Cognitive Behavioral Therapy vs. Eye Movement Desensitization and Reprocessing for Treating Panic Disorder: A Randomized Controlled Trial

Ferdinand Horst, Brenda Den Oudsten, Wobbe Zijlstra, Ad de Jongh, Jill Lobbestael, Jolanda De Vries, Ferdinand Horst, Brenda Den Oudsten, Wobbe Zijlstra, Ad de Jongh, Jill Lobbestael, Jolanda De Vries

Abstract

Objective: Cognitive Behavioral Therapy (CBT) is an effective intervention for patients with panic disorder (PD). From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR) therapy could also be useful in the treatment of PD because: (1) panic attacks can be experienced as life threatening; (2) panic memories specific to PD resemble traumatic memories as seen in posttraumatic stress disorder (PTSD); and (3) PD often develops following a distressing life event. The primary objective of this Randomized Controlled Trial (RCT), was to compare EMDR therapy with CBT for PD and determine whether EMDR is not worse than CBT in reducing panic symptoms and improving Quality Of Life (QOL). Methods: Two-arm (CBT and EMDR) parallel RCT in patients with PD (N = 84). Patients were measured at baseline (T1), directly after the last therapy session (T2), and 3 months after ending therapy (T3). Non-inferiority testing (linear mixed model with intention-to-treat analysis) was applied. Patients were randomly assigned to 13 weekly 60-min sessions of CBT (N = 42) or EMDR therapy (N = 42). Standard protocols were used. The primary outcome measure was severity of PD at T3, as measured with the Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ), and the Mobility Inventory (MI). The secondary outcome measure was QOL, as measured with the World Health Organization Quality of Life short version (WHOQOL-Bref), at T3. Results: The severity of PD variables ACQ and BSQ showed non-inferiority of EMDR to CBT, while MI was inconclusive (adjusted analyses). Overall QOL and general health, Psychological health, Social relationships, and Environment showed non-inferiority of EMDR to CBT, while Physical health was inconclusive. Conclusion: EMDR therapy proved to be as effective as CBT for treating PD patients. Trial Registration: Dutch Trial Register, Nr. 3134 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3134.

Keywords: CBT; EMDR; Panic disorder; RCT; psychotherapy.

Figures

Figure 1
Figure 1
Flow of participants through the trial.
Figure 2
Figure 2
Unadjusted effects and 90% CI of (A) the symptoms and (B) the quality of life facet and domains at T3. ACQ, Agoraphobic Cognitive Questionnaire; BSQ1, Body Symptoms Questionnaire (amount of fear); BSQ2, Body Symptoms Questionnaire (how often sensations are experienced); CBT, Cognitive Behavioral Therapy; CI, Confidence Interval; EMDR, Eye Movement Desensitization and Reprocessing; MI-ac, Mobility Inventory (when accompanied); MI-al, Mobility Inventory (when alone); QOL, Quality Of Life; OQOL/GH, Overall Quality Of Life and General Health.

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