Maintenance CBT Reduces Risk of Relapse for Panic and Agoraphobia

Panic is a complicated and debilitating psychological condition. Some people experience symptoms of agoraphobia, which further exacerbate their panic. The negative consequences of panic include increased terror, fear, and anxiety. People who have panic and agoraphobia may also have increased heart rate, agitation, and stress, which all coalesce to decrease overall physical and mental health. In fact, many individuals with panic and phobia have a significantly impaired quality of life due to the social limits they encounter.

Various treatments exist for panic, including psychotropic medication and behavioral therapies. To date, cognitive behavioral therapy (CBT) has been shown to be far more effective at preventing relapse and decreasing symptoms of panic than medication. However, when medication and CBT are stopped, neither seems to provide a more protective shield from eventual relapse in the long run. Therefore, Kamila S. White of the Department of Psychology at the University of Missouri thought that perhaps a maintenance treatment would help buffer clients from the negative effects of treatment termination and possible relapse.

In a recent study, White followed 379 participants with panic, some of whom had agoraphobia as well, after they completed 3 months of CBT. Half of the participants continued with 9 more months of maintenance CBT (M-CBT) and assessments, while the remaining half had 9 months of assessments only. Following that, White evaluated the participants for 12 more months and found a significant difference in relapse vulnerability between the two groups. Those in the M-CBT had a 5.2% relapse rate, while those who only had assessments had a nearly 20% relapse rate. The level of agoraphobic symptoms reported at the end of the initial three months of CBT was also associated with the length of time to relapse for the participants.

The researchers found that maintenance treatment is not only essential to sustain gains made in acute treatment, but it can also significantly reduce symptom severity in people with panic, whether they have agoraphobia or not. White added that although the M-CBT provided lasted 9 months in her study, it is possible that shorter treatment periods may be equally beneficial. “For now,” she said, “a reasonable clinical strategy would indicate continuing maintenance treatment until agoraphobia as well as panic disorder symptoms are no more than minimal in a given patient.”

Reference:
White, K. S., Payne, L. A., Gorman, J. M., Shear, M. K., Woods, S. W., Saksa, J. R., and Barlow, D. H. (2012). Does maintenance CBT contribute to long-term treatment response of panic disorder with or without agoraphobia? A randomized controlled clinical trial. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0030666

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  • Kayla

    Kayla

    December 22nd, 2012 at 1:11 PM

    No matter what you are trying to overcome, for most of us the key to healing and success is bound to be the maintenance phase.
    Whether you are trying to lose weight, stop drinking, or overcome panic and phobias, it is essential that in some way you continue with your treatment far past the time that you think that you have it beat.
    I know that in my case as I will try not to speak for others, there have been many times when I have successfully reached a weight loss goal only to backslide again because I gradually fall back into my old behavioral patterns.
    No matter the issue, there has to be some time of focusing on the maintenance of the success that you have achieved and working on ways to stay there while not letting yourself fall into old habits and patterns of behavior again.

  • don

    don

    December 23rd, 2012 at 2:28 AM

    just like a medication curs should not be stopped because you feel better,therapy could also do with this kind of a maintenance period,where the client continues to receive support.the low transition t being on their own is much better than a rapid transition from all the help to no help at all.In fact,agoraphobia is something that can wreck havoc ithw your mind and the better it is handled,the more good news is flowing.

  • ollie w

    ollie w

    December 23rd, 2012 at 5:13 AM

    what is agoraphobia? is that the one where you are afraid to leave the house?

  • Brooke

    Brooke

    December 23rd, 2012 at 12:55 PM

    Sounds like a good plan to prevent relapse in the participants. It is like an added safety net. May not be required for all but hey, precaution is always better than cure. And relapses can be a painful experience. My only concern with this is the increased cost in the procedure of maintenance therapy.

  • joseph

    joseph

    December 24th, 2012 at 8:53 AM

    I have had first hand experience in living with someone with agoraphobia and trust me it can ruin a person going through it.There is fear and paranoia in the air and anything could be a danger or threat.Imagine living with that every single day!

    @Brooke:I don’t think the costs would be an issue with insurance.Because the pain and suffering that comes with such a problem is far bigger than money to be too concerned about costs.

  • sensei kevin

    sensei kevin

    December 24th, 2012 at 10:20 AM

    Maintenance and moderation. The keys to making a marked difference with most behaviors that you wish to modify and correct and ensuring that you can get well.

    I have never met anyone who goes through treatment and never needs it again. That’s just not a possibility. Most of us need ongoing treatment and support. That’s just life and reality. The same thing goes for almost any situation. If there is something that needs to be treated, then yeah, deal with it head on, but don’t slack off. It has to be a total change of lifestyle and focus of your energy. And this mostly has to be maintenance for life.

  • Liz

    Liz

    December 24th, 2012 at 4:33 PM

    along with the continued help that is present in maintenance,what can also benefit the participants is knowing that they are making a progress.and if the progress is not up to the mark then appropriate changes could be made in the treatment.its like constant monitoring and fine tuning.and that definitely makes any system better.

  • Mr.Q

    Mr.Q

    December 25th, 2012 at 11:58 AM

    Panic attacks can be horrible.And to get over it would be a great relief to the sufferer.Now to relapse into it again must be not just a repetition of past experiences but also fear that they will never completely recover.So in that regard,maintenance therapy helps them doubly better.it should be made compulsory if we are looking to really looking at long term benefits and not a stop gap arrangement.

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