How is panic disorder treated by psychotherapy

09.01.2009 09:39

Panic disorders can be treated 90 percent successfully

Jan Messerschmidt Press and information office
Ernst Moritz Arndt University of Greifswald

People who suffer from panic attacks and claustrophobia (agoraphobia) can be relieved of their suffering in a relatively short time with special psychotherapy. This is proven by a Germany-wide study that will be completed these days. The Institute for Psychology at the University of Greifswald was also involved in the project. 47 of the total of 360 study participants were treated here.

In Germany around 2.5 million people suffer from panic attacks and agoraphobia. Around 70% of patients with panic disorders also suffer from other diseases (alcohol addiction, phobias, depression). Around 28% are dependent on medication. As a rule, those affected only receive psychotherapy after seven years. "Through an early intervention we could save many patients a lot of suffering and also a lot of money for the health insurance contributors. For this reason we took part in a tender by the Federal Ministry of Education and Research. The Ministry saw an urgent need for action in researching the effectiveness of psychotherapy. Ours A consortium with Dresden, Berlin and Greifswald as lead centers was supported with a sum of 3.5 million euros. Greifswald received around 400,000 euros of this. " This explains Professor Dr. Alfons Hamm Institute for Psychology, University of Greifswald.

Even if the follow-up examinations are not yet fully completed, the interim results show that almost 90 percent of patients can be helped with six weeks of behavioral therapy. You will learn how to deal with fear in a functional way over the long term.
The effect sizes of the therapy are extremely good. "We measured an effect size of 2.26 for the reduction in self-assessed anxiety. That is exceptionally good. Those affected become more mobile again and they overcome their fear of fear if we confront them with reality during the treatment. That means, them have to take the bus, visit a department store or go for a walk alone in the forest, all things that they have avoided for a long time because they were afraid of panic attacks, "says Prof. Dr. Alfons Hamm.
The psychologist hopes that the very efficient therapy will be introduced across the board. In this way, more affected people could be helped. In Mecklenburg-Western Pomerania, patients often wait a year for treatment. In addition, the therapy is relatively inexpensive.

Additional Information:
The clinical picture
Panic disorder is characterized by recurring panic attacks, i.e. episodes of rapidly increasing fear, combined with massive body symptoms (heartbeat, sweating, dizziness, etc.) and fears of dying, losing control, or embarrassing yourself in a panic attack. While panic attacks are a common and unproblematic phenomenon, panic disorder is characterized by anticipatory anxiety (fear of fear) and attempts to avoid fear (physical restraint, avoiding coffee, etc.).
In a second step, many panic patients avoid not only the anxiety attacks themselves, if possible, but also situations in which they could be "defenseless" at the mercy of them (being alone, crowds, narrow spaces, wide spaces). This phenomenon is known as claustrophobia or agoraphobia.
Unfortunately, avoiding anxiety only helps in the short term and all attempts to avoid anxiety lead to an increase in anticipatory anxiety in the long term.

In Germany, 3.6 percent of the population is affected. The disorder most commonly occurs between the ages of 25-30. Women are affected more often than men. 70% of patients with panic disorders also suffer from other diseases (alcohol addiction, phobias, 30-50% have had depression in the course of their life).

Therapy as part of the examination
In a compact behavioral therapy, the patient is taught how to deal with fear in a functional way over the long term. First the patients confront themselves with physical symptoms and in a second step with fear-inducing situations such as bus, department store, forest, whereby they neglect avoidance (escape, distraction or safety signals) and allow the fear until it subsides on its own.
Drug therapy is counterproductive in the long term for this group of patients, as it maintains the function of avoiding anxiety. Benzodiazepines in particular, such as Diazepam or Faustan, can cause the disease to become chronic. They also harbor a high potential for dependency.

The project
The entire project was applied for based on a call for tenders from the Federal Ministry of Education and Research. 5 of 38 applications were approved.
After Dresden and Berlin, Greifswald is the center with the most patients. Seven certified psychotherapists are now working in the outpatient department of the Institute for Psychology in this project. All therapists were trained by the responsible center in Dresden to carry out this standardized therapy (manual-controlled). The therapies were recorded and assessed by Dresden.

An interim evaluation shows extremely encouraging results. The effect sizes of the therapy are extremely good.
We have an effect size of 2.26 for the decrease in self-assessed anxiety (one speaks of a strong effect with an effect size of 0.8). It looks even better in the external assessment (2.8).
- The mobility, which is clearly restricted in these patients, increases again significantly, whereby the patients particularly benefit from the stimulus confrontation in reality (exposure in vivo). The effect size here is 1.65.
- The therapy is carried out by most of the patients (90%) up to the follow-up to the follow-up after one year. Ten percent of patients drop out of therapy. That is a very low rate.
- High effect sizes also result from the so-called secondary effect variables (e.g. quality of life, depression, ability to work). In addition to anxiety, depression is also significantly reduced (effect size 0.7). This is important because many patients are routinely prescribed antidepressant medication: Depressivity is also reduced by adequate psychotherapy, which means that antidepressant medication is no longer necessary.
- Significant cost savings can be achieved with the therapy. The cost-benefit ratio is 1: 5.6.

Contact person for queries:
Professor Dr. Alfons Hamm
Institute for Psychology, University of Greifswald
Franz-Mehring-Str. 47, 17487 Greifswald
Telephone 03834 86-3715
Fax 03834 86-3736
[email protected]

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