Short- and long- term efficacy of cognitive behavioral therapy for DSM-IV panic disorder in patients with and without severe psychiatric comorbidity.

Cognitive behavioral therapy (CBT) and/or pharmacological therapy are considered to be effective in the treatment of anxiety disorders. Anxiety patients frequently suffer from comorbid psychiatric disorders such as depression or substance disorders. Ongoing substance disorders and/or severe depressive symptomatology often are the reason why patients are not treated by outpatient psychotherapy. The present study was designed to evaluate whether CBT is comparably effective both in anxiety patients with and without comorbid axis-I-diagnoses. In a 5-weeks standardized inpatient CBT program for anxiety disorders at the Center of Mental Health, Ingolstadt, 48 patients with panic disorder according to DSM-IV were included. 42% of the patients suffered from panic disorder only, 58% from at least one further mental disorder, mainly from affective and/or substance disorders. The severity of symptomatology was determined using psychometric scales at admission, at discharge and at the follow-up investigation. In general, therapy was highly effective. Panic symptoms as well as anxious cognitions and avoidance behavior were significantly reduced at discharge and results remained stable until the follow-up investigation. Therapy was equally effective in both groups, in patients with pure and patients with comorbid panic disorder at discharge as well as at the follow-up investigation. Thus, patients with comorbid affective or substance disorders should not be excluded from psychotherapeutic programs in future.