A meta-analysis of treatment outcome for panic disorder

We compared the effectiveness of pharmacological, cognitive-behavioral, and combined pharmacological and cognitive-behavioral treatments in a meta-analysis of 43 controlled studies that included 76 treatment interventions. Cognitive-behavioral treatments yielded the highest mean effect sizes (ES = 0.68) relative to pharmacological (ES = 0.47) and combination treatments (ES = 0.56). In addition, the proportion of subjects who dropped out of cognitive-behavioral treatments was 5.6% relative to 19.8% in pharmacological treatments and 22.0% in combined treatments. Among cognitive-behavioral treatments, those studies that combined cognitive restructuring with interoceptive exposure yielded the strongest effect sizes (ES = 0.88). With regard to pharmacological treatments, there was no significant difference between antidepressants (ES = 0.55) and benzodiazepines (ES = 0.40). Long-term outcome analyses suggested that cognitive-behavioral interventions were the most successful at maintaining treatment gains. Cost analyses indicated that the lowest cost interventions were imipramine treatment and group cognitive-behavioral therapy. In general, cognitive-behavioral treatments yielded the largest effects sizes and the smallest attrition rates relative to pharmacotherapy and combined treatments, and are cost-effective.