Implications of naturalistic use of pharmacotherapy in CBT treatment for panic disorder

Behav Res Ther. 2007 Jul;45(7):1435-47. doi: 10.1016/j.brat.2007.01.005. Epub 2007 Jan 28.


This study examined naturalistic medication use and cognitive behavioral therapy (CBT) treatment outcomes in 105 patients meeting DSM-IV criteria for panic disorder (PD), assessed by structured clinical interview. The association between pre- and post-treatment use of SSRIs, benzodiazepines (BZs), and any anti-anxiety or anti-depressant (A/D) medication were investigated for three indicators of treatment outcome (PD severity, presence of agoraphobia (AG), anxiety sensitivity) at post-treatment and 6-month follow-up. Controlling for pre-treatment severity, pre-treatment SSRI use was associated with worse outcomes for AG (p=.04) and anxiety sensitivity (p=.047); post-treatment SSRI use was associated with delayed improvements in PD severity (p=.05). Pre-treatment use of A/D was associated with poorer PD severity outcomes (p=.04). Post-treatment use of A/D was associated with higher anxiety sensitivity scores across post-treatment and 6-month follow-up (p=.03). BZ use was not associated with significantly worse outcomes. However, there was a decrease in the number of patients using BZs from pre-treatment to post-treatment (p=.06) and follow-up (p=.006). In conclusion, controlling for pre-treatment severity, pre- and post-treatment use of SSRIs and A/D was associated with poorer outcomes, particularly for PD severity and anxiety sensitivity.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Anti-Anxiety Agents / therapeutic use*
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Benzodiazepines / therapeutic use
  • Cognitive Behavioral Therapy / methods*
  • Combined Modality Therapy / methods
  • Female
  • Humans
  • Male
  • Panic Disorder / drug therapy
  • Panic Disorder / therapy*
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Severity of Illness Index
  • Treatment Outcome


  • Anti-Anxiety Agents
  • Antidepressive Agents, Tricyclic
  • Serotonin Uptake Inhibitors
  • Benzodiazepines