Skip to main content
    • Aa
    • Aa

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)...

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.

Corresponding author
Reprint requests to Anders Hovland, Department of Clinical Psychology, Christiesgt. 12, 5015 Bergen, Norway. E-mail:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

B. Bandelow (1995). Assessing the efficacy of treatments for panic disorder and agoraphobia. II. The Panic and Agoraphobia Scale. International Clinical Psychopharmacology, 10, 7382.

J. P. Barber , B. S. Liese and M. J. Abrams (2003). Development of the Cognitive Therapy Adherence and Competence Scale. Psychotherapy Research, 13, 205221.

J. J. Broman-Fulks , M. E. Berman , B. A. Rabian and M. J. Webster (2004). Effects of aerobic exercise on anxiety sensitivity. Behaviour Research and Therapy, 42, 125136.

J. J. Broman-Fulks and K. M. Storey (2008). Evaluation of a brief aerobic exercise intervention for high anxiety sensitivity. Anxiety Stress and Coping, 21, 117128.

A. Broocks , B. Bandelow , G. Pekrun , A. George , T. Meyer , U. Bartmann , et al. (1998). Comparison of aerobic exercise, clomipramine, and placebo in the treatment of panic disorder. American Journal of Psychiatry, 155, 603609.

D. L. Chambless , G. C. Caputo , P. Bright and R. Gallagher (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.

D. L. Chambless , G. C. Caputo , S. E. Jasin , E. J. Gracely and C. Williams (1985). The Mobility Inventory for Agoraphobia. Behaviour Research and Therapy, 23, 3544.

D. M. Clark (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461470.

D. M. Clark , P. M. Salkovskis , A. Hackmann , H. Middleton , P. Anastasiades and M. Gelder (1994). A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. The British Journal of Psychiatry, 164, 759769.

D. M. Clark , P. M. Salkovskis , A. Hackmann , A. Wells , J. Ludgate and M. Gelder (1999). Brief cognitive therapy for panic disorder: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 67, 583589.

J. Cohen (1988). Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum.

B. J. Cox , E. Cohen , D. M. Direnfeld and R. P. Swinson (1996). Does the Beck Anxiety Inventory measure anything beyond panic attack symptoms? Behaviour Research and Therapy, 34, 949954.

G. Esquivel , J. Diaz-Galvis , K. Schruers , C. Berlanga , C. Lara-Munoz and E. Griez (2008). Acute exercise reduces the effects of a 35% CO2 challenge in patients with panic disorder. Journal of Affective Disorders, 107, 217220.

G. Esquivel , K. Schruers , H. Kuipers and E. Griez (2002). The effects of acute exercise and high lactate levels on 35% CO2 challenge in healthy volunteers. Acta Psychiatrica Scandinavica, 106, 394397.

F. Faul , E. Erdfelder , A. G. Lang and A. Buchner (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175191.

M. B. Frisch , J. Cornell , M. Villanueva and P. J. Retzlaff (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.

R. A. Gould , M. W. Otto and M. H. Pollack (1995). A meta-analysis of treatment outcome for panic disorder. Clinical Psychology Review, 15, 819844.

W. L. Haskell , I. M. Lee , R. R. Pate , K. E. Powell , S. N. Blair , B. A. Franklin , 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.

M. P. Herring , P. J. O'Connor and R. K. Dishman (2010). The effect of exercise training on anxiety symptoms among patients: a systematic review. Archives of Internal Medicine, 170, 321331.

N. S. Jacobson and P. Truax (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.

D. A. Lawlor and S. W. Hopker (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.

B. C. Long and R. van Stavel (1995). Effects of exercise training on anxiety: a meta-analysis. Journal of Applied Sport Psychology, 7, 167189.

E. W. Martinsen , A. Hoffart and O. Y. Solberg (1989). Aerobic and non-aerobic forms of exercise in the treatment of anxiety disorders. Stress Medicine, 5, 115120.

R. K. McHugh , M. W. Otto , D. H. Barlow , J. M. Gorman , M. K. Shear and S. W. Woods (2007). Cost-efficacy of individual and combined treatments for panic disorder. Journal of Clinical Psychiatry, 68, 10381044.

D. Merom , P. Phongsavan , R. Wagner , T. Chey , C. Marnane , Z. Steel , 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.

T. Meyer and A. Broocks (2000). Therapeutic impact of exercise on psychiatric diseases: guidelines for exercise testing and prescription. Sports Medicine, 30, 269279.

K. Modigh , P. Westberg and E. Eriksson (1992). Superiority of clomipramine over imipramine in the treatment of panic disorder: a placebo-controlled trial. Journal of Clinical Psychopharmacology, 12, 251261.

A. Orwin (1974). Treatment of a situational phobia: a case for running. British Journal of Psychiatry, 125, 9598.

S. J. Petruzzello , D. M. Landers , B. D. Hatfield , K. A. Kubitz and W. Salazar (1991). A meta-analysis on the anxiety-reducing effects of acute and chronic exercise: outcomes and mechanisms. Sports Medicine, 11, 143182.

M. L. Pollock , G. A. Gaesser , J. D. Butcher , J. P. Despres , R. K. Dishman , B. A. Franklin , 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.

P. Salmon (2001). Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clinical Psychology Review, 21, 3361.

N. B. Schmidt , D. R. Lerew and R. J. Jackson (1999). Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension. Journal of Abnormal Psychology, 108, 532537.

H. Sexton , A. Maere and N. H. Dahl (1989). Exercise intensity and reduction in neurotic symptoms. Acta Psychiatrica Scandinavica, 80, 231235.

J. A. J. Smits , A. C. Berry , D. Rosenfield , M. B. Powers , E. Behar and M. W. Otto (2008). Reducing anxiety sensitivity with exercise. Depression and Anxiety, 25, 689699.

J. A. J. Smits , A. E. Meuret , M. J. Zvolensky , D. Rosenfield and A. Seidel (2009). The effects of acute exercise on CO2 challenge reactivity. Journal of Psychiatric Research, 43, 446454.

J. M. Stein , L. A. Papp , D. F. Klein , S. Cohen , J. Simon , D. Ross , et al. (1992). Exercise tolerance in panic disorder patients. Biological Psychiatry, 32, 281287.

A. Strohle , C. Feller , M. Onken , F. Godemann , A. Heinz and F. Dimeo (2005). The acute antipanic activity of aerobic exercise. American Journal of Psychiatry, 162, 23762378.

A. Strohle , B. Graetz , M. Scheel , A. Wittmann , C. Feller , A. Heinz , 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.

M. J. Telch , J. A. Lucas , N. B. Schmidt , H. H. Hanna , T. L. Jaimez and R. A. Lucas (1993). Group cognitive-behavioral treatment of panic disorder. Behaviour Research and Therapy, 31, 279287.

D. Wedekind , A. Broocks , N. Weiss , K. Engel , K. Neubert and B. Bandelow (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.

B. M. Wipfli , C. D. Rethorst and D. M. Landers (2008). The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose-response analysis. Journal of Sport and Exercise Psychology, 30, 392410.

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? *


Type Description Title
Supplementary Materials

Hovland supplementary material
Hovland supplementary material

 Word (35 KB)
35 KB