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Behavioral Treatments of Panic Disorder with Agoraphobia: Treatment Process and Determinants of Change
Stockholm University, Faculty of Social Sciences, Department of Psychology.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Stockholm: Psykologiska institutionen , 2005.
Keyword [en]
Panic disorder with agoraphobia, cognitive-behavior therapy, exposure in vivo, outcome prediction, therapeutic relationship, working alliance
National Category
Psychology
Identifiers
URN: urn:nbn:se:su:diva-404ISBN: 91-7155-022-4 (print)OAI: oai:DiVA.org:su-404DiVA: diva2:193460
Public defence
2005-04-08, David Magnussonsalen (U31), hus 8, Frescati hagväg 8, Stockholm, 10:00
Opponent
Supervisors
Available from: 2005-03-14 Created: 2005-03-14Bibliographically approved
List of papers
1. Cognitive behavior therapy vs. exposure in-vivo in the treatment of panic disorder with agoraphobia
Open this publication in new window or tab >>Cognitive behavior therapy vs. exposure in-vivo in the treatment of panic disorder with agoraphobia
2004 In: Behaviour Research and Therapy, ISSN 0005-7967, Vol. 42, no 10, 1105-1127 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:su:diva-23616 (URN)
Note
Part of urn:nbn:se:su:diva-404Available from: 2005-03-14 Created: 2005-03-14Bibliographically approved
2. Prediction of outcome in the behavioral treatment of panic disorder with agoraphobia
Open this publication in new window or tab >>Prediction of outcome in the behavioral treatment of panic disorder with agoraphobia
2004 In: Cognitive Behaviour Therapy, ISSN 1650-6073, Vol. 33, no 4, 176-180 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:su:diva-23617 (URN)
Note
Part of urn:nbn:se:su:diva-404Available from: 2005-03-14 Created: 2005-03-14Bibliographically approved
3. Therapists’ and clients’ perceptions of each other and working alliance in the behavioral treatment of panic disorder with agoraphobia
Open this publication in new window or tab >>Therapists’ and clients’ perceptions of each other and working alliance in the behavioral treatment of panic disorder with agoraphobia
2007 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 7, no 3, 320-328 p.Article in journal (Refereed) Published
Abstract [en]

Fifty-nine patients who fulfilled criteria for a primary diagnosis of panic disorder with moderate to severe agoraphobia were treated with 16 sessions of behavioral therapy. The study investigated the relationship between therapists' and clients' perception of each other, working alliance, and outcome. There was initially a low correspondence between therapist and client perceptions but a growing consensus during treatment. This was most pronounced regarding high ratings of therapist qualities and the perception of the client as attractive. Clients' perceptions showed virtually zero correlation with outcome regardless of time. Therapist perception of client as showing active participation and goal direction yielded positive correlations with outcome at posttreatment and follow-up from Session 4 and throughout treatment. No significant relation between working alliance and outcome was found apart from the fact that those who improved during follow-up rated the alliance significantly higher than those who did not improve.

National Category
Psychology
Identifiers
urn:nbn:se:su:diva-23618 (URN)10.1080/10503300600650852 (DOI)
Available from: 2005-03-14 Created: 2005-03-14 Last updated: 2017-12-13Bibliographically approved
4. Panic and avoidance in panic disorder with agoraphobia: Clinical relevance of change in different aspects of the disorder
Open this publication in new window or tab >>Panic and avoidance in panic disorder with agoraphobia: Clinical relevance of change in different aspects of the disorder
2007 (English)In: Journal of Behavior Therapy and Experimental Psychiatry, ISSN 0005-7916, E-ISSN 1873-7943, Vol. 38, no 1, 29-39 p.Article in journal (Refereed) Published
Abstract [en]

Different aspects of change were examined in 62 patients who fulfilled the DSM-IV criteria for a primary diagnosis of panic disorder with agoraphobia of moderate to severe magnitude, and who were treated with 16 sessions of behavioral therapy. The treatment resulted in substantial effects on panic attacks and agoraphobic avoidance. Panic-free status only differentiated the patients regarding mood at pre- and post-treatment. Changes in panic and avoidance were related to each other, but change in avoidance was more related to change in negative affect. Change in quality of life (QOL) was also more associated with change in avoidance at post-treatment. At follow-up change in QOL was more related to change in panic than change in avoidance.

Keyword
Exposure in vivo, Cognitive-behavior therapy, Negative affect, Quality of life
National Category
Psychology
Identifiers
urn:nbn:se:su:diva-23619 (URN)10.1016/j.jbtep.2006.01.002 (DOI)000243809000004 ()
Available from: 2005-03-14 Created: 2005-03-14 Last updated: 2017-12-13Bibliographically approved

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