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Combined Exposure-Drug Therapy for Phobic Disorders

PI: Peter Milgrom, D.D.S., Professor, Dental Public Health Sciences, School of Dentistry, University of Washington

This clinical trial is designed to examine the influence of alprazolam on exposure therapy for fear of dental anesthetic injections. It addresses an important therapeutic and public policy debate over the merit of combining psychoactive medication with traditional psychological treatments to expedite and/or improve therapeutic outcomes. Efficiency is a concern when the patient's life is in danger (such as when a patient is depressed to the point of suicidal ideation) or when it is desirable to decrease time spent in expensive psychological treatment sessions. This issue has attracted attention because managed care organizations have been recommending pharmacological treatment for mental disorders in place of extended psychological therapy.

The study has two primary goals: 1) to determine whether subjects receiving alprazolam progress through exposure therapy more quickly than do subjects receiving placebo, and 2) to determine whether subjects who have received alprazolam during exposure therapy have greater fear of injections in the absence of alprazolam than do subjects who received placebo during exposure therapy

Alprazolam (an anxiolytic medication in the benzodiazepine family) is often used in conjunction with exposure therapy in the treatment of anxiety disorders (e.g., agoraphobia and flight phobia). However, recent studies examining the effects of alprazolam on treatment of agoraphobia and flight phobia have indicated that alprazolam may detract from the therapeutic benefits of exposure therapy. Despite this information, alprazolam continues to be commonly used in clinical settings because it is viewed as being an expedient method of helping patients cope with feared situations. We are aware of no studies examining whether or not anxiolytic medication does indeed decrease psychological treatment time.

Subjects continue to be enrolled. Investigators are six months from breaking the blind and analyzing the data.

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