Maintenance of remission following cognitive behavior therapy for panic disorder: Possible deleterious effects of concurrent medication treatment

In a prospective, naturalistic study, we examined the long-term outcome of patients with panic disorder who entered remission following cognitive behavior therapy (CBT) alone or CBT plus medications (combined treatment). Similar to previous studies, severity of the panic disorder and agoraphobic avoidance served as predictors of relapse in a survival analysis. However, the most powerful predictor of maintenance of remission was treatment type. Despite ongoing pharmacotherapy, patients who entered remission with combined treatment and continued their pharmacologic treatment relapsed sooner than patients treated with CBT who entered remission medication-free. Consideration of baseline levels of anxiety severity, comorbidity, and history of previous remissions did not account for the prediction afforded by consideration of treatment type. These findings are discussed in the context of other evidence for deleterious effects of concomitant pharmacotherapy on the long-term outcome of patients with panic disorder treated with CBT. Treatment implications are discussed.