Am J Psychiatry 1995; 152:683-691
Copyright © 1995 by American Psychiatric Association
Treatment of panic disorder with agoraphobia: comparison of fluvoxamine, placebo, and psychological panic management combined with exposure and of exposure in vivo alone
E de Beurs, AJ van Balkom, A Lange, P Koele and R van Dyck
Department of Clinical Psychology, University of Amsterdam, The Netherlands.
OBJECTIVE: The purpose of this comparative outcome study was to investigate
whether the effects of exposure in vivo treatment for panic disorder with
agoraphobia could be enhanced by adding interventions specifically for
panic attacks before the start of exposure treatment. The additional effect
of two types of treatment for panic attacks-- pharmacological (fluvoxamine)
and psychological (repeated hyperventilation provocations and respiratory
training)--was examined. Thus, the combined treatment of panic
interventions with exposure in vivo could be compared to exposure in vivo
alone. METHOD: Ninety-six patients were randomly assigned to four treatment
conditions: double- blind, placebo-controlled fluvoxamine followed by
exposure in vivo, psychological panic management followed by exposure, and
exposure in vivo alone. Outcome was assessed by self-report measures, a
standardized multitask behavioral avoidance test, and continuous monitoring
of panic attacks. Seventy-six patients completed the study. RESULTS: All
four treatments were effective and resulted in a significant decrease of
agoraphobic avoidance. Moreover, the combination of fluvoxamine and
exposure in vivo demonstrated efficacy superior to that of the other
treatments and had twice as large an effect size (difference between pre-
and posttreatment scores) on self- reported agoraphobic avoidance. The
other treatments did not differ among each other in effectiveness.
CONCLUSIONS: Results of the study indicate that the short-term outcome of
exposure in vivo treatment can be enhanced by adding fluvoxamine treatment.
Psychological panic management combined with exposure was not superior to
exposure alone of equal duration.
