapy only or panic control with agoraphobia therapy (in vivo exposure) for 16 weeks. Agoraphobia treatment included extensive discussion about the method of in vivo exposure and application of panic control strategies to in vivo exposure.

Patients were assessed at baseline, mid-treatment, post treatment, and 6-months later. Panic and agoraphobia were both evaluated using ADIS-IV (Anxiety Disorder Interviews Schedule for DSM-IV) ratings as well as measures of behavioral, physiological, and subjective anxiety responses. Functionality was measured with a 0 to 8 rating of severity of distress and disablement.

The researchers found that the two treatments were equally efficacious for both panic disorder and agoraphobia.

Dr. Craske and colleagues provide two explanations for their findings: 1) once an individual learns to no longer fear the symptoms of panic, then hesitation about entering agoraphobic situations naturally subsides, and 2) participants who received the panic control only treatment may take it upon themselves to conduct their own in vivo exposure therapy.

"Overall rates of success are on par with other studies involving more severely agoraphobic patient samples treated in a weekly cognitive-behavioral group format," the researchers point out.

"The findings suggest that structured in vivo exposure therapy, involving a hierarchy of agoraphobic situations, detailed instruction and rehearsal, specific graduated in vivo exposures, and weekly corrective feedback does not significantly improve the outcome from panic control treatment," they conclude.
J Anxiety Disord 2003;17:3:321-33. "Panic control treatment for agoraphobia"

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