{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T14:10:18Z","timestamp":1784124618674,"version":"3.55.0"},"reference-count":53,"publisher":"Royal College of Psychiatrists","issue":"6","license":[{"start":{"date-parts":[[2018,1,2]],"date-time":"2018-01-02T00:00:00Z","timestamp":1514851200000},"content-version":"unspecified","delay-in-days":8981,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[1993,6]]},"abstract":"<jats:p>A cross-national randomised trial of alprazolam for chronic panic disorder with agoraphobia was run. Compared with previous trials it had three new features: an exposure therapy contrast group, a six-month treatment-free follow-up, and a low rate of early placebo drop-outs (\u2018non-evaluables\u2019). The dose of alprazolam was high (5 mg\/day). The 154 patients had eight weeks of: alprazolam and exposure (combined treatment); or alprazolam and relaxation (a psychological placebo); or placebo and exposure; or placebo and relaxation (double placebo). Drug taper was from weeks 8 to 16. Follow-up was to week 43. Results were similar at both sites. Treatment integrity was good. All four treatment groups, including double placebo, improved well on panic throughout. On non-panic measures, by the end of treatment, both alprazolam and exposure were effective, but exposure had twice the effect size of alprazolam. During taper and follow-up, gains after alprazolam were lost, while gains after exposure were maintained. Combining alprazolam with exposure marginally enhanced gains during treatment, but impaired improvement thereafter. The new features put previous trials in a fresh light. By the end of treatment, though gains on alprazolam were largely as in previous studies, on phobias and disability they were half those with exposure. Relapse was usual after alprazolam was stopped, whereas gains persisted to six-month follow-up after exposure ceased. Panic improved as much with placebo as with alprazolam or exposure.<\/jats:p>","DOI":"10.1192\/bjp.162.6.776","type":"journal-article","created":{"date-parts":[[2008,10,15]],"date-time":"2008-10-15T01:21:28Z","timestamp":1224033688000},"page":"776-787","source":"Crossref","is-referenced-by-count":320,"title":["Alprazolam and Exposure Alone and Combined in Panic Disorder with Agoraphobia"],"prefix":"10.1192","volume":"162","author":[{"given":"Isaac M.","family":"Marks","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard P.","family":"Swinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Metin","family":"Ba\u015fo\u01e7lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Kuch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Homa","family":"Noshirvani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geraldine","family":"O'Sullivan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul T.","family":"Lelliott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene","family":"Kirby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"McNamee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seda","family":"Sengun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Wickwire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2018,1,2]]},"reference":[{"key":"S0007125000180912_ref53","volume-title":"Behaviour Therapy Techniques.","author":"Wolpe","year":"1966"},{"key":"S0007125000180912_ref25","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-73543-1_5"},{"key":"S0007125000180912_ref31","volume-title":"Living with Fear.","author":"Marks","year":"1978"},{"key":"S0007125000180912_ref48","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1988.01800290043006"},{"key":"S0007125000180912_ref13","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1192\/bjp.160.2.191","article-title":"Drug treatment of panic disorders. Comparative efficacy of alprazolam, imipramine and placebo","volume":"160","year":"1992","journal-title":"British Journal of Psychiatry"},{"key":"S0007125000180912_ref47","unstructured":"O'Sullivan G. & Marks I. M. , Ba\u015fo\u01e7lu M. , et al (1992) Side effects of alprazolam. (Submitted for publication.)"},{"key":"S0007125000180912_ref51","volume-title":"Structured Clinical Interview for DSM-III, Upjohn version (SCID-UP).","author":"Spitzer","year":"1983"},{"key":"S0007125000180912_ref36","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(79)90041-X"},{"key":"S0007125000180912_ref12","doi-asserted-by":"publisher","DOI":"10.1007\/BF00464571"},{"key":"S0007125000180912_ref6","doi-asserted-by":"crossref","unstructured":"Ba\u015fo\u01e7lu M. , Marks I. M. , Kilic C. , et al (1993b) Alprazolam and exposure for panic disorder with agoraphobia: attribution of improvement to medication predicts subsequent relapse. (Submitted for publication.)","DOI":"10.1192\/bjp.164.5.652"},{"key":"S0007125000180912_ref52","article-title":"Clonazepam vs alprazolam in the treatment of panic disorder: interim analysis of a prospective, double-blind, placebo-controlled trial","volume":"48","author":"Tesar","year":"1987","journal-title":"Journal of Clinical Psychiatry"},{"key":"S0007125000180912_ref11","doi-asserted-by":"publisher","DOI":"10.1177\/106002808602001102"},{"key":"S0007125000180912_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)92524-6"},{"key":"S0007125000180912_ref16","doi-asserted-by":"crossref","unstructured":"Echebur\u00faa E. , Decorral P. & Bajos E. G. (1993) Self-exposure and alprazolam in the treatment of agoraphobia without current panic. Behavioural Psychotherapy (in press).","DOI":"10.1017\/S1352465800010481"},{"key":"S0007125000180912_ref50","doi-asserted-by":"publisher","DOI":"10.1017\/S0790966700016669"},{"key":"S0007125000180912_ref8","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1961.01710120031004"},{"key":"S0007125000180912_ref7","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1992.01820090009002"},{"key":"S0007125000180912_ref37","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1983.01790020047004"},{"key":"S0007125000180912_ref46","volume-title":"Handbook of Anxiety","volume":"Vol. 