OBJECTIVE: In a previous paper the authors reported survival data for 20
panic disorder patients whose therapeutic doses of alprazolam were tapered
by one of two methods: slow, flexible drug taper with supportive medical
management or the same taper procedure carried out concurrently with
cognitive behavior therapy. This report is an analysis of predictors of
drug discontinuation success in that study. In addition, between-group
comparisons of clinical measures at follow- up are presented. METHOD: The
subjects in the previous study (10 in each group) were assessed blindly at
baseline, 2 weeks after completion of drug taper, and at 3- and 6-month
follow-up. Potential predictors of drug discontinuation success were tested
by using logistic regression. Between-group differences in symptom severity
at 3-month follow-up were examined by using analyses of covariance.
RESULTS: Thirteen subjects (nine receiving alprazolam plus cognitive
behavior therapy and four receiving alprazolam only) completed the drug
taper on schedule and were still medication free at follow-up. A single
variable--baseline-to- posttaper change in anxiety sensitivity--predicted
drug status at follow-up in 85% of the cases. At follow-up, subjects in the
combined- treatment group were significantly more improved on measures of
anxiety, depression, catastrophic thinking related to anxiety, perception
of emotional control, and disability than subjects in the drug-only group.
CONCLUSIONS: Across groups, reduction in the fear of anxiety symptoms was
the best predictor of patients' ability to achieve and maintain drug
abstinence. Some implications of that finding for the pharmacotherapy of
panic disorder are discussed.