Behavioral Treatments of Panic Disorder with Agoraphobia: Treatment Process and Determinants of Change

Abstract

The present dissertation comprises four empirical studies within the area of behavioral treatment of panic disorder with agoraphobia. The focus is on studying issues pertaining to outcome, treatment process and determinants of change. The first study is a randomized controlled treatment study of 73 patients undergoing 16 sessions of either exposure in vivo (E), or cognitive behavior therapy (CBT). Both treatments showed clear improvements at post-treatment that were well maintained at 1-year follow up, and there were no significant differences between the treatments. The second study concerned prediction of outcome in the same sample. From a variety of pre-treatment characteristics severity of avoidance was the one most related to outcome. Most predictors were found unrelated. Two approaches of prediction were also compared: treating outcome as a categorical vs. continuous variable. The different approaches yielded a somewhat dissimilar picture of the impact of pre-treatment severity of avoidance. The third study examined different aspects of the therapeutic relationship, and their relation to outcome. Clients' perceptions of therapists and their ratings of the working alliance were generally not related to outcome at any point. On the other hand, therapists' perceptions of patients as showing goal-direction and active participation were related to outcome from early on in therapy. The fourth study examined different aspects of change. It was found that change in indices of the frequency of panic attacks was not closely related to change in agoraphobic avoidance at post-treatment. Change in avoidance was also more related to other aspects of outcome. At one-year follow-up, a more unitary picture, regarding the different aspects of change was observed.