Determination of Efficacy of Intervention based on the Cognitive-Behavioral Therapy Model of Panic Attack Treatment in Comorbid Heart Diseases: A Pilot Randomized Controlled Trial

Background: Panic disorder (PD) and cardiovascular disease (CVD) exhibit similar symptoms, such as palpitations, dyspnea, and chest pain, complicating clinical differentiation, especially when they coexist. This overlap has led to challenges in the context of psychocardiology, including frequent medical visits, and in some cases, misdiagnoses and inappropriate treatments. The “Panic Attack Treatment in Comorbid Heart Disease (PATCHD)” model implements some modifications to the standard cognitive-behavioral therapy (CBT) for PD to address these issues. We investigated the effectiveness of this model in reducing panic symptom severity among patients with PD and comorbid CVD. Methods: Of the 512 patients with heart disease who were screened, 30 patients with PD comorbid with heart disease were identified as eligible for inclusion in the study. They were randomly assigned–based on a computer-generated sequence–to two experimental and a waiting-list control group. The experimental group received eight weekly 90-min therapy sessions. A licensed clinical psychologist implemented the intervention. To maintain allocation concealment, we used the participant allocation order through opaque, sealed, and sequentially numbered envelopes. We measured PD symptom severity at three time points–pre-test, post-test, and three-month follow-up–using the Panic Disorder Severity Scale (PDSS). The final analysis was based on data from 22 participants who completed all study assessments. Repeated-measures Analysis of Variance (RM-ANOVA) analyzed symptom severity changes over time between the two groups. Results: The RM-ANOVA results showed a significant interaction effect of group and time on the severity of panic symptoms ( P < 0.001, η 2 = 0.73). In the intervention group, the mean PDSS scores decreased from 20.64 ± 3.91 at pre-test to 6.18 ± 4.56 at post-test. This change was in sharp contrast to the control group, whose mean PDSS scores remained essentially unchanged, from 21.00 ± 2.79 at pre-test to 21.18 ± 3.03 at post-test. The reduction observed in the intervention group was stable until the three-month follow-up. Conclusion: The substantial reduction in panic symptoms among the intervention group suggests that the PATCHD model is a promising method for treating panic symptoms in patients with comorbid PD and CVDs. Due to the preliminary nature of this study and the limited sample size, these findings should be interpreted with caution. To draw reliable clinical conclusions from these findings, studies with larger sample sizes and extended follow-up periods are necessary.