CBT More Cost-Effective Than SSRI for Panic Disorder


A two-year study of 150 panic-disorder patients found that the societal cost of cognitive-behavioral was less than that of CBT plus SSRI or SSRI alone. When looking at the balance between costs and outcomes, the paper concluded, “both CBT and CBT+SSRI led to more positive outcomes than SSRI” alone. The study was published by Acta Psychiatrica Scandinavica.

Abstract →

Apeldoom, F.J.; Stant, A.D.; van Hout, P.J.; Mersch, P.P.A.; den Boer, J.A.; Cost-effectiveness of CBT, SSRI, and CBT+SSRI in the treatment for panic disorder. Acta Psychiatrica Scandinavica. Online July 3, 2013

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


      • A ‘Good’ counselor is a counselor who paperwork justifies their expenditures by certifying that the client is incurably broken.

        We’re drowning under a tidal wave of young, Pharma U. produced counselors who all need to make the Public Money funded, Non-Profit which gives them their check, happy.

        And the only way to do that is by Increasing the amount of funding that organization gets by increasing the check list/depression rating scale, etc. justification for inflicting More of their useless crap on Everybody they come into contact with.

        A ‘Bad’ counselor couldn’t stomach the con and wouldn’t stick around long enough to get fired.


        This Performance Audit Memo is one of the best arguments I’ve seen yet for abolishing the Feral Dept of Indoctrination/Education.

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      • I would say that a lot of good counselors don’t get funding, and a lot of really bad counselors continue to work for agencies for a long time, especially when involuntary “clients” are involved. I’ve worked with a lot of these agencies, and most don’t know a good counselor from a bad one. Also, the training for counselors these days is really limited, with way too much emphasis on diagnosis and “techniques” of “evidence-based medicine” instead of a proper focus on relationship-building, empowerment, and sensitive and intelligent exploration of current needs as well as of traumatic events that may contribute to the current situation. Good counselors also recognize multiple factors that impact mood and behavior, including basics like food, sleep, and exercise.

        In short, there are good counselors out there, but there’s no guarantee they will be funded or promoted or even allowed to continue to work at a place where they may be too threatening. I’d say that mediocre to poor counselors abound and are probably much safer in their positions than the really good ones, because any really good counselor would find the current practice parameters ridiculously restrictive and often quite destructive and would try to change them, which naturally would upset his/her bosses or someone up the food chain who is invested in the status quo.

        Bottom line, I believe a really effective counselor is bound to have a subversive impact on entrenched bureaucracies, because they’d be focused on the needs of the client vs. the needs of the institution. Such behavior is rarely rewarded in the system.

        —- Steve

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        • Steve;

          Isn’t it amazing that there are so many experts out there who’ve all got the be all, end all Theory of what motivates human beings and how to adjust their motivations/emotions, and yet nobody seems to understand or be willing to turn over the rock to look underneath it, labeled money?

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    There was a very interesting interview on ABC (Australia) television the other day, noting the increased use of meditation, by the U.S. military, and just how cost effective it is. Of course, the person interviewed reported that the acknowledged effectiveness of this approach was being treated with caution and some suspicion, by a very “objectively” rational, medical fraternity, who seem to think it, too good to be true? I guess the point is, we are NOT objects, we are organic, biological creatures? Please watch the interview here;


    Its a view I’ve posted here before, as the increase in understanding, of the role of our autonomic nervous system, in mediating our so-called symptoms of mental-illness, grows?

    See a comprehensive paper issued by the military in 2011, here: http://www.dcoe.health.mil/Content/Navigation/Documents/Mind-Body%20Skills%20for%20Regulating%20the%20Autonomic%20Nervous%20System.pdf

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