공황장애 환자에서의 인지 행동 치료의 약물감량 효과

The Effects of Cognitive Behavioral Therapy for Diseontinuation of Medication in Panic Disorder

Objective: The purpose of this study is to determine whether CBT is effective in tapering or discontinuing medication regardless of the type of medication and its maintenance effects after long-term follow up. Method:224 patients meet DSM-IV criteria for panic disorder with or without agoraphobia completed 12 weekly sessions of Panic Control Therapy (PCT ; Barlow et al.). 80 patients who were using benzodiazepines alone and 144 patients who were using benzodiazepines and Antidepressants were measured with several screening scales at the pre- and post-treatment. The scales were Beck Depression Inventory (BDI), Spielberg State Anxiety Inventory (STAI-State), Spielberg Trait Anxiety Inventory (STAI-Trait), Body Sensation Questionnaire (BSQ), Agoraphobic Cognition Questionnaire (ACQ), Anxiety Sensitivity Index (ASI), Panic Belief Questionnaire (PBQ). These patients were assessed at 3 months, 6 months, 12 months of follow up and they were also assessed for their medications, panic frequency, and End-State Functioning. Results: After the completion of PCP, both benzodiazepines alone group and benzodiazepines and antidepressants combination group showed significant improvement (p<0.001) in all the results on-self reported questionnaires. 54% of patients discontinued their medication and 90.9% of patients were in RES at post-treatment. 70 % of patients were in RES at 3 month, 6 month, and 12 month follow up. The patients who could not discontinue medication also tapered their medication afterwards. The rate of discontinuing medication was significantly higher for the patients using benzodiazepines alone (86.3%) than patients using combination of benzodiazepines and antidepressants (56.3%). Conclusion: These findings support cognitive behavioral therapy can replace medication and these effects seem to last long. (Korean J Psychopharmacol 2003;14(4):367-376)