Comparison of Alprazolam and Cognitive Behavior Therapy in the Treatment of Panic Disorder: A Preliminary Report

Abstract

Pharmacological treatments are well established for panic disorder. Clinical evidence exists for the effectiveness of tricyclic antidepressants, monoamine oxidase inhibitors, and benzodiazepines (Barlow, in press). However, many of these reports are uncontrolled, open clinical trials conducted with heterogeneous groups of patients. More rigorous controlled trials seem to demonstrate that tricyclic antidepresants, in particular imipramine, can confer a significant advantage on psychologically based exposure therapies. Studies by Zitrin et al. (1980, 1983) have examined the separate and combined effects of imipramine and group in vivo exposure (Zitrin et al. 1980) or imaginal exposure (Zitrin et al. 1983). Generally, behavioral treatments produced improvement, but imipramine conferred an advantage on these behavioral treatments. Similar results have been reported by Telch et al. (1985) and Mavissakalian and Michelson (1986). Only Marks et al. (1983) have reported that no particular advantage was conferred by adding imipramine to exposure-based treatments.

This study was submitted in partial fulfillment of the requirements for a Ph. D. at SUNY-Albany by Janet S. Klosko and was supported in part by the Upjohn Company and the National Institute of Mental Health