Keep taking the tablets? Inadequate controls for concurrent psychotropic medication in studies of psychological treatments for panic disorder

Power, Kevin; Sharp, Donald

doi:10.1177/026988119500900113

Cited by 9 publications

(5 citation statements)

References 19 publications

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“…Pharmacological interventions also yield large effect sizes for measures of social anxiety (ES = .62) and depression (ES = .83), although their effects on cognitive change were unclear given the infrequent assessment of t h i s variable. Our findings are consistent with previous reviews and analyses supporting the effectiveness of pharmacological (Pollack & Gould, 1996;Rosenbaum & Pollock, 1994) and cognitive-behavioral (Chambless & Gfis, 1993;Feske & Chambless, 1995;Heimberg, 1993) treatments.…”

Section: Discussionsupporting

confidence: 92%

“…Treatment contamination may also occur in less detectable ways. Power and Sharp (1995), for example, questioned the efficacy of CBT for panic disorder based on the inclusion, in some studies, of patients using concurrent psychotropic medication. Effective monitoring and/or restriction of CBT subjects' use of concurrent medication and medication subjects' concurrent use of CBT is essential for ensuring valid interpretation of data from these trials.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis.

Gould¹,

Buckminster²,

Pollack³

et al. 1997

Clinical Psychology: Science and Practice

308

232

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We conducted a meta-analysis using all available controlled treatment outcome studies of cognitivebehavioral and pharmacological treatments for social phobia (N = 24 studies, N = 1079 subjects). The mean social anxiety effect size for cognitive-behavioral treatments was .74 and for pharmacological treatments was .62. Both were significantly different from zero and the difference between them was not significant. Among cognitive-behavioral treatments, exposure-interventions yielded the largest effect size (ES) whether alone (ES = .89) or combined with cognitive restructuring (ES = .SO). Selective serotonin reuptake inhibitors (ES = 1.89) and benzodiazepines (ES = .72) yielded the largest effect sizes for phannacotherapy. According to cost projections, p u p cognitive-behavioral treatment offered the most cost-effective intervention.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis.

Gould¹,

Buckminster²,

Pollack³

et al. 1997

Clinical Psychology: Science and Practice

308

232

View full text Add to dashboard Cite

show abstract

“…There has been considerable debate as to the most appropriate means of controlling for concurrent psychotropic medication use in treatment outcome studies. It has been argued (Power & Sharp 1995), that concurrent psychotropic drug use should be prohibited in explanatory research designs, e.g. drug versus psychological treatment outcome studies (e.g.…”

Section: Subjectsmentioning

confidence: 99%

A comparison of the efficacy and acceptability of group versus individual cognitive behaviour therapy in the treatment of panic disorder and agoraphobia in primary care

Sharp

Power

Swanson

2004

Clin Psychology and Psychoth

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Panic disorder and agoraphobia is a prevalent clinical condition which places heavy demands on treatment resources in primary care. The efficient delivery of evidence-based psychological treatment for this disorder is therefore important. Previous research has investigated both individual and group treatment formats for cognitive behaviour therapy (CBT) for panic disorder and agoraphobia. These two modalities of treatment delivery are, however, rarely compared within the same study format. Also little is known of patients' preferences regarding treatment delivery formats. The present study investigated the relative efficacy of a group treatment CBT and an individual treatment CBT in comparison with a waiting list control group in the treatment of panic disorder with or without agoraphobia in primary care. Ninety-seven patients suffering from DSM-IV panic disorder with or without agoraphobia were randomly allocated to receive either group CBT, individual CBT, or waiting list control. All patients were seen by the same therapist and all received an identical treatment manual. Treatment response was measured by blind assessor, therapist and patient-rated measures of anxiety, depression, and agoraphobic avoidance, and was analysed in terms of both traditional statistical significance and clinical significance of outcome. At treatment end-point, in terms of traditional statistical significance, both the group and individual CBT were significantly superior to waiting list control but did not differ significantly from each other. When clinical significance of outcome at treatment end-point was considered, individual CBT showed a significant advantage over both group CBT and waiting list control. At 3-month follow-up, however, the individual CBT treatment group showed significant superiority to the group CBT treatment on clinical significance of outcome on one outcome measure only. This was principally due to a reduction

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“…Patients must be matched on initial severity and not screened or excluded because of either current psychopathology or past failure to respond to one or other treatment. Previous treatment should be carefully and assiduously sought (Power & Sharp, 1995) and any current medication tapered off. Then the patient is carefully reassessed to establish the absence of any persistent withdrawal symptoms which might respond to the re-institution of a benzodiazepine-like substance.…”

Section: Possible Negative Effectsmentioning

confidence: 99%

Interaction of pharmacological and psychological treatments of anxiety

Lader¹,

Bond²

1998

Br J Psychiatry

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Background Pharmacological and psychological treatments for anxiety are often combined in clinical practice but there is little research from which to predict the effects.Method The theoretical outcomes of combining treatments and methods of investigating these as well as methodological difficulties are described. Studies which have been completed in anxiety disorders are reviewed. A double-blind trial, using a factorial design, evaluated buspirone v. placebo and anxiety management training v. nondirective therapy in 60 patients with generalised anxiety disorder (GAD).Results Relatively few germane studies have been carried out in the anxiety disorders except for panic disorder with agoraphobia. There is some evidence that short-term, combined treatment does confer additional benefits which are evident both in speed of onset and lasting remission. All four treatment combinations proved effective in the short-term treatment of GAD.Conclusions More studies examining combined treatment are needed. Although differences may not be apparent at the end of the treatment period, psychological treatment appears to confer advantages at follow-up.

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Keep taking the tablets? Inadequate controls for concurrent psychotropic medication in studies of psychological treatments for panic disorder

Cited by 9 publications

References 19 publications

Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis.

Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis.

A comparison of the efficacy and acceptability of group versus individual cognitive behaviour therapy in the treatment of panic disorder and agoraphobia in primary care

Interaction of pharmacological and psychological treatments of anxiety

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