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Early intervention in panic: pragmatic randomised controlled trial

  • Peter Meulenbeek (a1), Godelief Willemse (a2), Filip Smit (a3), Anton van Balkom (a4), Philip Spinhoven (a5) and Pim Cuijpers (a6)...
Abstract
Background

Many people suffer from subthreshold and mild panic disorder and are at risk of developing more severe panic disorder.

Aims

This study (trial registration: ISRCTN33407455) was conducted to evaluate the effectiveness of an early group intervention based on cognitive–behavioural principles to reduce panic disorder symptomatology.

Method

Participants with subthreshold or mild panic disorder were recruited from the general population and randomised to the intervention (n = 109) or a waiting-list control group (n = 108). The course was offered by 17 community mental health centres.

Results

In the early intervention group, 43/109 (39%) participants presented with a clinically significant change on the Panic Disorder Severity Scale–Self Report (PDSS–SR) v. 17/108 (16%) in the control group (odds ratio (OR) for favourable treatment response 3.49, 95% CI 1.77–6.88, P = 0.001). The course also had a positive effect on DSM–IV panic disorder status (OR = 1.96, 95% CI=1.05–3.66, P = 0.037). The PDSS–SR symptom reduction was also substantial (between-group standardised mean difference of 0.68). The effects were maintained at 6-month follow-up.

Conclusions

People presenting with subthreshold and mild panic disorder benefit from this brief intervention.

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Copyright
Corresponding author
Correspondence: Peter Meulenbeek, GGNet, PO Box 2003, 7230 GC Warnsveld, The Netherlands. Email: p.meulenbeek@compaqnet.nl
Footnotes
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Supported by The Netherlands Health Research Council, The Hague (ZonMw) grant number 50-50110-98-035 (awarded to F.S.).

Declaration of interest

None.

