Page 1 of 9http://spider.apa.org/ftdocs/ccp/2000/june/ccp683506.html 8/30/2000Effectiveness of an Empirically Based Treatment for Panic Disorder Delivered in a Service Clinic Setting 1-Year Follow-Up Gregory L. StuartCenter for Alcohol and Addiction Studies Brown University Teresa A. TreatDepartment of Psychology Indiana University Wendy A. WadeCenter for Behavioral Health ABSTRACTThe transportability of cognitive—behavioral therapy (CBT) for panic disorder to a community mental health center (CMHC) setting at 1-year follow-up was examined by comparing CMHC treatment outcome data with results obtained in controlled efficacy studies. Participants were 81 CMHC clients with a primary diagnosis of panic disorder with or without agoraphobia who completed CBT for panic disorder. Despite differences in settings, clients, and treatment providers, both the magnitude of change from pretreatment to follow-up and the maintenance of change from posttreatment to follow-up in the CMHC sample were comparable with the parallel findings in the efficacy studies. At follow-up, 89% of the CMHC clients were panic free and a substantial proportion of the sample successfully discontinued benzodiazepine use. Portions of this research were presented at the 30th Annual Association for the Advancement of Behavior Therapy Convention, New York, New York, November 1996. This study would not have been possible without the support of the board of directors, administration, and staff of the Center for Behavioral Health. We thank all the Center for Behavioral Health staff who worked to make this program a success. We also thank Richard M. McFall and Richard J. Viken for their invaluable expertise and advice. Correspondence may be addressed to Gregory L. Stuart, Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, 02912. Electronic mail may be sent to [email protected] Received: March 17, 1999 Accepted: October 14, 1999 Treatment outcome researchers have cautioned that the results of efficacy studies may not generalize from research to service settings because of differences in clients, settings, therapists, and other treatment delivery factors ( Borkovec & Castonguay, 1998 ; Chambless & Hollon, 1998 ; Goldfried & Wolfe, 1998 ; Hollon,1996 ; Jacobson & Christensen, 1996 ; Kendall, 1998a , 1998b ; Kendall & Southam-Gerow, 1995 ; Persons & Silberschatz, 1998 ; Seligman, 1996 ). A promising solution to the generalizability problem is effectiveness research, in which empirically based interventions are evaluated in service settings ( BorkovecJournal of Consulting and Clinical Psychology © 2000 by the American Psychological Association June 2000 Vol. 68, No. 3, 506-512 For personal use only--not for distribution.Page 2 of 9http://spider.apa.org/ftdocs/ccp/2000/june/ccp683506.html 8/30/2000& Castonguay, 1998 ; Hoagwood, Hibbs, & Brent, 1995 ; Kendall, 1998a , 1998b ; Kendall & Southam-Gerow, 1995 ; Persons & Silberschatz, 1998 ). Effectiveness studies can provide invaluable information about factors that may mitigate the transportability of empirically based treatments to other settings. An example comes from our earlier investigation of the transportability of cognitive—behavioral therapy (CBT) for panic disorder to a community mental health center (CMHC) setting ( Wade, Treat, & Stuart, 1998 ). In our original effectiveness study, we used a benchmarking research strategy ( McFall, 1996 ) to evaluate the generalizability of Barlow and Craske's (1994 ) CBT protocol for panic disorder. The benchmarking strategy compares treatment outcome data obtained in service settings with data obtained in efficacy studies. Using point-by-point comparisons of data sets, we found that despite differences in clients, settings, exclusionary criteria, and treatment providers, the outcomes for treatment completers at the CMHC were comparable with treatment outcomes reported in efficacy studies ( Barlow, Craske, Cerny, & Klosko,1989 ; Telch et al., 1993 ). Specifically, 87% of the CMHC treatment completers were panic free at the end of treatment, and they reported significant improvements on measures of anticipatory anxiety, agoraphobia, and depression. There were interesting differences between the CMHC and benchmarking samples: The CMHC group was less educated, was more likely to be taking psychotropic medication, and reported more severe agoraphobia symptoms. Twenty-six percent of the CMHC group did not complete treatment; Barlowet al. (1989 ) and Telch et al. (1993 ) reported the combined loss of 1 participant. One of the goals of treatment in the CMHC sample was discontinuation of potentially addictive anxiolytic medications. Previous research has demonstrated that rebound panic attacks and withdrawal symptoms often follow benzodiazepine tapering ( Fyer et al., 1987 ; Pecknold, Swinson, Kuch, & Lewis, 1988 ), leading to difficulties with medication discontinuation. Benzodiazepine discontinuation for the CMHC participants was modeled after the program described by Spiegel ( Bruce, Spiegel, & Hegel, 1999 ; Spiegel,Bruce, Gregg, & Nuzzarello, 1994 ). The present study extended Wade et al.'s (1998 ) effectiveness research on CBT for panic disorder by extending benchmark comparisons to 1 year posttreatment. Two research teams have conducted follow-up studies of CBT for panic disorder. Telch et al. (1993 ) reported that 83% of their sample was panic free at the 6-month follow-up. In a 2-year follow-up study, Craske, Brown, and Barlow (1991 ) reported that 87% of their sample was panic free. Although our original study suggests the short-term effectiveness of CBT for panic disorder in a CMHC, it is unclear whether these effects hold up over time. Thus, in the present study, we attempted a more rigorous test of CBT transportability by examining treatment outcome at 1 year posttreatment. Once again, we adopted McFall's (1996 ) benchmarking strategy to address the following questions: (a) To what extent are treatment gains sustained in a CMHC sample? and (b) How does the CMHC sample compare with the benchmarking samples on measures of normative functioning? We benchmarked our 1-year follow-up data against the data obtained in two efficacy studies: (a) the study by Craske et al. (1991 ), who presented 2-year follow-up data for the Barlow et al. (1989 ) sample, and (b) the study by Telch et al. (1993 ), who presented 6-month follow-up data on their sample. Method Participants Participants were 81
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