Predictors of relapse in the second follow-up year post cognitive-behavior therapy for panic disorder

Abstract

OBJECTIVE: To investigate predictors of relapse two years after a brief cognitive-behavior group therapy in patients with panic disorder who had failed to respond to pharmacologic treatment. METHOD: A total of 56 patients with panic disorder were followed who had met remission criteria at 1 year evaluation after 12 sessions of cognitive-behavior group therapy. Demographic and clinical features and life stressors were investigated as predictors of relapse. RESULTS: At the 2 year assessment, 39 (70%) patients maintained remission status and use of medication was reduced significantly, such that 36 (64%) patients were not undergoing any psychiatric treatment. Among all independent variables investigated, only "conflict" as a stressful life event, RR = 3.20 (CI95% 1.60; 7.20 - p = 0.001), and the severity or residual anxiety symptoms, RR = 3.60 for each scale point (CI95% 1.02; 1.08 - p < 0.001), emerged as nonredundant predictors. CONCLUSION: In spite of the high treatment gains across two years of follow-up, clinicians should pay attention to stress management and to the role of residual symptoms during this period. Results were discussed in the context of treatment cost-efficacy and potential strategies to prolong treatment gains from cognitive-behavior group therapy.

Development and Validation of a Risk-Prediction Algorithm for the Recurrence of Panic Disorder

“…Previous studies have identified a number of risk factors for recurrence, including demographic and socioeconomic characteristics (younger age, female sex, and lower household annual income), stressful life events (financial crisis, interpersonal conflict, etc. ), tobacco use, psychological disorders (including major depression and generalized anxiety disorder), personality disorders, panic symptoms during episodes, family history, and childhood traumatic experiences . Identification of these risk factors has laid a strong foundation for early identification and prevention.…”

Effectiveness of Group Cognitive Behavior Therapies for Panic Disorder: Systematic Review and Meta-analysis

“…(2) can be provided by non-physicians (e.g. trained psychologists or nurses); (3) are associated with lower relapse rates; and (4) appear to be more cost -effective in the long run (Heldt et al, 2010).…”

Temperamento e Caráter na Resposta à Terapia Cognitivo-Comportamental para Transtorno de Pânico

“…Entre os preditores de pior resposta ao tratamento, os estudos relatam a presença de comorbidades com o TP, como a fobia social e o estresse pós-traumático (Chavira et al, 2009), a distimia e a ansiedade generalizada (Heldt et al, 2006). Também a sensibilidade à ansiedade após tratamento farmacológico combinado com TCC individual (Chavira et al, 2009) e os eventos estressores negativos no período de dois anos após TCCG foram preditores de pior resposta ao tratamento (Heldt et al, 2011).…”