Schwartze, D., Barkowski, S., Strauss, B., Burlingame, G., Barth, J., & Rosendahl, J. (2017). Efficacy of group therapy for panic disorder: Meta-analysis of randomized controlled trials. Group Dynamics, 21, 77-93.
Panic disorder (PD) is characterized by recurrent episodes of intense fear or discomfort accompanied by physical and cognitive symptoms that may include sweating, trembling, or fear of dying. The panic attacks can lead to avoidant behavior that results in isolation, impaired functioning and lower quality of life. Often, those with PD also experience agoraphobia or an intense fear of having a panic attack in public, open spaces, or in a crowd. PD has a lifetime prevalence of 5% among adults in the US. Patients with PD use health care services at a higher rate than the general population, and those with PD may not receive adequate treatment. An evidence-based treatment for PD is cognitive behavioral therapy (CBT). Practice guidelines for PD recommend pharmacotherapy and psychotherapy with CBT. However, these practice guidelines do not take into account group therapy for PD. In this meta analysis, Schwartze and colleagues included group treatment studies of PD that were randomized controlled trials (RCT) and in which direct comparisons of group therapy to other treatments were conducted. RCTs of direct comparisons provide the best quality evidence of the efficacy of a treatment approach. The authors included 15 studies (14 of which were of group CBT for panic) that had 864 patients. There was a large significant effect on panic and agoraphobic symptoms favoring group over no-treatment controls (k = 9; g = 1.08; 95% CI [0.82, 1.34]; p = .001). Similar results were found for depressive symptoms and general anxiety symptoms. There was no significant difference between group and alternative PD treatments (pharmacotherapy, individual therapy) on the primary outcomes (k = 6; g = 0.18; 95% CI [-0.14, 0.49]; p = .264). Again similar results were found for depression and anxiety symptoms. In total 78% of patients with PD were symptom-free after group psychotherapy, compared with 33% in no-treatment control groups, and 71% in alternative treatment.
The number of studies were small, but the results of this meta analysis indicate that group therapy is an effective treatment for PD and perhaps as effective as typical alternatives like pharmacotherapy and individual therapy. Group CBT protocols usually involve multiple components such as (a) education regarding the etiology and maintenance of PD, (b) cognitive restructuring (identifying and modifying panic-related cognitions), (c) exposure to external situations (in vivo exposure) or internal bodily sensations (interoceptive exposure), (d) relaxation training and/or breathing retraining. Group therapy may also provide a lower cost, more accessible, and possibly as effective treatment alternative than individual therapy for PD.