People with a panic disorder benefit most from a combination of cognitive behavioural therapy (talk) and antidepressants (pills). Many people with a panic disorder avoid places or situations that could cause the next panic attack; this is also known as agoraphobia. The combined treatment works better for people with a panic disorder and moderate or severe agoraphobia than the two separate forms of treatment. These are the findings of a study by psychologist Franske van Apeldoorn from the University Medical Center Groningen. ‘The combined treatment lasted a year; after nine months the medication was gradually reduced to zero’, says Van Apeldoorn. She will be awarded a PhD by the University of Groningen on 4 November.
These findings could represent an important contribution to the treatment of people with a panic disorder with or without agoraphobia. Van Apeldoorn: ‘If people do not seek help for a panic disorder, it can develop into a chronic condition. Some people suffer in silence for years.’
An estimated 3.8% of people suffer from a panic disorder at some point in their lives. ‘A panic attack is a particularly unpleasant experience’, Van Apeldoorn explains. ‘A person suddenly, and without clear cause, becomes afraid. The fear then quickly builds up and reaches a peak. The physical symptoms can be heart palpitations, shaking, dizziness, hyperventilation and tightness in the chest.’ People who suffer from a panic attack usually think that something really bad is going to happen such as a heart attack, losing control or going mad. Between the panic attacks they therefore become more afraid of the next attack, or its effects.
‘People are often treated with antidepressants, what is known as an SSRI, or with cognitive behavioural therapy, and sometimes with both. We have now compared these three treatments in a single study, and we also looked at the consequences for the long term’, says Van Apeldoorn. Antidepressants, cognitive behavioural therapy and the combination of both were all effective in the treatment of a panic disorder with or without agoraphobia. The most significant benefit that Van Apeldoorn found was that people with moderate or severe agoraphobia improved faster when they received the combined treatment. ‘With these people the number of panic attacks decreased quicker if they received the combined treatment compared with pills or talk alone.’
The patients in the study received individual cognitive behavioural therapy. This focuses on examining whether the person’s fear is based on a realistic expectation. ‘People with a panic disorder are scared of what is happening in their bodies during an attack. They think, for example, that dizziness means “danger” and predicts a “disaster” such as fainting’, says Van Apeldoorn. ‘In cognitive behavioural therapy exercises are used to produce the physical sensations. This allows them to discover that the sensations are a product of fear and panic, and are harmless. People also learn how to examine and change their own interpretations or cognitions. They then practise by seeking out situations and places that they would formerly have avoided.’
Once people with a panic disorder are symptom-free, they and their doctors are sometimes reticent about discontinuing the antidepressants because they are worried that the symptoms will return. This worry, however, seems to be unfounded. ‘The positive effects could still be seen a year after the behavioural therapy had been completed and the antidepressants discontinued. This treatment therefore proves to have a lasting effect’, says Van Apeldoorn. She has also looked at the cost, and found that behavioural therapy and the combined treatment were more cost-effective than antidepressants alone. Van Apeldoorn: ‘I would argue for – more than is now the case – sufficient availability of cognitive behavioural therapy for people with a panic disorder. For people with moderate and severe agoraphobia in particular, this is an essential part of the treatment.’
Franske van Apeldoorn (Groningen, 1973) studied Psychology at the University of Groningen. She works as a researcher and clinical psychologist at the Department of Psychiatry in the University Medical Center Groningen (UMCG). Her research was supervised by Professor J.A. den Boer, Dr W.J.P.J. van Hout and Dr P.P.A. Mersch. The title of Van Apeldoorn’s thesis is ‘The treatment of panic disorder; psycotherapy, pharmacotherapy, or the two combined?’
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