A systematic review of predictors and moderators of improvement in cognitive-behavioral therapy for panic disorder and agoraphobia

Porter, Eliora; Chambless, Dianne L.

doi:10.1016/j.cpr.2015.09.004

Cited by 78 publications

(64 citation statements)

References 71 publications

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“…Consistent with two other studies of CBT for panic disorder (see Porter & Chambless, 2015) and with the results of a meta-analysis of expectancy across disorders and types of treatment (Constantino et al, 2011), treatment outcome expectancy as assessed at Session 2, on the whole, predicted better treatment response in the present sample for both treatments with a medium-large effect size. We assessed expectancy after the patient had one or two meetings with the therapist to learn the rationale for the treatment.…”

Section: Discussionsupporting

confidence: 91%

Prediction and moderation of improvement in cognitive-behavioral and psychodynamic psychotherapy for panic disorder.

Chambless

Milrod

Porter

et al. 2017

Journal of Consulting and Clinical Psychology

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Objective To identify variables predicting psychotherapy outcome for panic disorder or indicating which of two very different forms of psychotherapy - Panic-Focused Psychodynamic Psychotherapy (PFPP) or Cognitive-Behavioral Therapy (CBT) - would be more effective for particular patients. Method Data were from 161 adults participating in a randomized controlled trial including these psychotherapies. Patients included 104 women; 118 patients were White, 33 were Black, and 10 were of other races; 24 were Latino(a). Predictors/moderators measured at baseline or by Session 2 of treatment were used to predict change on the Panic Disorder Severity Scale. Results Higher expectancy for treatment gains (Credibility/Expectancy Questionnaire d= -1.05, CI95% [-1.50, -0.60]), and later age of onset (d= -0.65, CI95% [-0.98, -0.32]) were predictive of greater change. Both variables were also significant moderators: Patients with low expectancy of improvement improved significantly less in PFPP than their counterparts in CBT, whereas this was not the case for patients with average or high levels of expectancy. When patients had an onset of panic disorder later in life (≥27.5 yrs. old), they fared as well in PFPP as CBT. In contrast, at low and mean levels of onset age, CBT was the more effective treatment. Conclusions Predictive variables suggest possibly fruitful foci for improvement of treatment outcome. In terms of moderation, CBT was the more consistently effective treatment, but moderators identified some patients who would do as well in PFPP as in CBT, thereby widening empirically supported options for treatment of this disorder.

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Section: Discussionsupporting

confidence: 91%

Prediction and moderation of improvement in cognitive-behavioral and psychodynamic psychotherapy for panic disorder.

Chambless

Milrod

Porter

et al. 2017

Journal of Consulting and Clinical Psychology

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“…Improving the effectiveness of psychological treatments for eating disorders requires the identification of factors that reliably and robustly predict an individual's success or failure in treatment . Identifying reliable predictors of outcome in the treatment of eating disorders has proven difficult thus far.…”

Section: Introductionmentioning

confidence: 99%

Rapid response to eating disorder treatment: A systematic review and meta‐analysis

Linardon

Brennan

Garcia

2016

Intl J Eating Disorders

125

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As there is a solid evidence base supporting the prognostic importance of rapid response, the focus should shift toward identifying the within-treatment mechanisms that predict a rapid response so that the effectiveness of eating disorder treatment can be improved. There is a need for future research to use theories of eating disorders as a guide to assess within-treatment predictors of rapid response. © 2016 Wiley Periodicals, Inc. Int J Eat Disord 2016; 49:905-919.

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“…The large changes across time may also reflect that there was much room for improvement on measures due to low levels reported at baseline. Agoraphobic avoidance has been identified as the most consistent predictor of poorer outcomes in response to CBT (Porter & Chambless, 2015) and our sample had a very high rate of agoraphobia (CBPT=87.5%, MRT=79.2%). Major depressive disorder was also highly comorbid (37.5%) with moderate depression levels on the BDI at baseline.…”

Section: Discussionmentioning

confidence: 73%

Psychological treatment of comorbid asthma and panic disorder in Latino adults: Results from a randomized controlled trial

Feldman

Matte

Interian³

et al. 2016

Behaviour Research and Therapy

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Confusion between panic and asthma symptoms can result in serious self-management errors. A cognitive behavior psychophysiological therapy (CBPT) intervention was culturally adapted for Latinos consisting of CBT for panic disorder (PD), asthma education, differentiation between panic and asthma symptoms, and heart rate variability biofeedback. An RCT compared CBPT to music and relaxation therapy (MRT), which included listening to relaxing music and paced breathing at resting respiration rates. Fifty-three Latino (primarily Puerto Rican) adults with asthma and PD were randomly assigned to CBPT or MRT for 8 weekly sessions. Both groups showed improvements in PD severity, asthma control, and several other anxiety and asthma outcome measures from baseline to post-treatment and 3-month follow-up. CBPT showed an advantage over MRT for improvement in adherence to inhaled corticosteroids. Improvements in PD severity were mediated by anxiety sensitivity in CBPT and by depression in MRT, although earlier levels of these mediators did not predict subsequent improvements. Attrition was high (40%) in both groups, albeit comparable to CBT studies targeting anxiety in Latinos. Additional strategies are needed to improve retention in this high-risk population. Both CBPT and MRT may be efficacious interventions for comorbid asthma-PD, and CBPT may offer additional benefits for improving medication adherence.

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A systematic review of predictors and moderators of improvement in cognitive-behavioral therapy for panic disorder and agoraphobia

Cited by 78 publications

References 71 publications

Prediction and moderation of improvement in cognitive-behavioral and psychodynamic psychotherapy for panic disorder.

Prediction and moderation of improvement in cognitive-behavioral and psychodynamic psychotherapy for panic disorder.

Rapid response to eating disorder treatment: A systematic review and meta‐analysis

Psychological treatment of comorbid asthma and panic disorder in Latino adults: Results from a randomized controlled trial

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