Agoraphobia and Panic Disorder: 3.5 Years after Alprazolam and/or Exposure Treatment

Abstract

Background: Long-term follow-ups after controlled studies of exposure therapy for agoraphobia/panic are few. Most of these studies found that improvement during treatment persists to the end of follow-up. Methods: Out of 69 patients with panic disorder plus agoraphobia who had been in an 8-week controlled study of alprazolam and/or exposure, 31 were followed up at a mean of 3.5 years later (4 years after trial entry). The 31 patients followed up included more cases who had relapsed at week 43 than did the group which did not attend the 3.5-year follow-up. Results: As a group, followed-up cases maintained their gains over the 3.5 years, more so among ex-exposure than ex-relaxation cases. Ex-exposure patients did significantly better than relaxation patients on disability and survival time. Ex-alprazolam and ex-exposure patients did not differ significantly on any variable at the 3.5-year follow-up. No baseline variable predicted outcome at follow-up. Conclusions: Present results modestly confirm those of previous studies finding lasting improvement years after exposure, though some residual symptoms were the norm.

The Comparative Effectiveness of a Multimodal Program Versus Exercise Alone for the Secondary Prevention of Chronic Low Back Pain and Disability

“…In consequence, the process of deconditioning could be discontinued. Because graded exposure to the feared stimulus (situation) has proven to be very effective [75,76], it is possible that the learning experience during GPE as used in this EP, and MP can change movement related cognitions as well as behavior.…”

Well-Being Therapy: Conceptual and Technical Issues

“…Relapse and recurrence are vexing problems in mood and anxiety disorders [12, 23, 24]. Treatment of residual symptoms by cognitive behavioral methods in unipolar depression resulted in a significantly lower relapse rate at a 4-year follow-up [25, 26].…”

“…Behavioral treatment based on exposure in vivo has emerged as a major therapeutic tool in panic disorder with agoraphobia [24]. Unlike drug treatment, it has been found to provide lasting relief to the majority of patients [50].…”

Subclinical Symptoms of Panic Disorder: New Insights into Pathophysiology and Treatment

“…Its long-term outcome appears to be associated with the type of treatment patients receive (pharmacological, behavioral, etc.). Medication discontinuation, whether it involves alprazolam or imipramine, appears to result in relapse of panic in a high proportion of patients, whereas behavioral treatment of panic disorder was found to yield long-term benefits [76, 77, 78, 79, 80, 81, 82, 83]. Regardless of the type of treatment involved and despite achievement of clinical remission, residual symptoms were found to be extremely common [75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91].…”