Skip to main content

A randomized clinical trial of cognitive behavioral therapy and interpersonal psychotherapy for panic disorder with agoraphobia

  • S. P. F. Vos (a1), M. J. H. Huibers (a1), L. Diels (a2) and A. Arntz (a1)

Interpersonal psychotherapy (IPT) seems to be as effective as cognitive behavioral therapy (CBT) in the treatment of major depression. Because the onset of panic attacks is often related to increased interpersonal life stress, IPT has the potential to also treat panic disorder. To date, a preliminary open trial yielded promising results but there have been no randomized controlled trials directly comparing CBT and IPT for panic disorder.


This study aimed to directly compare the effects of CBT versus IPT for the treatment of panic disorder with agoraphobia. Ninety-one adult patients with a primary diagnosis of DSM-III or DSM-IV panic disorder with agoraphobia were randomized. Primary outcomes were panic attack frequency and an idiosyncratic behavioral test. Secondary outcomes were panic and agoraphobia severity, panic-related cognitions, interpersonal functioning and general psychopathology. Measures were taken at 0, 3 and 4 months (baseline, end of treatment and follow-up).


Intention-to-treat (ITT) analyses on the primary outcomes indicated superior effects for CBT in treating panic disorder with agoraphobia. Per-protocol analyses emphasized the differences between treatments and yielded larger effect sizes. Reductions in the secondary outcomes were equal for both treatments, except for agoraphobic complaints and behavior and the credibility ratings of negative interpretations of bodily sensations, all of which decreased more in CBT.


CBT is the preferred treatment for panic disorder with agoraphobia compared to IPT. Mechanisms of change should be investigated further, along with long-term outcomes.

