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Comparing Physical Exercise in Groups to Group Cognitive Behaviour Therapy for the Treatment of Panic Disorder in a Randomized Controlled Trial

Published online by Cambridge University Press:  05 July 2012

Anders Hovland*
University of Bergen, and Solli District Psychiatric Centre (DPS), Nesttun, Norway
Inger Hilde Nordhus
University of Bergen, Norway
Trond Sjøbø
Solli District Psychiatric Centre (DPS), Nesttun, Norway
Bente A. Gjestad
Solli District Psychiatric Centre (DPS), Nesttun, Norway
Birthe Birknes
Solli District Psychiatric Centre (DPS), Nesttun, Norway
Egil W. Martinsen
University of Oslo, Norway
Torbjørn Torsheim
University of Bergen, Norway
Ståle Pallesen
University of Bergen, Norway
Reprint requests to Anders Hovland, Department of Clinical Psychology, Christiesgt. 12, 5015 Bergen, Norway. E-mail:


Background: Previous studies have suggested that physical exercise can reduce symptoms for subjects suffering from panic disorder (PD). The efficacy of this intervention has so far not been compared to an established psychotherapy, such as cognitive behaviour therapy (CBT). Assessment of controlled long-term effects and the clinical significance of the treatment are also lacking. Aim: To compare physical exercise to CBT as treatment for PD, and assess controlled long-term and clinically significant effects. Method: PD-patients were randomized to either three weekly sessions of physical exercise (n = 17), or one weekly session of CBT (n = 19). Both treatments ran for 12 weeks, were manualized and administered in groups. Patients were assessed twice before the start of treatment, at post-treatment and at 6 and 12 months thereafter. Primary outcome-measures consisted of the Mobility Inventory (MI), the Agoraphobia Cognitions Questionnaire (ACQ) and the Body Sensations Questionnaire (BSQ). Results: A two-way repeated measures MANOVA of these measures demonstrated a significant effect of time, F(16, 544) = 7.28, p < .01, as well as a significant interaction effect, F(16, 544) = 1.71, p < .05, in favour of CBT. This finding was supported by the assessment of clinically significant changes of avoidant behaviour and of treatment-seeking one year later. Conclusion: Group CBT is more effective than group physical exercise as treatment of panic disorder, both immediately following treatment and at follow-up assessments.

