Comparing Two Brief Psychological Interventions to Usual Care in Panic Disorder Patients Presenting to the Emergency Department with Chest Pain

Lessard, Marie-Josée; Marchand, André; Pelland, Marie-Ève; Belleville, Geneviève; Vadeboncœur, Alain; Chauny, Jean‐Marc; Poitras, Julien; Dupuis, Gilles; Fleet, Richard; Foldes-Busque, Guillaume; Lavoie, Kim

doi:10.1017/s1352465811000506

Cited by 32 publications

(39 citation statements)

References 65 publications

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“…There was an improvement in the severity of panic disorder, relative to supportive care. Although the sample size was small ( n = 19) this promising result was in line with the results of our study …”

Section: Discussionsupporting

confidence: 91%

“…Although the sample size was small (n = 19) this promising result was in line with the results of our study. [41,60] Second, the inclusion criteria of the five studies in the Cochrane review [1] were largely based on noncardiac chest pain irrespective of the presence of psychiatric pathology. None of the studies selected cases based on the presence of psychiatric comorbidity, which may have led to floor effects of CBT on general measures of depression and anxiety.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the CBT intervention often consisted of 12 sessions, while a shorter intervention may also be effective. [1,30,41] The objective of the present study was to examine the effectiveness of brief CBT on anxiety and depressive symptoms after 6 months in patients presenting at a cardiac emergency unit with noncardiac chest pain with comorbid panic and/or depressive disorders. The present randomized controlled trial (RCT) adds value to the five previous CBT studies because it (I) examines CBT consisting of six sessions rather than 12, (II) was conducted with a large sample almost equal to the total number of subjects in the five previous studies combined (n = 113 versus n = 136), (III) was conducted over a longer period (6 months versus 3 months) [1] and (IV) addressed the most severe cases to specifically target, NCCP patients with a comorbid psychiatric disorder.…”

Section: Introductionmentioning

confidence: 99%

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A Brief Cognitive-Behavioral Intervention for Treating Depression and Panic Disorder in Patients With Noncardiac Chest Pain: A 24-Week Randomized Controlled Trial

et al. 2013

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Brief Cognitive-Behavioral Intervention for Treating Depression and Panic Disorder in Patients With Noncardiac Chest Pain: A 24-Week Randomized Controlled Trial

et al. 2013

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“…The 42 comparisons between CBT and control conditions in PAD resulted in a pooled effect size of g=0.81 (95% CI: 0.59‐1.04; I 2 =77; NNT=3.53). In the vast majority of the comparisons (N=33), a waiting list control condition was used.…”

Section: Resultsmentioning

confidence: 99%

How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta‐analytic update of the evidence

et al. 2016

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We report the current best estimate of the effects of cognitive behavior therapy (CBT) in the treatment of major depression (MDD), generalized anxiety disorder (GAD), panic disorder (PAD) and social anxiety disorder (SAD), taking into account publication bias, the quality of trials, and the influence of waiting list control groups on the outcomes. In our meta-analyses, we included randomized trials comparing CBT with a control condition (waiting list, care-as-usual or pill placebo) in the acute treatment of MDD, GAD, PAD or SAD, diagnosed on the basis of a structured interview. We found that the overall effects in the 144 included trials (184 comparisons) for all four disorders were large, ranging from g50.75 for MDD to g50.80 for GAD, g50.81 for PAD, and g50.88 for SAD. Publication bias mostly affected the outcomes of CBT in GAD (adjusted g50.59) and MDD (adjusted g50.65), but not those in PAD and SAD. Only 17.4% of the included trials were considered to be high-quality, and this mostly affected the outcomes for PAD (g50.61) and SAD (g50.76). More than 80% of trials in anxiety disorders used waiting list control groups, and the few studies using other control groups pointed at much smaller effect sizes for CBT. We conclude that CBT is probably effective in the treatment of MDD, GAD, PAD and SAD; that the effects are large when the control condition is waiting list, but small to moderate when it is care-as-usual or pill placebo; and that, because of the small number of high-quality trials, these effects are still uncertain and should be considered with caution.Key words: Cognitive behavior therapy, major depression, generalized anxiety disorder, panic disorder, social anxiety disorder, meta-analysis, publication bias, quality of trials, waiting list control groups (World Psychiatry 2016;15:245-258) Every year almost 20% of the general population suffers from a common mental disorder, such as depression or an anxiety disorder 1 . These conditions not only result in personal suffering for patients and their families, but also in huge economic costs, in terms of both work productivity loss and health and social care expenditures 2-6 .Several evidence-based treatments are available for common mental disorders, including pharmacological and psychological interventions. Many patients receive pharmacological treatments, and these numbers are increasing in high-income countries 7 . Psychological treatments are equally effective in the treatment of depression 8 and anxiety disorders [9][10][11] . However, they are less available or accessible 12 , especially in low-and middle-income countries. At the same time, about 75% of patients prefer psychotherapy over the use of medication 13 . The most extensively tested form of psychotherapy is cognitive behavior therapy (CBT). Dozens of trials and several meta-analyses have shown that CBT is effective in treating depression 8,14 and anxiety disorders 9-11 . However, in recent years, it has become clear that the effects of CBT and other psychotherapies have been considerably ...

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“…Recent research has also emphasised the success of brief cognitive behavioural therapy; a three session CBT intervention was found to be effective for NCCP patients in terms of illness perception [ 27 ]. A brief cognitive behavioural intervention significantly reduced levels of anxiety and depression in patients with NCCP, with a diagnosis of panic and/or a depressive disorder [ 15 ], and cognitive behavioural interventions as brief as even a single session initiated within 2 weeks of an emergency attendance for the primary complaint of chest pain, seem to be effective for panic disorder [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

The prevalence of non-cardiac chest pain (NCCP) using emergency department (ED) data: a Northern Ireland based study

McDevitt-Petrovic

Kirby

Shevlin

2017

BMC Health Serv Res

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BackgroundThe aim of this study was to assess the frequency of chest pain presentations and the subsequent non-cardiac chest pain diagnoses in an emergency department (ED) over a 3 year period.MethodsAdministrative data on ED attendances to an urban general hospital in Northern Ireland between March 2013 and March 2016 were used. Data were coded and analysed to estimate frequencies of ‘chest pain’ presentation and the subsequent diagnoses for each year.ResultsBoth chest pain presentations and chest pain presentations with a subsequent diagnosis of unknown cause increased each year. In total, 58.7% of all chest presentations across 3 years resulted in a non-cardiac diagnosis of either ‘anxiety’, ‘panic’ or ‘chest pain of unknown cause’.DiscussionThere is a significant amount of patients in the ED leaving with a non-cardiac diagnosis, following an initial presentation with chest pain. ConclusionGiven the link between non-cardiac chest pain and frequent use of services, the degree of repeat attendance should be investigated.

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Comparing Two Brief Psychological Interventions to Usual Care in Panic Disorder Patients Presenting to the Emergency Department with Chest Pain

Cited by 32 publications

References 65 publications

A Brief Cognitive-Behavioral Intervention for Treating Depression and Panic Disorder in Patients With Noncardiac Chest Pain: A 24-Week Randomized Controlled Trial

A Brief Cognitive-Behavioral Intervention for Treating Depression and Panic Disorder in Patients With Noncardiac Chest Pain: A 24-Week Randomized Controlled Trial

How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta‐analytic update of the evidence

The prevalence of non-cardiac chest pain (NCCP) using emergency department (ED) data: a Northern Ireland based study

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