Several additional studies highlight effective treatment approaches and potential medication risks in patients with PD. Findings published in Psychiatry and Clinical Neurosciences in 2015 show that approximately 61% of patients with PD studied had psychological dependence on benzodiazepines, as measured by the Severity of Dependence Scale (SDS).4 “This may be especially true for patients with PD that is characterized by expectation anxiety,” study co-author Hiroyuki Uchida, MD, PhD, a senior lecturer in the department of neuropsychiatry at the Keio University School of Medicine in Tokyo, told Psychiatry Advisor. Such patients likely become dependent due to fear that symptoms will return if they discontinue the medication. “This speculation is supported by the significant association between greater severity of illness and more frequent psychological dependence on benzodiazepines.” He advises that physicians should consider the high rate of psychological dependence on benzodiazepines in patients with PD before prescribing them, especially for patients whose illness is severe. Patients should also be informed about the risk and benefits of these medications, and safer treatment options such as selective serotonin reuptake inhibitors should be considered, though they confer risks of their own.

In terms of psychotherapeutic approaches, a study reported in Psychotherapy and Psychosomatics investigated the efficacy of acceptance and commitment therapy (ACT) in 43 patients with PD who had not responded to previous treatment attempts, such as medication, cognitive-based approaches, and exposure therapy.5 According to results, the patients improved significantly –vs previous treatment efforts and compared with a wait-list control group in the current study– after 4 weeks of twice-weekly sessions of ACT administered by novice therapists.  A follow-up assessment 6 months posttreatment found that the patients had maintained these improvements in functioning and symptomatology.

Specific tools and techniques that are body-focused seem to be especially helpful for patients with PD.  A study reported in Depression and Anxiety in 2015 linked regular aerobic exercise to greater improvement on the Hamilton Anxiety Scale in PD patients receiving cognitive behavioral therapy (CBT) compared with those in a low-intensity exercise control group who also received CBT.6 The improvement may be due to the effects of higher-intensity exercise on the neuroendocrine stress response, as the researchers found in 2014.7

Training patients in therapeutic breathing techniques can also help to reduce symptoms of PD, according to research that appeared in a 2015 issue of the Bulletin of the Menninger Clinic.8 “The simple breathing techniques can give patients a great sense of control. They can use it when they start feeling panicky or anxious,” Sunyoung Kim, PhD, associate professor of psychology at the University of Hawaii at Hilo, told Psychiatry Advisor. Kim co-authored the study while working previously at the Stanford University School of Medicine. “Also, breathing training itself helps them realize that they can handle mild discomfort without developing a panic attack.”

References

  1. National Institutes of Health: National Institute of Mental Health. Panic Disorder. Available at: http://www.nimh.nih.gov/health/topics/panic-disorder/index.shtml#part_145355.  Accessed December 15, 2015.
  2. Batterham PJ, Mackinnon AJ, Christensen H. The panic disorder screener (PADIS): development of an accurate and brief population screening tool. Psychiatry Res. 2015;228(1):72-76.
  3. Pattyn T, Van Den Eede F, Lamers F, Veltman D, Sabbe BG, Penninx BW. Identifying panic disorder subtypes using factor mixture modeling. Depress Anxiety. 2015;32(7):509-517.
  4. Fujii K, Uchida H, Suzuki T, Mimura M. Dependence on benzodiazepines in patients with panic disorder: A cross-sectional study. Psychiatry Clin Neurosci. 2015;69(2):93-99.
  5. Gloster AT, Sonntag R, Hoyer J, et al. Treating treatment-resistant patients with panic disorder and agoraphobia using psychotherapy: a randomized controlled switching trial. Psychother Psychosom. 2015; 84(2):100-109.
  6. Gaudlitz K, Plag J, Dimeo F, Ströhle A. Aerobic exercise training facilitates the effectiveness of cognitive behavioral therapy in panic disorder. Depress Anxiety. 2015;32(3):221-228.
  7. Plag J, Gaudlitz K, Schumacher S, et al. Effect of combined cognitive-behavioural therapy and endurance training on cortisol and salivary alpha-amylase in panic disorder. J Psychiatr Res. 2014;58:12-19.
  8. Kim S, Roth WT, Wollburg E. Effects of therapeutic relationship, expectancy, and credibility in breathing therapies for anxiety. Bull Menninger Clin. 2015;79(2):116-130.