Footnotes
References
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1 Norton, GR, Cox, BJ, Malan, J. Nonclinical panickers: a critical review. Clin Psychol Rev 1992; 12: 121–39.
2 Batelaan, N, De Graaf, R, Van Balkom, A, Vollebergh, W, Beekman, A. Thresholds for health and thresholds for illness: panic disorder versus subthreshold panic disorder. Psychol Med 2007; 37: 247–56.
3 Harvison, K, Woodruff-Borden, J, Jeffery, S. Mismanagement of panic disorder in emergency departments: contributors, costs, and implications for integrated models of care. J Clin Psychol Med Settings 2004; 11: 217–32.
4 Marciniak, M, Lage, M, Landbloom, R, Dunayevich, E, Bowman, L. Medical and productivity costs of anxiety disorders: case control study. Depress Anxiety 2004; 19: 112–20.
5 Smit, F, Cuijpers, P, Oostenbrink, J, Batelaan, N, De Graaf, R, Beekman, A. Costs of nine common mental disorders: implications for curative and preventive psychiatry. J Ment Health Policy Econ 2006; 9: 193200.
6 Gardenswartz, CA, Craske, MG. Prevention of panic disorder. Behav Ther 2001; 32: 725–37.
7 Swinson, RP, Soulios, C, Cox, BJ, Kuch, K. Brief treatment of emergency room patients with panic attacks. Am J Psychiatry 1992; 149: 944–6.
8 Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, et al. The Mini International Neuropsychiatric Interview (MINI): the development and validation of structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59 (suppl 20): 2233.
9 Michelson, D, Allgulander, C, Dantendorfer, K, Knezevic, A, Maierhofer, D, Micev, V, et al. Efficacy of usual antidepressant dosing regimens of fluoxetine in panic disorder. Randomised, placebo-controlled trial. Br J Psychiatry 2001; 179: 514–8.
10 Van Vliet, IM, Leroy, H, Van Megen, HJGM. M.I.N.I. Plus: M.I.N.I. Internationaal Neuropsychiatrisch Interview: Dutch version 5.0.0. Leiden LUMC, 2000.
11 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). APA, 1994.
12 Bakker, A. Recente ontwikkelingen in de behandeling van paniekstoornis en agorafobie [Recent developments in the treatment of panic disorder and agoraphobia]. Tijdschrift voor Psychiatrie 2001; 43: 385–93.
13 Margraf, J, Barlow, DH, Clark, DM, Telch, MJ. Psychological treatment of panic: works in progress on outcome, active ingredients, and follow-up. Behav Res Ther 1993; 31: 18.
14 Van Balkom, AJLM, Bakker, A, Spinhoven, P, Blaauw, BMJW, Smeenk, S, Ruesink, B. A meta-analysis of the treatment of panic disorder with or without agoraphobia: a comparison of psychopharmacological, cognitive-behavioral, and combination treatments. J Nerv Ment Dis 1997; 185: 510–6.
15 Meulenbeek, P, Herzmanatus, J, Smit, F, Willemse, G, Van der Zanden, R. Draaiboek: Geen Paniek, Leren Omgaan met Paniekklachten [Manual and Workbook: Don't Panic, Learn to Cope with Panic Complaints]. Trimbos Institute/GGNet, 2005.
16 Meulenbeek, P, Willemse, G, Smit, F, Smits, N, Van Balkom, A, Spinhoven, P, et al. Effects and feasibility of a preventive intervention in sub-threshold and mild panic disorder: results of a pilot study. BMC Res Notes 2009, 2: 4.
17 Shear, MK, Rucci, P, Williams, J, Frank, E, Grochocinski, V, Vander Bilt, J, et al. Reliability and validity of the panic disorder severity scale: replication and extension. J Psychiatr Res 2001; 35: 293–6.
18 Van der Meer, A, Burgerhout, K. Nederlandse versie van de Panic Disorder Severity Scale [Dutch version of the Panic Disorder Severity Scale]. Universiteit van Amsterdam, 2004.
19 Leon, AC, Olfson, M, Portera, L, Farber, L, Sheehan, DV. Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med 1997; 27: 93105.
20 Rohde, P, Lewinsohn, PM, Seeley, JR. Comparability of telephone and face-to-face interviews in assessing axis I and II disorders. Am J Psychiatry 1997; 154: 1593–8.
21 Evans, M, Kessler, D, Lewis, G, Peters, TJ, Sharp, D. Assessing mental health in primary care research using standardized scales: can it be carried out over the telephone? Psychol Med 2004; 34: 157–62.
22 Chambless, DL, Caputo, GC, Jasin, SE, Gracely, EJ, Williams, C. The Mobility Inventory for agoraphobia. Behav Res Ther 1985; 23: 3544.
23 De Beurs, E. The Assessment and Treatment of Panic Disorder and Agoraphobia. Thesis Publications, 1993.
24 Zigmond, AS, Sniath, RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361–70.
25 Spinhoven, P, Ormel, J, Sloekers, PPA, Kempen, GIJM, Speckens, AEM, Van Hemert, AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med 1997; 27: 363–70.
26 Beck, AT, Steer, RA, Brown, GK. Manual for the Beck Depression Inventory-II. Psychological Corporation, 1996.
27 Van der Does, AJW. Handleiding bij de Nederlandse versie van de Beck Depression Inventory, Second Edition (BDI-II-NL) [Manual of the Dutch version of the Beck Depression Inventory, Second Edition (BDI-II-NL)]. Swets Test Publishers, 2002.
28 Jacobson, NS, Truax, P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991; 59: 12–9.
29 Greeven, A, Van Balkom, AJLM, Visser, S, Merkelbach, JW, Van Rood, YR, Van Dyck, R, et al. Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. Am J Psychiatry 2007; 164: 91–9.
30 Everitt, BS. Modern Medical Statistics: A Practical Guide. Oxford University Press, 2003.
31 Demirtas, H. Simulation driven inferences for multiply imputed longitudinal datasets. Stat Neerl 2004; 58: 466–82.
32 Lipsey, MW, Wilson, DB. The efficacy of psychological, educational and behavioral treatment. Confirmation from meta-analysis. Am Psychol 1993; 48: 1181–209.
33 Birchall, H, Brandon, S, Taub, N. Panic in a general practice population: prevalence, psychiatric comorbidity and associated disability. Soc Psychiatry Psychiatr Epidemiol 2000; 35: 235–41.
34 Smit, F, Willemse, G, Meulenbeek, P, Koopmanschap, M, Van Balkom, A, Spinhoven, P, et al. Preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial. Cost Eff Resour Alloc 2009; 7: 8.
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Early intervention in panic: pragmatic randomised controlled trial

  • Peter Meulenbeek (a1), Godelief Willemse (a2), Filip Smit (a3), Anton van Balkom (a4), Philip Spinhoven (a5) and Pim Cuijpers (a6)...
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