Research Article
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012 

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American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorder (4th ed., text rev.). Washington, DC: American Psychiatric Association.Google Scholar
Bandelow, B. (1995). Assessing the efficacy of treatments for panic disorder and agoraphobia. II. The Panic and Agoraphobia Scale. International Clinical Psychopharmacology, 10, 7382.Google Scholar
Barber, J. P., Liese, B. S. and Abrams, M. J. (2003). Development of the Cognitive Therapy Adherence and Competence Scale. Psychotherapy Research, 13, 205221.Google Scholar
Beck, A. T. and Steer, R. A. (1993). Beck Anxiety Inventory Manual. San Antonio, TX: The Psychological Corporation.Google Scholar
Beck, A. T., Steer, R. A. and Brown, G. K. (1996). Beck Depression Inventory-II Manual. San Antonio, TX: The Psychological Corporation.Google Scholar
Broman-Fulks, J. J., Berman, M. E., Rabian, B. A. and Webster, M. J. (2004). Effects of aerobic exercise on anxiety sensitivity. Behaviour Research and Therapy, 42, 125136.Google Scholar
Broman-Fulks, J. J. and Storey, K. M. (2008). Evaluation of a brief aerobic exercise intervention for high anxiety sensitivity. Anxiety Stress and Coping, 21, 117128.Google Scholar
Broocks, A., Bandelow, B., Pekrun, G., George, A., Meyer, T., Bartmann, U., et al. (1998). Comparison of aerobic exercise, clomipramine, and placebo in the treatment of panic disorder. American Journal of Psychiatry, 155, 603609.CrossRefGoogle ScholarPubMed
Chambless, D. L., Caputo, G. C., Bright, P. and Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology, 52, 10901097.Google Scholar
Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J. and Williams, C. (1985). The Mobility Inventory for Agoraphobia. Behaviour Research and Therapy, 23, 3544.CrossRefGoogle ScholarPubMed
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461470.Google Scholar
Clark, D. M., Salkovskis, P. M., Hackmann, A., Middleton, H., Anastasiades, P. and Gelder, M. (1994). A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. The British Journal of Psychiatry, 164, 759769.Google Scholar
Clark, D. M., Salkovskis, P. M., Hackmann, A., Wells, A., Ludgate, J. and Gelder, M. (1999). Brief cognitive therapy for panic disorder: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 67, 583589.Google Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
Cox, B. J., Cohen, E., Direnfeld, D. M. and Swinson, R. P. (1996). Does the Beck Anxiety Inventory measure anything beyond panic attack symptoms? Behaviour Research and Therapy, 34, 949954.Google Scholar
Crapo, R. O., Casaburi, R., Coates, A. L., Enright, P. L., MacIntyre, N. R., McKay, R., et al. (2002). ATS statement: guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine, 166, 111117.Google Scholar
Cromarty, P., Robinson, G., Callcott, P. and Freeston, M. (2004). Cognitive therapy and exercise for panic and agoraphobia in primary care: pilot study and service development. Behavioural and Cognitive Psychotherapy, 32, 371374.Google Scholar
Esquivel, G., Diaz-Galvis, J., Schruers, K., Berlanga, C., Lara-Munoz, C. and Griez, E. (2008). Acute exercise reduces the effects of a 35% CO2 challenge in patients with panic disorder. Journal of Affective Disorders, 107, 217220.Google Scholar
Esquivel, G., Schruers, K., Kuipers, H. and Griez, E. (2002). The effects of acute exercise and high lactate levels on 35% CO2 challenge in healthy volunteers. Acta Psychiatrica Scandinavica, 106, 394397.Google Scholar
Faul, F., Erdfelder, E., Lang, A. G. and Buchner, A. (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175191.CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (1995). Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-I/P, Version 2.0). New York: Biometric Research Department, New York State Psychiatric Institute.Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M., Williams, J. B. W. and Benjamin, L. (1994). Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
Frisch, M. B., Cornell, J., Villanueva, M. and Retzlaff, P. J. (1992). Clinical validation of the Quality of Life Inventory: a measure of life satisfaction for use in treatment planning and outcome assessment. Psychological Assessment, 4, 92101.Google Scholar
Gould, R. A., Otto, M. W. and Pollack, M. H. (1995). A meta-analysis of treatment outcome for panic disorder. Clinical Psychology Review, 15, 819844.Google Scholar
Haskell, W. L., Lee, I. M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A., et al. (2007). Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise, 39, 14231434.Google Scholar
Herring, M. P., O'Connor, P. J. and Dishman, R. K. (2010). The effect of exercise training on anxiety symptoms among patients: a systematic review. Archives of Internal Medicine, 170, 321331.Google Scholar
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.Google Scholar
King, S., Wessel, J., Bhambhani, Y., Maikala, R., Sholter, D. and Maksymowych, W. (1999). Validity and reliability of the 6 minute walk in persons with fibromyalgia. Journal of Rheumatology, 26, 22332237.Google ScholarPubMed
Lawlor, D. A. and Hopker, S. W. (2001). The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. British Medical Journal, 322, 763767.Google Scholar
Long, B. C. and van Stavel, R. (1995). Effects of exercise training on anxiety: a meta-analysis. Journal of Applied Sport Psychology, 7, 167189.Google Scholar
Martinsen, E. W., Hoffart, A. and Solberg, O. Y. (1989). Aerobic and non-aerobic forms of exercise in the treatment of anxiety disorders. Stress Medicine, 5, 115120.Google Scholar
Martinsen, E. W., Sandvik, L. and Kolbjørnsrud, O. B. (1989). Aerobic exercise in the treatment of nonpsychotic mental disorders: an exploratory study. Nordic Journal of Psychiatry, 43, 521529.Google Scholar
McHugh, R. K., Otto, M. W., Barlow, D. H., Gorman, J. M., Shear, M. K. and Woods, S. W. (2007). Cost-efficacy of individual and combined treatments for panic disorder. Journal of Clinical Psychiatry, 68, 10381044.CrossRefGoogle ScholarPubMed
Merom, D., Phongsavan, P., Wagner, R., Chey, T., Marnane, C., Steel, Z., et al. (2008). Promoting walking as an adjunct intervention to group cognitive behavioral therapy for anxiety disorders: a pilot group randomized trial. Journal of Anxiety Disorders, 22, 959968.Google Scholar
Meyer, T. and Broocks, A. (2000). Therapeutic impact of exercise on psychiatric diseases: guidelines for exercise testing and prescription. Sports Medicine, 30, 269279.Google Scholar
Modigh, K., Westberg, P. and Eriksson, E. (1992). Superiority of clomipramine over imipramine in the treatment of panic disorder: a placebo-controlled trial. Journal of Clinical Psychopharmacology, 12, 251261.Google Scholar
National Institute for Health and Clinical Excellence (2004). Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. London: NICE.Google Scholar
Nes, B. M., Janszky, I., Wisløff, U., Støylen, A. and Karlsen, T. (2012). Age-predicted maximal heart rate in healthy subjects: the HUNT Fitness Study. Scandinavian Journal of Medicine and Science in Sports. Advance online publication. doi:10.1111/j.1600-0838.2012.01445.xGoogle Scholar
Orwin, A. (1974). Treatment of a situational phobia: a case for running. British Journal of Psychiatry, 125, 9598.Google Scholar
Petruzzello, S. J., Landers, D. M., Hatfield, B. D., Kubitz, K. A. and Salazar, W. (1991). A meta-analysis on the anxiety-reducing effects of acute and chronic exercise: outcomes and mechanisms. Sports Medicine, 11, 143182.Google Scholar
Pollock, M. L., Gaesser, G. A., Butcher, J. D., Despres, J. P., Dishman, R. K., Franklin, B. A., et al. (1998). ACSM position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Medicine and Science in Sports and Exercise, 30, 975991.Google Scholar
Salmon, P. (2001). Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clinical Psychology Review, 21, 3361.Google Scholar
Schmidt, N. B., Lerew, D. R. and Jackson, R. J. (1999). Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension. Journal of Abnormal Psychology, 108, 532537.Google Scholar
Sexton, H., Maere, A. and Dahl, N. H. (1989). Exercise intensity and reduction in neurotic symptoms. Acta Psychiatrica Scandinavica, 80, 231235.Google Scholar
Smits, J. A. J., Berry, A. C., Rosenfield, D., Powers, M. B., Behar, E. and Otto, M. W. (2008). Reducing anxiety sensitivity with exercise. Depression and Anxiety, 25, 689699.CrossRefGoogle ScholarPubMed
Smits, J. A. J., Meuret, A. E., Zvolensky, M. J., Rosenfield, D. and Seidel, A. (2009). The effects of acute exercise on CO2 challenge reactivity. Journal of Psychiatric Research, 43, 446454.Google Scholar
Spielberger, C. D., Gorsuch, R. L., Lushene, R. E., Vagg, P. R. and Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Stein, J. M., Papp, L. A., Klein, D. F., Cohen, S., Simon, J., Ross, D., et al. (1992). Exercise tolerance in panic disorder patients. Biological Psychiatry, 32, 281287.Google Scholar
Strohle, A., Feller, C., Onken, M., Godemann, F., Heinz, A. and Dimeo, F. (2005). The acute antipanic activity of aerobic exercise. American Journal of Psychiatry, 162, 23762378.Google Scholar
Strohle, A., Graetz, B., Scheel, M., Wittmann, A., Feller, C., Heinz, A., et al. (2009). The acute antipanic and anxiolytic activity of aerobic exercise in patients with panic disorder and healthy control subjects. Journal of Psychiatric Research, 43, 10131017.Google Scholar
Telch, M. J., Lucas, J. A., Schmidt, N. B., Hanna, H. H., Jaimez, T. L. and Lucas, R. A. (1993). Group cognitive-behavioral treatment of panic disorder. Behaviour Research and Therapy, 31, 279287.Google Scholar
Wedekind, D., Broocks, A., Weiss, N., Engel, K., Neubert, K. and Bandelow, B. (2010). A randomized, controlled trial of aerobic exercise in combination with paroxetine in the treatment of panic disorder. World Journal of Biological Psychiatry, 11, 904913.Google Scholar
Wipfli, B. M., Rethorst, C. D. and Landers, D. M. (2008). The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose-response analysis. Journal of Sport and Exercise Psychology, 30, 392410.CrossRefGoogle ScholarPubMed
Yalom, I. D., and Leszcz, M. (2005). Theory and Practice of Group Psychotherapy (5th ed.). New York: Basic Books.Google Scholar
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