Article Text

Which psychotherapy is effective in panic disorder? And which delivery formats are supported by the evidence? Study protocol for two systematic reviews and network meta-analyses
  1. Davide Papola1,
  2. Giovanni Ostuzzi1,
  3. Chiara Gastaldon1,
  4. Marianna Purgato1,
  5. Cinzia Del Giovane2,
  6. Alessandro Pompoli3,
  7. Eirini Karyotaki4,
  8. Marit Sijbrandij4,
  9. Toshi A Furukawa5,
  10. Pim Cuijpers4,
  11. Corrado Barbui1
  1. 1WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation; Department of Neuroscience, Biomedicine and Movement Sciences; Section of Psychiatry, University of Verona, Verona, Italy
  2. 2Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
  3. 3Psychiatric Rehabilitation Clinic Villa San Pietro, Trento, Italy
  4. 4Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, the Netherlands
  5. 5Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
  1. Correspondence to Dr Davide Papola; candido09{at}


Introduction Panic disorder is among the most prevalent anxiety diseases. Although psychotherapy is recommended as first-line treatment for panic disorder, little is known about the relative efficacy of different types of psychotherapies. Moreover, there is little evidence concerning the effectiveness of different formats of major psychotherapeutic types, such as cognitive–behavioural therapy (CBT). In this protocol, we present an overarching project consisting of two systematic reviews and network meta-analyses (NMA) to shed light on which psychotherapy (NMA-1), and specifically, which CBT delivery format (NMA-2) should be considered most effective for adults suffering from panic disorder with or without agoraphobia.

Methods and analyses Starting from a common pool of data, we will conduct two systematic reviews and NMA of randomised controlled trials examining panic disorder. A comprehensive search will be performed in electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Register of Controlled Trials—CENTRAL from database inception to 1 January 2021 to identify relevant studies. A systematic approach to searching, screening, reviewing and data extraction will be applied. Titles, abstract and—whenever necessary—full texts will be examined independently by at least two reviewers. The quality of the included studies will be assessed using the revised Cochrane risk of bias tool V.2. The primary efficacy outcome will be anxiety symptoms at study endpoint. The primary acceptability outcome will be all-cause discontinuation, as measured by the proportion of patients who had discontinued treatment for any reason at endpoint. Data will be pooled using a random-effects model. Pairwise and NMA will be conducted.

Ethics and dissemination No ethical approval is necessary for these two studies, as there will be no collection of primary data. The results will be disseminated through peer-reviewed publications and presentations at national and international conferences and meetings.

  • anxiety disorders
  • epidemiology
  • adult psychiatry

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  • Twitter @KaryotakiEirini, @Toshi_FRKW

  • Contributors DP and CB conceived the study. DP drafted the protocol manuscript. CB, PC, TAF, EK, MS, GO, MP, CG, CDG and AP assisted in the protocol design and revision. GO, CB, TAF, CDG and DP designed the statistical analysis; PC, TAF and CB are the guarantors. All authors read and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests TAF reports personal fees from Mitsubishi-Tanabe, MSD and Shionogi, and a grant from Mitsubishi-Tanabe, outside the submitted work; TAF has a patent 2018–1 77 688 pending.

  • Patient consent for publication Not required.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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