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A randomized trial of sertraline, self-administered cognitive behavior therapy, and their combination for panic disorder

  • D. Koszycki (a1) (a2), M. Taljaard (a3) (a4), Z. Segal (a5) and J. Bradwejn (a2)

Self-administered cognitive behavior therapy (SCBT) has been shown to be an effective alternative to therapist-delivered treatment for panic disorder (PD). However, it is unknown whether combining SCBT and antidepressants can improve treatment. This trial evaluated the efficacy of SCBT and sertraline, alone or in combination, in PD.


Patients (n=251) were randomized to 12 weeks of either placebo drug, placebo drug plus SCBT, sertraline, or sertraline plus SCBT. Those who improved after 12 weeks of acute treatment received treatment for an additional 12 weeks. Outcome measures included core PD symptoms (panic attacks, anticipatory anxiety, agoraphobic avoidance), dysfunctional cognitions (fear of bodily sensations, agoraphobic cognitions), disability, and clinical global impression of severity and improvement. Efficacy data were analyzed using general and generalized linear mixed models.


Primary analyses of trends over time revealed that sertraline/SCBT produced a significantly greater rate of decline in fear of bodily sensations compared to sertraline, placebo/SCBT and placebo. Trends in other outcomes were not significantly different over time. Secondary analyses of mean scores at week 12 revealed that sertraline/SCBT fared better on several outcomes than placebo, with improvement being maintained at the end of continuation treatment. Outcome did not differ between placebo and either sertraline monotherapy or placebo/SCBT. Moreover, few differences emerged between the active interventions.


This trial suggests that sertraline combined with SCBT may be an effective treatment for PD. The study could not confirm the efficacy of sertraline monotherapy or SCBT without concomitant medication or therapist assistance in the treatment of PD.

Corresponding author
*Address for correspondence: D. Koszycki. Ph.D., C.Psych., Faculty of Education, University of Ottawa, 145 Jean-Jacques Lussier, Ottawa, Ontario, K1N 6N5, Canada. (Email:
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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.

P Carlbring , E Nillsson-Ihrfelt , J Waara , C Kollenstam , M Burman , V Kaldo , M Soderberg , L Ekselius , G Anderson (2005). Treatment of panic disorder: live therapy vs. self-help via internet. Behaviour Research and Therapy 43, 13211333.

P Carlbring , BE Westling , P Ljungstrad , L Ekselius , G Andersson (2001). Treatment of panic disorder via the Internet: A randomized trial of a self-help intervention. Behaviour Therapy 32, 751764.

TA Furukawa , N Watanabe , R Churchill (2006). Psychotherapy plus antidepressants for panic disorder with or without agoraphobia. British Journal of Psychiatry 188, 305312.

TA Furukawa , N Watanabe , IM Omori , R Churchill (2007). Can pill placebo augment cognitive-behavior therapy for panic disorder? BMC Psychiatry 7, 73.

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