Videoconference-delivered cognitive behavioral therapy in patients with symptomatic panic disorder following primary pharmacotherapy: a randomized, assessor-blinded, controlled trial.

BACKGROUND

Additional treatment options for pharmacotherapy-refractive patients with panic disorder are needed. Given the difficulty in accessing professional cognitive behavioral therapy in real-world clinical settings, pharmacotherapy remains the typical treatment in patients with panic disorder. However, some patients with panic disorder remain symptomatic despite pharmacotherapy. In this study, to highlight next-step treatment options for patients with panic disorder, we aimed to assess the efficacy of videoconference-based cognitive behavioral therapy for patients with panic disorder who remained symptomatic despite initial pharmacological treatment. To this end, we evaluated the effectiveness of videoconference-based cognitive behavioral therapy for patients as an adjunct to usual care.

METHODS

Symptomatic patients with panic disorder following primary pharmacotherapy were randomly assigned to videoconference-based cognitive behavioral therapy or usual care-only groups. The primary outcomes were a reduction in symptomatology assessed at 8 and 16 weeks, using the Panic Disorder Severity Scale. We calculated the 95% confidence intervals (CIs) of the mean with an unknown variance.

RESULTS

Thirty participants were included in this study. After 16 weeks, the adjusted mean changes in Panic Disorder Severity Scale score from baseline were - 7.92 and 0.75 in the videoconference-based cognitive behavioral therapy (n = 15) and usual care (n = 15) groups, respectively, with a between-group difference of - 8.67 (95% CI: -11.80 to - 5.54; P < .0001). A considerable proportion of patients in the videoconference-based cognitive behavioral therapy group achieved a positive response at week 16 (80% vs. 6.7%; P < .001) and demonstrated a higher remission rate (66.7% vs. 0.0%; P < .001) than that in the usual care group.

CONCLUSIONS

Thus, videoconference-based cognitive behavioral therapy is an effective treatment for patients with panic disorder who remain symptomatic following pharmacotherapy. The results suggest that videoconference-based cognitive behavioral therapy, which can be used at home, may be effective for patients with panic disorder or chronic panic disorder who have difficulty accessing cognitive behavioral therapy.

TRIAL REGISTRATION: The study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000029987) on Nov 20, 2017.