CBT did well at both sites, but PFPP performed better at Cornell, where the modality has a strong history.

Attrition rates across both sites were 41% for ART, 25% for CBT, and 22% for PFPP. Results showed that the most symptomatic patients were more likely to drop out of ART compared with CBT or PFPP (P = .013). In the most impaired patients, the attrition rate for patients receiving ART was 69%.

Patients who completed the 3-month course of therapy, regardless of treatment group, were more likely to improve.

Dr Milrod noted that this finding highlights the importance of completing a course of psychotherapy in achieving optimal outcomes. “Patients who do so,” she said, “have a much better chance of getting better.”

The researchers concluded that both CBT and PFPP were more appealing treatments for patients with panic disorder than ART at both Cornell and Penn, regardless of how well trained the therapists were in that modality. But for some patients, ART may still be an effective approach.

“The idea behind this research is how we can best treat this disorder and practice better medicine,” said Dr Milrod. “If one treatment doesn’t benefit the patient, another one probably will. The point is, all three approaches helped people to get better. There is hope.”

Novel Finding

Commenting on the study for Medscape Medical News, Eric Hollander, MD, director, Autism and Obsessive Compulsive Spectrum Program and Anxiety and Depression Program at Albert Einstein College of Medicine, in New York City, said “the study is important because it incorporates psychodynamic psychotherapies for treatment of panic disorder. This hasn’t been shown before.”

“The multisite component also makes the study interesting. What a clinician believes can play a role in how well panic disorder patients do. For example, how strongly a clinician believes in a treatment can be well received by patients,” said Dr. Hollander.

Although the study showed that patients who completed a course of treatment, albeit brief, improved during the multisite trial, Dr Hollander said it is important to consider the generalizability of a given treatment.

“Results may not translate the same as it becomes widely available. Still, the study is helpful because it shines a light on new types of approaches for patients with panic disorder,” he said.

The authors and Dr Hollander report no relevant financial relationships.

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J Clin Psychiatry. Published online June, 9 2015. Abstract