Skip to main content
×
×
Home

Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis

  • Alessandro Pompoli (a1), Toshi A. Furukawa (a2), Orestis Efthimiou (a3) (a4), Hissei Imai (a2), Aran Tajika (a2) and Georgia Salanti (a3) (a4)...
Abstract

Cognitive-behaviour therapy (CBT) for panic disorder may consist of different combinations of several therapeutic components such as relaxation, breathing retraining, cognitive restructuring, interoceptive exposure and/or in vivo exposure. It is therefore important both theoretically and clinically to examine whether specific components of CBT or their combinations are superior to others in the treatment of panic disorder. Component network meta-analysis (NMA) is an extension of standard NMA that can be used to disentangle the treatment effects of different components included in composite interventions. We searched MEDLINE, EMBASE, PsycINFO and Cochrane Central, with supplementary searches of reference lists and clinical trial registries, for all randomized controlled trials comparing different CBT-based psychological therapies for panic disorder with each other or with control interventions. We applied component NMA to disentangle the treatment effects of different components included in these interventions. After reviewing 2526 references, we included 72 studies with 4064 participants. Interoceptive exposure and face-to-face setting were associated with better treatment efficacy and acceptability. Muscle relaxation and virtual-reality exposure were associated with significantly lower efficacy. Components such as breathing retraining and in vivo exposure appeared to improve treatment acceptability while having small effects on efficacy. The comparison of the most v. the least efficacious combination, both of which may be provided as ‘evidence-based CBT,’ yielded an odds ratio for the remission of 7.69 (95% credible interval: 1.75 to 33.33). Effective CBT packages for panic disorder would include face-to-face and interoceptive exposure components, while excluding muscle relaxation and virtual-reality exposure.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Author for correspondence: Toshi A. Furukawa, E-mail: furukawa@kuhp.kyoto-u.ac.jp
References
Hide All
American Psychiatric Association (1998) Practice guideline for the treatment of patients with panic disorder. Work group on panic disorder. American Journal of Psychiatry 155, 134.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edn. Arlington, VA: American Psychiatric Association.
Barlow, DH and Craske, MG (2000) Mastery of Your Anxiety and Panic: MAP-3. New York: Graywind Publications.
Berger, T, Boettcher, J and Caspar, F (2014) Internet-based guided self-help for several anxiety disorders: a randomized controlled trial comparing a tailored with a standardized disorder-specific approach. Psychotherapy (Chic) 51, 207219.
Bernstein, DA and Borkovec, TD (1973) Progressive Relaxation Training: A Manual for the Helping Professions. Champaign, IL: Research Press.
Clark, DM and Salkovskis, PM (1986) Cognitive Treatment of Panic: Therapist's Manual. Oxford: Department of Psychiatry, University of Oxford.
Craske, MG, DeCola, JP, Sachs, AD and Pontillo, DC (2003) Panic control treatment for agoraphobia. Journal of Anxiety Disorders 17, 321333.
Craske, MG, Rowe, M, Lewin, M and Noriega-Dimitri, R (1997) Interoceptive exposure versus breathing retraining within cognitive-behavioural therapy for panic disorder with agoraphobia. British Journal of Clinical Psychology 36(Pt 1), 8599.
Cuijpers, P, Donker, T, van Straten, A, Li, J and Andersson, G (2010) Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine 40, 19431957.
de Ruiter, C, Ryken, H, Garssen, B and Kraaimaat, F (1989) Breathing retraining, exposure and a combination of both, in the treatment of panic disorder with agoraphobia. Behavior Research and Therapy 27, 647655.
Furukawa, TA, Cipriani, A, Barbui, C, Brambilla, P and Watanabe, N (2005) Imputing response rates from means and standard deviations in meta-analyses. International Clinical Psychopharmacology 20, 4952.
Furukawa, TA, Guyatt, GH and Griffith, LE (2002) Can we individualize the ‘number needed to treat’? An empirical study of summary effect measures in meta-analyses. International Journal of Epidemiology 31, 7276.
Higgins, JP, Altman, DG, Gotzsche, PC, Juni, P, Moher, D, Oxman, AD et al. (2011) The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 343, d5928.
