Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Adults with panic disorder with or without agoraphobia
Intervention: Psychologic therapies (psychoeducation; supportive psychotherapy; physiologic therapies; behavior therapy; cognitive therapy; cognitive behavior therapy [CBT]; third-wave CBT; psychodynamic psychotherapy)
Comparison: No treatment; waiting list; attention/psychologic placebo; alternative psychologic therapy from list above
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Remission (short‐term, mean 3 months) | Favors supportive psychotherapy (ranked first) ᵃ ᵇ | Low |
Response (short‐term, mean 3 months) | Favors CBT (ranked first) ᵃ | Low |
Improvement of panic disorder (short‐term, mean 3 months) | Favors psychodynamic therapies (ranked first) ᵃ | Low |
Remission/response (long‐term, mean 12 months) | Favors CBT (ranked first) ᵃ | Low |
Withdrawals (short‐term, mean 3 months) | Favors no treatment (ranked first) ᵃ | Low |
Note The Cochrane review which underpins these results concludes that CBT - the most extensively studied psychologic therapy - was often superior to other therapies, although the effect size was small and the level of precision was often insufficient or clinically irrelevant. Caution is advised when interpreting the ranking of interventions due to GRADE being low for all outcomes. ᵃ The Cochrane Clinical Answer (CCA) is based upon a network meta-analysis where interventions from the same treatment class are compared with multiple options via direct and indirect comparisons which seek to determine the best overall option from that group. It ranks the best performing intervention for each outcome and we have included the interventions which are ranked first for each outcome in this table (please see the CCA for more details). ᵇ For this outcome, supportive psychotherapy was ranked first ahead of CBT, psychodynamic therapies, cognitive training, behavior therapy, physiologic therapies, no treatment, and waiting list. However, the CCA notes that since supportive psychotherapy was connected to the wider network analysis via a single comparison group and was only compared with CBT in the trials evaluated by the reviewers, this result should be interpreted with caution.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the benefits and harms of psychological therapies in adults with panic disorder?
- How do benzodiazepines compare with placebo for adults with panic disorder?
- For adults with depression and anxiety disorders, what are the effects of tapered discontinuation of long‐term antidepressants?
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