Psychological treatment of comorbid asthma and panic disorder: A pilot study

https://doi.org/10.1016/j.janxdis.2007.07.001Get rights and content

Abstract

We evaluated two protocols for treating adults with comorbid asthma and panic disorder. The protocols included elements of Barlow's panic control therapy and elements of Barlow's “panic control therapy” and several asthma education programs, as well as modules designed to teach participants how to differentiate asthma and panic symptoms, and how to apply specific home management strategies for each. Fifty percent of subjects dropped out of a 14-session protocol by the eighth session; however, 83% of patients were retained in an eight-session protocol. Clinical results were mostly equivalent: significant decreases of >50% in panic symptoms, clinically significant decreases in asthma symptoms, improvement in asthma quality of life, and maintenance of clinical stability in asthma. Albuterol use decreased significantly in the 14-session protocol and at a borderline level I the 8-session protocol, while pulmonary function was maintained. A controlled evaluation of this procedure is warranted.

Section snippets

Methods

The study was approved by the Institutional Review Board of UMDNJ-Robert Wood Johnson Medical School. In both protocols, each session lasted approximately 60-min.

Results

In the 14-session protocol, of the 54 participants who met criteria for PD in the initial screening session and appeared to have a positive history of asthma (prior to the pulmonologist visit), 31 (57%) said that they were not interested in treatment or did not return telephone calls. Thirteen did not meet either DSM-IV criteria for panic disorder or pulmonologist screening criteria for asthma. Of ten participants who began, only five (50%) completed all 14 sessions. These subjects also

Discussion

The effects of both protocols were large and clinically meaningful. Panic symptomatology, as reflected in PDSS scores, dropped by more than 50% and remained low during the follow-up period. Asthma symptoms also decreased during treatment, along with decreases in albuterol use in the 14-session protocol, consistent with better and more appropriate asthma control (National Heart Lung and Blood Institute, 1997, National Heart Lung and Blood Institute, 2002). This decrease did not compromise

Acknowledgements

This work was supported by Grant #R21MH58196 from the National Institute for Mental Health. The authors are indebted to Anthony Scardella, M.D., Mahmood Siddique, M.D., and Stuart Hockron, M.D., for evaluation of asthma, and to Jim Lewellis for help in developing the treatment manual.

References (65)

  • R.A. Peterson et al.

    The anxiety Sensitivity Index: construct validity and factor analytic structure

    Journal of the Anxiety Disorders

    (1987)
  • Z. Rihmer

    Successful treatment of salbutamol-induced panic disorder with citalopram

    European Neuropsychopharmacoligy

    (1997)
  • R.G. Shavitt et al.

    The association of panic/agoraphobia and asthma: Contributing factors and clinical implications

    General Hospital Psychiatry

    (1992)
  • A. Smith et al.

    Psychosocial factors, respiratory viruses and exacerbation of asthma

    Psychoneuroendocrinology

    (2001)
  • A.S. Van Peski-Oosterbaan et al.

    Is there a specific relationship between asthma and panic disorder?

    Behaviour Research and Therapy

    (1996)
  • H. Akaike

    Information theory and an extension of the maximum likelihood principle.

  • R.E. Alberti et al.

    Your perfect right

    (1995)
  • American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, fourth edition...
  • Anonymous (1994). Integrated care for asthma: a clinical, social, and economic evaluation. Grampian Asthma Study of...
  • D. Barlow et al.

    Mastery of your anxiety and panic (MAP-3): Client workbook for anxiety and panic

    (2000)
  • J.H. Barlow et al.

    A review of self-management interventions for panic disorders, phobias and obsessive-compulsive disorders

    Acta Psychiatrica Scandinavica

    (2005)
  • D.H. Barlow et al.

    Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial

    JAMA

    (2000)
  • A.T. Beck et al.

    An inventory for measuring anxiety, Psychometric properties

    Journal of Consulting and Clinical Psychology

    (1988)
  • M. Biondi et al.

    Increased probability of remaining in remission from panic disorder with agoraphobia after drug treatments in patients who received concurrent cognitive behavioural therapy: A follow-up study

    Psychotherapy and Psychosomatics

    (2003)
  • C.M. Brooks et al.

    Subjective symptomatology of asthma in an outpatient population

    Psychosomatic Medicine

    (1989)
  • T.A. Brown et al.

    Anxiety disorders interview schedule for DSM-IV

    (1994)
  • D.L. Chambless et al.

    Assessment of fear of fear in agoraphobics: The Body Sensations Questionnaire and the agoraphobic cognitions questionnaire

    Journal of Consulting and Clinical Psychology

    (1985)
  • M. Cazzola et al.

    Inhaled beta 2-adrenoceptor agonists: cardiovascular safety in patients with obstructive lung disease

    Drugs

    (2005)
  • J. Cohen

    Statistical power analysis for the behavioral sciences

    (1988)
  • A. Custovic et al.

    Allergen avoidance in the treatment of asthma and atopic disorders

    Thorax

    (1998)
  • J.M. Feldman et al.

    Asthma and panic disorder

  • J.M. Feldman et al.

    Health care use and quality of life among patients with asthma and panic disorder

    Journal of Asthma

    (2005)
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