Journal ArticleDOI
Alprazolam and exposure alone and combined in panic disorder with agoraphobia. A controlled study in London and Toronto.
Isaac Marks,Richard P. Swinson,Metin Başoğlu,Klaus Kuch,Homa Noshirvani,G. O'Sullivan,Paul Lelliott,M. Kirby,McNamee Ga,Seda Sengun +9 more
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TLDR
By the end of treatment, though gains on alprazolam were largely as in previous studies, on phobias and disability they were half those with exposure, whereas gains persisted to six-month follow-up after exposure ceased.Abstract:
A cross-national randomised trial of alprazolam for chronic panic disorder with agoraphobia was run. Compared with previous trials it had three new features: an exposure therapy contrast group, a six-month treatment-free follow-up, and a low rate of early placebo drop-outs ('non-evaluables'). The dose of alprazolam was high (5 mg/day). The 154 patients had eight weeks of: alprazolam and exposure (combined treatment); or alprazolam and relaxation (a psychological placebo); or placebo and exposure; or placebo and relaxation (double placebo). Drug taper was from weeks 8 to 16. Follow-up was to week 43. Results were similar at both sites. Treatment integrity was good. All four treatment groups, including double placebo, improved well on panic throughout. On non-panic measures, by the end of treatment, both alprazolam and exposure were effective, but exposure had twice the effect size of alprazolam. During taper and follow-up, gains after alprazolam were lost, while gains after exposure were maintained. Combining alprazolam with exposure marginally enhanced gains during treatment, but impaired improvement thereafter. The new features put previous trails in a fresh light. By the end of treatment, though gains on alprazolam were largely as in previous studies, on phobias and disability they were half those with exposure. Relapse was usual after alprazolam was stopped, whereas gains persisted to six-month follow-up after exposure ceased. Panic improved as much with placebo as with alprazolam or exposure.read more
Citations
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Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear.
Kerry J. Ressler,Barbara O. Rothbaum,Libby Tannenbaum,Page L. Anderson,Ken Graap,Elana Zimand,Larry F. Hodges,Michael Davis +7 more
TL;DR: These pilot data provide initial support for the use of acute dosing of DCS as an adjunct to exposure-based psychotherapy to accelerate the associative learning processes that contribute to correcting psychopathology.
Journal ArticleDOI
Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial.
TL;DR: Combining imipramine and CBT appeared to confer limited advantage acutely but more substantial advantage by the end of maintenance, and each treatment worked well immediately following treatment and during maintenance;CBT appeared durable in follow-up.
Journal ArticleDOI
World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision
Borwin Bandelow,J. Zohar,Eric Hollander,Siegfried Kasper,Hans-Jürgen Möller,Obsessive-Compulsive Wfsbp Task Force on Treatment Guidelines for Anxiety,Posttraumatic Stress Disorders +6 more
TL;DR: Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.
Journal ArticleDOI
The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings.
TL;DR: It is tentatively proposed that short- term anxiety reduction from alcohol use, in concert with longer-term anxiety induction from chronic drinking and withdrawal, can initiate a vicious feed-forward cycle of increasing anxiety symptoms and alcohol use that results in comorbidity.
Journal ArticleDOI
A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies.
Drew Westen,Kate H. Morrison +1 more
TL;DR: A meta-analysis of high-quality studies published from 1990-1998 on the efficacy of manualized psychotherapies for depression, panic disorder, and generalized anxiety disorder suggests that a substantial proportion of patients with panic improve and remain improved.
References
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An inventory for measuring depression
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A rating scale for depression
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Brief standard self-rating for phobic patients.
Isaac Marks,Andrew Mathews +1 more
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Journal ArticleDOI
Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder.
Lewis R. Baxter,Jeffrey M. Schwartz,Kenneth S. Bergman,Martin P. Szuba,Barry H. Guze,John C. Mazziotta,Adina Alazraki,Carl Selin,Huan-Kwang Ferng,Paul Munford,Michael E. Phelps +10 more
TL;DR: Right orbital cortex/hem was significantly correlated with ipsilateral Cd/hem and thalamus/hem before treatment but not after, and the differences before and after treatment were significant, suggesting a brain circuit involving these brain regions may mediate obsessive-compulsive disorder symptoms.