Corresponding author
*Address for correspondence: S. P. F. Vos, M.Sc., Department of Clinical Psychological Science, Maastricht University, PO Box 616, NL-6200 MD Maastricht, The Netherlands. (Email:
Hide All
Arntz, A (2002). Cognitive therapy versus interoceptive exposure as treatment of panic disorder without agoraphobia. Behaviour Research and Therapy 40, 325341.
Arrindell, WA, Ettema, JHM (1981). Dimensional structure, reliability and validity of the Dutch version of the Symptom Checklist (SCL-90): data based on a phobic and ‘normal’ population [in Dutch]. Nederlands Tijdschrift voor de Psychologie en Haar Grensgebieden 36, 77–108.
Barlow, DH (1988). Anxiety and its Disorders: The Nature and Treatment of Anxiety and Panic. Guilford Press: New York.
Barlow, DH, Craske, MG (1994). Mastery of your Anxiety and Panic, II. Graywind: Albany, NY.
Beck, AT, Emery, G, Greenberg, RL (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. Basic Books: New York.
Beck, AT, Rush, AJ, Shaw, BF, Emery, G (1979). Cognitive Therapy of Depression. Guilford Press: New York.
Borkovec, TD, Nau, SD (1972). Credibility of analogue therapy rationales. Journal of Behavior Therapy and Experimental Psychiatry 3, 257260.
Bouman, TK (1998). The Body Sensation Questionnaire [in Dutch]. Gedragstherapie 31, 165168.
Chambless, DL, Caputo, GC, Bright, P, 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.
Clark, DM (1986). A cognitive approach to panic. Behaviour Research and Therapy 24, 461470.
Clark, DM, Salkovskis, PM, Hackmann, A, Middleton, H, Anastasiades, P, Gelder, M (1994). A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. British Journal of Psychiatry 164, 759769.
Clark, DM, Salkovskis, PM, Ost, LG, Breitholtz, E, Koehler, KA, Westling, BE, Jeavons, A, Gelder, M (1997). Misinterpretation of body sensations in panic disorder. Journal of Consulting and Clinical Psychology 65, 203213.
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn.Lawrence Erlbaum Associates: Hillsdale, NJ.
Craske, MG, Maidenberg, E, Bystritsky, A (1995). Brief cognitive-behavioral versus nondirective therapy for panic disorder. Journal of Behavior Therapy and Experimental Psychiatry 26, 113120.
Derogatis, LR, Lipman, RS, Covi, L (1973). SCL-90: an outpatient psychiatric rating scale – preliminary report. Psychopharmacology Bulletin 9, 1327.
Devilly, JG, Borkovec, TD (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry 31, 7386.
Elkin, I, Parloff, MB, Hadley, SW, Autry, JH (1985). NIMH treatment of depression collaborative research program. Archives of General Psychiatry 42, 305316.
Elkin, I, Shea, T, Watkins, JT, Imber, SD, Sotsky, SM, Collins, JF, Glass, DR, Pilkonis, PA, Leber, WR, Docherty, JP, Fiester, SJ, Parloff, MB (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program. Archives of General Psychiatry 46, 971983.
Evers, A, Vliet-Mulder, JC, Van Groot, CJ (2000). Documentation of Tests and Test Research in the Netherlands, parts 1 and 2 [in Dutch]. NIP/Van Gorcum: Amsterdam/Assen.
Fairburn, CG, Jones, R, Peveler, RC, Carr, SJ, Solomon, RA, O'Connor, ME, Burton, J, Hope, RA (1991). Three psychological treatments for bulimia nervosa: a comparative trial. Archives of General Psychiatry 48, 463469.
Faravelli, C, Pallanti, S (1989). Recent life events and panic disorder. American Journal of Psychiatry 146, 622626.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1990). Structured Clinical Interview for DSM-III-R. American Psychiatric Press: Washington, DC.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). American Psychiatric Press: Washington, DC.
Goisman, RM, Rogers, MP, Steketee, GS, Warshaw, MG, Cuneo, P, Keller, MB (1993). Utilization of behavioral methods in a multicenter anxiety disorders study. Journal of Clinical Psychiatry 54, 213218.
Hill, CE, O'Grady, KE (1992). Applying the Collaborative Study Psychotherapy Rating Scale to rate therapist adherence in cognitive-behavior therapy, interpersonal therapy, and clinical management. Journal of Consulting and Clinical Psychology 60, 7379.
Hollon, SD, DeRubeis, RJ, Evans, MD, Wiemer, MJ, Garvey, MJ, Grove, WM, Tuason, VB (1992). Cognitive therapy and pharmacotherapy for depression: singly and in combination. Archives of General Psychiatry 49, 774781.
Hollon, SD, Evans, MD, Auerbach, A, DeRubeis, RJ, Elkin, I, Lowery, A, Kriss, M, Grove, W, Thason, VB, Piasecki, J (1988). Development of a system for rating therapies for depression: differentiating cognitive therapy, interpersonal psychotherapy, and clinical management pharmacotherapy. Unpublished manuscript, University of Minnesota, Twin Cities Campus, Minneapolis, MN.
Hollon, SD, Waskow, IE, Evans, MD, Lowery, HA (1984). Systems for rating therapies for depression. Paper presented at the annual convention of the American Psychiatric Association, Los Angeles, CA.
Horowitz, M, Rosenberg, ME, Bear, BA, Ureno, G, Villaseñor, VS (1988). Inventory of interpersonal problems: psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology 56, 885892.
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.
Klerman, GL, Weissman, MM, Rounsaville, BJ, Chevron, E (1984). Interpersonal Psychotherapy of Depression. Basic Books: New York.
Lipsitz, JD, Gur, M, Miller, NL, Forand, N, Vermes, D, Fyer, AJ (2006). An open pilot study of interpersonal psychotherapy for panic disorder (IPT-PD). Journal of Nervous and Mental Disease 194, 440445.
Luty, SE, Carter, JD, McKenzie, JM, Rae, AM, Frampton, CMA, Mulder, RT, Joyce, PR (2007). Randomised controlled trial of interpersonal psychotherapy and cognitive behavioural therapy for depression. British Journal of Psychiatry 190, 496502.
Marks, IM, Mathews, AM (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy 17, 263267.
Metzger, RC (1976). A reliability and validity study of the State-Trait Anxiety Inventory. Journal of Clinical Psychology 32, 276278.
Norman, GR, Sloan, JF, Wyrwick, KW (2003). Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Medical Care 41, 582592.
Pollard, CA, Pollard, HJ, Corn, KJ (1989). Panic onset and major events in the lives of agoraphobics: a test of contiguity. Journal of Abnormal Psychology 89, 318321.
R Development Core Team (2009). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria.
Reiss, S, Peterson, RA, Gursky, DM, McNaly, RJ (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy 24, 18.
Shear, MK, Houck, P, Greeno, C, Masters, S (2001). Emotion-focused psychotherapy for patients with panic disorder. American Journal of Psychiatry 158, 19931998.
Shear, MK, Pilkonis, PA, Cloitre, M, Leon, AC (1994). Cognitive behavioral treatment compared with nonprescriptive treatment of panic disorder. Archives of General Psychiatry 51, 395401.
Shear, MK, Weiner, K (1997). Psychotherapy for panic disorder. Journal of Clinical Psychiatry 58, 3845.
Spielberger, CD, Gorsuch, RL, Lushene, R, Vagg, PR, Jacobs, GA (1983). Manual for the State–Trait Anxiety Inventory. Consulting Psychologists: Palo Alto, CA.
Van den Hout, MA, van der Molen, GM, Griez, E, Lousberg, H (1987). Specificity of interoceptive fear to panic disorder. Journal of Psychopathology and Behavioral Assessment 9, 99–109.
Weissman, MM, Markowitz, JC, Klerman, GL (2000). Comprehensive Guide to Interpersonal Psychotherapy. Basic Books: New York.
Wilcox, RR (2005). Introduction to Robust Estimation and Hypothesis Testing, 2nd edn. Academic Press: San Diego, CA.
Wilfley, DE, Welsch, RR, Stein, RI, Spurrell, EB, Cohen, LR, Saelens, BE, Dounchis, JZ, Frank, MA, Wiseman, CV, Matt, GE (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge eating disorder. Archives of General Psychiatry 59, 713721.
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? *


Type Description Title
Supplementary materials

Vos supplementary material

 Word (79 KB)
79 KB


Altmetric attention score

Full text views

Total number of HTML views: 21
Total number of PDF views: 191 *
Loading metrics...

Abstract views

Total abstract views: 589 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 18th March 2018. This data will be updated every 24 hours.