Two controlled studies were identified involving the combined use of CBT and DCS in the treatment of panic disorder with or Diperodon without agoraphobia. One found positive results and the other found weak results for enhancement with DCS. In Otto et al., patients with or without agoraphobia and panic disorder severity of at least 4 on the CGIS were selected for 5 sessions of CBT. This was the first study using DCS for a treatment protocol emphasizing exposure to feared internal sensations. Thirty-one participants were randomized to 50 mg of DCS or placebo, administered one hour before 3�C5 sessions of CBT. Most study participants were taking psychoactive medications at stable doses for at least two months before entering the trial without positive results. Soon after the end of treatment and at 1-month follow-up, the group that received DCS instead of placebo showed better results on the Panic Disorder Severity Scale and CGI-S, changes which were clinically significant, and larger effect size. Treatment gains were maintained at 1-month follow-up, although the difference between the DCS group and the placebo group with regard to participants meeting criteria for clinically significant change was no longer significant at follow-up. The study suggests that DCS was effective for participants who failed to respond adequately to the traditional drug treatment for panic disorder. Siegmund et al. randomized 39 participants with panic disorder and agoraphobia. All of them received 11 CBT sessions. This is the only study that used flooding. One hour before the beginning of each exposure session, patients received 50 mg of DCS or placebo. After randomization, the Sivelestat sodium tetrahydrate baseline assessment showed differences between the groups in three secondary measures; in all of them, the DCS group had less severity than the placebo group. However, comorbidities were significantly higher in the placebo group. Both groups improved after treatment and there was no statistical difference in the primary outcome measure �C Panic and Agoraphobia Scale, or on any of the secondary outcome measures. However, subsequent evaluation showed a statistical tendency to greater reduction of the PAS score in the DCS group.