Preliminary Clinical Outcomes of Culturally Adapted Cognitive Behavioral Therapy for Reducing Panic Disorder Symptoms and Improving Quality of Life: Pilot Study

Abstract

Cognitive behavioral therapy (CBT) is an evidence-based treatment for panic disorder, but culturally adapted interventions remain insufficiently studied in Palestinian populations. Pilot trials are needed to estimate recruitment, retention, acceptability, and preliminary clinical outcomes before a definitive trial is undertaken. To examine preliminary clinical outcomes of a culturally adapted cognitive behavioral therapy (CA-CBT) intervention for reducing panic disorder symptoms and improving quality of life among Palestinian adults. A two-arm randomized pilot study with a waitlist control was conducted among 30 adults diagnosed with panic disorder in the West Bank of Palestine. Participants were allocated to CA-CBT (n = 15) or waitlist control (n = 15). The intervention comprised structured weekly brief psychotherapy sessions up to 12 individual sessions, adapted to the Palestinian sociocultural context. Panic symptoms were assessed using the Clinical Indicators Scale for Diagnosing Panic Disorder (CISDPD) and the Hamilton Anxiety Rating Scale (HAM-A), while quality of life was assessed using the WHOQOL-BREF. Analyses were conducted among participants who completed post-intervention assessments; therefore, outcome estimates should be interpreted as complete-case pilot findings. Thirty participants were enrolled, and 22 completed post-intervention assessment (CA-CBT: 13/15, 86.7%; waitlist: 9/15, 60.0%). Mixed-model repeated-measures ANOVA showed significant group × time interactions for CISDPD (F(1, 20) = 112.81, p < 0.001, partial η2 = 0.85) and WHOQOL-BREF (F(1, 20) = 10.67, p = 0.004, partial η2 = 0.35). The HAM-A group × time interaction was borderline and should be interpreted cautiously (F(1, 20) = 3.48, p = 0.05, partial η2 = 0.15). The findings provide feasibility evidence and preliminary outcome estimates to inform a fully powered randomized controlled trial with prespecified feasibility criteria, intention-to-treat analysis, treatment-fidelity assessment, and longer-term follow-up. Ethics approval: The study was approved by the Research Ethics Secretariat of Universiti Kebangsaan Malaysia (Approval No. JEP-2024-551). All participants received information about the study and provided written informed consent before participation. The study was not prospectively registered as a clinical trial.