Cognitive-Behavioral Treatment of Panic Disorder in Adolescence

Abstract

This investigation represents the first randomized controlled trial to evaluate the feasibility and efficacy of Panic Control Treatment for Adolescents (PCT-A). Thirteen adolescents, ages 14 to 17, were randomized to 11 weekly sessions of PCT-A treatment, whereas 13 were randomized to a self-monitoring control group. Results indicate that adolescents receiving immediate PCT-A showed a significant reduction in clinician-rated severity of panic disorder and in self-reported anxiety, anxiety sensitivity, and depression, in comparison to control group participants. These treatment gains were maintained at 3- and 6-month follow-up. Clinical severity of panic continued to improve from posttreatment to 3-month follow-up and then remained stable at 6-month follow-up. In light of study limitations, these findings suggest that cognitive-behavioral treatment for panic disorder in adolescence is a feasible and potentially efficacious intervention for this debilitating condition in youth.

A psychometric evaluation of the Panic Disorder Severity Scale for children and adolescents.

“…Whereas previous measurement advances support the utility of adult measures of PDA symptom frequency, severity, and impairment (e.g., Houck et al, 2002; Wuyek et al, 2011), the present study provides the first psychometric evaluation of a panic severity measure for youth among a sample of youth with PDA. The present report offers preliminary support for the reliability, validity, and clinical utility of the PDSS-C scores, which have already been used in clinical trials (e.g., Pincus et al, 2010, 2013). …”

“…Importantly, several items from the adult PDSS may not be relevant to child populations (e.g., items about work or sexual activity), and key life domains of adolescence, such as school, are not assessed. To afford a developmentally sensitive, brief assessment of panic severity for use with adolescent populations, Pincus and colleagues adapted the traditional PDSS-SR for youth ages 11 to 17 (PDSS-Child Version; PDSS-C; Pincus, Spiegel, & Mattis, 2004) and used the measure as a self-administered primary outcome measure of panic severity at baseline, post-treatment, and follow-up evaluations in several adolescent PDA clinical trials (Pincus, May, Whitton, Mattis, & Barlow, 2010; Pincus et al, 2013). Items on the PDSS-C are functionally parallel to the PDSS, with the exception of item word changes to maximize appropriateness for the target youth audience.…”

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

“…A meta-analysis of 24 clinical trials showed that almost 70% of youths who received CBT no longer met diagnostic criteria for their anxiety disorder compared to only 13% of wait-list controls [1189]. Meta-analyses and RCTs have confirmed the efficacy of CBT in children with SAD [1192-1197], panic disorder [1198], OCD [1199-1204], PTSD [946,1205-1211], school refusal [1212-1215], and separation anxiety disorder [1216]. …”

Trajectories of Change Across Outcomes in Intensive Treatment for Adolescent Panic Disorder and Agoraphobia

“…Limited work has evaluated the efficacy of CBT in the treatment of panic disorder with agoraphobia in adolescent populations. In a rare exception, Pincus and colleagues evaluated weekly CBT in a sample of adolescents with PD and demonstrated significantly greater reductions in panic disorder severity, anxiety sensitivity, overall anxiety, and depression at posttreatment relative to waitlist controls, with gains maintained at 3-and 6-month follow-up (Pincus, May, et al, 2010). Other work has begun to evaluate and show support for intensive treatment formats for the delivery of CBT for adolescent PD, in which patients receive all-day treatment across a 1-week period .…”

“…Cognitive-behavioral therapies (CBTs) for youth anxiety disorders have demonstrated considerable efficacy across a broad empirical literature, with research showing that CBTs are efficacious in reducing or eliminating the deleterious effects of anxiety disorders from pre-to posttreatment (Kendall, 2002;Pincus, May, Whitton, Mattis, & Barlow, 2010;Silverman, Pina, & Viswesvaran, 2008). CBT has also been evaluated in comparison with, and in combination with, psychopharmacological treatment (i.e., sertraline) for childhood anxiety and shown to be efficacious as either a monotherapy or as part of a combined multimodal treatment strategy (Walkup et al, 2008).…”