Higgins, JP, Jackson, D, Barrett, JK, Lu, G, Ades, AE and White, IR (2012) Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Research Synthesis Methods 3, 98110.
Hutton, B, Salanti, G, Caldwell, DM, Chaimani, A, Schmid, CH, Cameron, C et al. (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Annals of Internal Medicine 162, 777784.
Ito, LM, Noshirvani, H, Basoglu, M and Marks, IM (1996) Does exposure to internal cues enhance exposure to external cues in agoraphobia with panic? A pilot controlled study of self-exposure. Psychotherapy and Psychosomatics 65, 2428.
Karekla, M (2004) A comparison between acceptance enhanced cognitive behavioral and panic control treatment for panic disorder. Doctoral Dissertation, New York: University at Albany, State University of New York.
Katzman, MA, Bleau, P, Blier, P, Chokka, P, Kjernisted, K, Van Ameringen, M et al. (2014) Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry 14(suppl. 1), S1.
Kessler, RC, Chiu, WT, Jin, R, Ruscio, AM, Shear, K and Walters, EE (2006) The epidemiology of panic attacks, panic disorder, and agoraphobia in the national comorbidity survey replication. Archives of General Psychiatry 63, 415424.
King, M, Nazareth, I, Levy, G, Walker, C, Morris, R, Weich, S et al. (2008) Prevalence of common mental disorders in general practice attendees across Europe. British Journal of Psychiatry 192, 362367.
Lewis, C, Pearce, J and Bisson, JI (2012) Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review. British Journal of Psychiatry 200, 1521.
Lunn, D, Spiegelhalter, D, Thomas, A and Best, N (2009) The BUGS project: evolution, critique and future directions. Statistics in Medicine 28, 30493067.
NICE (2011) Generalised Anxiety Disorder and Panic Disorder in Adults: Management. London: National Institute for Health and Care Excellence.
Olthuis, JV, Watt, MC, Bailey, K, Hayden, JA and Stewart, SH (2015) Therapist-supported internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database of Systematic Reviews 3, CD011565.
Ost, LG (1987) Applied relaxation: description of a coping technique and review of controlled studies. Behavior Research and Therapy 25, 397409.
Pompoli, A, Furukawa, TA, Imai, H, Tajika, A, Efthimiou, O and Salanti, G (2016) Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis. Cochrane Database of Systematic Reviews 4, CD011004.
Roemer, L, Erisman, SM, and Orsillo, SM (2008) Mindfulness and acceptance-based treatments for anxiety disorders. In Antony, MM, Stein, MB (eds) Oxford Handbook of Anxiety and Related Disorders. Oxford: Oxford University Press, pp. 476487.
Royal Australian and New Zealand College of Psychiatrists (2003) Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia. Australian and New Zealand Journal of Psychiatry 37, 641656.
Sanchez-Meca, J, Rosa-Alcazar, AI, Marin-Martinez, F and Gomez-Conesa, A (2010) Psychological treatment of panic disorder with or without agoraphobia: a meta-analysis. Clinical Psychology Review 30, 3750.
Schmidt, NB, Woolaway-Bickel, K, Trakowski, J, Santiago, H, Storey, J, Koselka, M et al. (2000) Dismantling cognitive-behavioral treatment for panic disorder: questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology 68, 417424.
Siev, J and Chambless, DL (2007) Specificity of treatment effects: cognitive therapy and relaxation for generalized anxiety and panic disorders. Journal of Consulting and Clinical Psychology 75, 513522.
Turner, RM, Davey, J, Clarke, MJ, Thompson, SG and Higgins, JP (2012) Predicting the extent of heterogeneity in meta-analysis, using empirical data from the Cochrane database of systematic reviews. International Journal of Epidemiology 41, 818827.
Welton, NJ, Caldwell, DM, Adamopoulos, E and Vedhara, K (2009) Mixed treatment comparison meta-analysis of complex interventions: psychological interventions in coronary heart disease. American Journal of Epidemiology 169, 11581165.
Winston, A, Rosenthal, RN and Pinsker, H (2004) Introduction to Supportive Psychotherapy. American Psychiatric Publishing: Washington, DC.
Recommend this journal

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

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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

Pompoli et al. supplementary material
Pompoli et al. supplementary material 1

 Word (1.3 MB)
1.3 MB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed