Skip to main content
×
×
Home

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

  • Anders Hovland (a1), Inger Hilde Nordhus (a2), Trond Sjøbø (a3), Bente A. Gjestad (a3), Birthe Birknes (a3), Egil W. Martinsen (a4), Torbjørn Torsheim (a2) and Ståle Pallesen (a2)...
Abstract

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.

Copyright
Corresponding author
Reprint requests to Anders Hovland, Department of Clinical Psychology, Christiesgt. 12, 5015 Bergen, Norway. E-mail: anders.hovland@psykp.uib.no
References
Hide All
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorder (4th ed., text rev.). Washington, DC: American Psychiatric Association.
Bandelow, B. (1995). Assessing the efficacy of treatments for panic disorder and agoraphobia. II. The Panic and Agoraphobia Scale. International Clinical Psychopharmacology, 10, 7382.
Barber, J. P., Liese, B. S. and Abrams, M. J. (2003). Development of the Cognitive Therapy Adherence and Competence Scale. Psychotherapy Research, 13, 205221.
Beck, A. T. and Steer, R. A. (1993). Beck Anxiety Inventory Manual. San Antonio, TX: The Psychological Corporation.
Beck, A. T., Steer, R. A. and Brown, G. K. (1996). Beck Depression Inventory-II Manual. San Antonio, TX: The Psychological Corporation.
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.
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.
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.
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.
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.
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461470.
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.
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.
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Long, B. C. and van Stavel, R. (1995). Effects of exercise training on anxiety: a meta-analysis. Journal of Applied Sport Psychology, 7, 167189.
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.
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.
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.
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.
Meyer, T. and Broocks, A. (2000). Therapeutic impact of exercise on psychiatric diseases: guidelines for exercise testing and prescription. Sports Medicine, 30, 269279.
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.
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.
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.x
Orwin, A. (1974). Treatment of a situational phobia: a case for running. British Journal of Psychiatry, 125, 9598.
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.
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.
Salmon, P. (2001). Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clinical Psychology Review, 21, 3361.
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.
Sexton, H., Maere, A. and Dahl, N. H. (1989). Exercise intensity and reduction in neurotic symptoms. Acta Psychiatrica Scandinavica, 80, 231235.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Yalom, I. D., and Leszcz, M. (2005). Theory and Practice of Group Psychotherapy (5th ed.). New York: Basic Books.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
WORD
Supplementary materials

Hovland supplementary material
Hovland supplementary material

 Word (35 KB)
35 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 16
Total number of PDF views: 191 *
Loading metrics...

Abstract views

Total abstract views: 1013 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 15th August 2018. This data will be updated every 24 hours.