4","author":"O'Sullivan","year":"1990"},{"key":"S0007125000180912_ref29","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1988.01800290053007"},{"key":"S0007125000180912_ref35","volume-title":"Nursing in Behavioural Psychotherapy.","author":"Marks","year":"1977"},{"key":"S0007125000180912_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7894(87)80047-3"},{"key":"S0007125000180912_ref42","first-page":"111","article-title":"Quality assurance of outcome in mental health care in clinical settings","volume":"20","author":"McDonald","year":"1988","journal-title":"Health Trends"},{"key":"S0007125000180912_ref34","volume-title":"Fears, Phobias and Rituals.","author":"Marks","year":"1987"},{"key":"S0007125000180912_ref43","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7894(89)80128-5"},{"key":"S0007125000180912_ref19","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.112.484.309"},{"key":"S0007125000180912_ref40","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1192\/S0007125000035583","article-title":"Comment on the second phase of the Cross-National Panic Study","volume":"160","author":"Marks","year":"1992","journal-title":"British Journal of Psychiatry"},{"key":"S0007125000180912_ref5","doi-asserted-by":"crossref","unstructured":"Ba\u015fo\u01e7lu M. , Marks I. M. , Kilic C. , et al (1993a) The relationship between panic, anticipatory anxiety, agoraphobia, and global involvement in panic disorders with agoraphobia treated with alprazolam and exposure. (Submitted for publication.)","DOI":"10.1192\/bjp.164.5.647"},{"key":"S0007125000180912_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/0887-6185(88)90026-6"},{"key":"S0007125000180912_ref3","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1988.01800290027004"},{"key":"S0007125000180912_ref15","first-page":"458","article-title":"Effect of alprazolam and diazepam on anxiety and panic attacks in panic disorder: a controlled study","volume":"47","author":"Dunner","year":"1986","journal-title":"Journal of Clinical Psychiatry"},{"key":"S0007125000180912_ref30","doi-asserted-by":"publisher","DOI":"10.1007\/BF02219714"},{"key":"S0007125000180912_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7894(05)80224-2"},{"key":"S0007125000180912_ref24","volume-title":"APA Abstracts, Montreal, May 10.","author":"Kellner","year":"1988"},{"key":"S0007125000180912_ref26","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291700003214"},{"key":"S0007125000180912_ref2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1991.tb03097.x"},{"key":"S0007125000180912_ref17","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-73543-1_8"},{"key":"S0007125000180912_ref38","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.152.4.522"},{"key":"S0007125000180912_ref41","first-page":"117","article-title":"Agoraphobia: therapist-assisted in vivo exposure and imipramine","volume":"47","author":"Mavissakalian","year":"1986","journal-title":"Journal of Clinical Psychiatry"},{"key":"S0007125000180912_ref21","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4899-0827-8_20"},{"key":"S0007125000180912_ref33","volume-title":"Behavioural Psychotherapy: Maudsley Pocketbook of Management.","author":"Marks","year":"1986"},{"key":"S0007125000180912_ref39","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1001\/archpsyc.1989.01810070094015","article-title":"The \u2018efficacy\u2019 of alprazolam in panic disorder and agoraphobia: a critique of recent reports","volume":"46","author":"Marks","year":"1989","journal-title":"Archives of General Psychiatry"},{"key":"S0007125000180912_ref14","first-page":"13","article-title":"An out-patient psychiatric rating scale: preliminary report","volume":"9","author":"Derogatis","year":"1973","journal-title":"Psychopharmaco-logical Bulletin"},{"key":"S0007125000180912_ref18","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1176\/ajp.144.3.303","article-title":"Discontinuation of alprazolam in panic patients","volume":"144","author":"Fyer","year":"1987","journal-title":"American Journal of Psychiatry"},{"key":"S0007125000180912_ref28","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-198710000-00004"},{"key":"S0007125000180912_ref44","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1176\/ajp.143.11.1464","article-title":"Withdrawal syndrome with gradual tapering of alprazolam","volume":"143","author":"Mellman","year":"1986","journal-title":"American Journal of Psychiatry"},{"key":"S0007125000180912_ref49","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291700000660"},{"key":"S0007125000180912_ref10","doi-asserted-by":"publisher","DOI":"10.1037\/0735-7044.104.1.44"},{"key":"S0007125000180912_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3956(84)90045-1"},{"key":"S0007125000180912_ref23","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.23.1.56"},{"key":"S0007125000180912_ref22","doi-asserted-by":"publisher","DOI":"10.1111\/j.2044-8341.1959.tb00467.x"},{"key":"S0007125000180912_ref32","volume-title":"Psychiatric Nurse Therapists in Primary Care. Research Series.","author":"Marks","year":"1985"},{"key":"S0007125000180912_ref45","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-198902000-00005"}],"container-title":["British Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0007125000180912","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,5,15]],"date-time":"2019-05-15T19:02:21Z","timestamp":1557946941000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0007125000180912\/type\/journal_article"}},"subtitle":["A Controlled Study in London and Toronto"],"short-title":[],"issued":{"date-parts":[[1993,6]]},"references-count":53,"journal-issue":{"issue":"6","published-print":{"date-parts":[[1993,6]]}},"alternative-id":["S0007125000180912"],"URL":"https:\/\/doi.org\/10.1192\/bjp.162.6.776","relation":{},"ISSN":["0007-1250","1472-1465"],"issn-type":[{"value":"0007-1250","type":"print"},{"value":"1472-1465","type":"electronic"}],"subject":[],"published":{"date-parts":[[1993,6]]}}}