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Stepped care versus face-to–face cognitive behavior therapy for panic disorder and social anxiety disorder: Predictors and moderators of outcome
Haukeland University Hospital and University of Bergen, Bergen, Norway.
Haukeland University Hospital and University of Bergen, Bergen, Norway.
Stockholm University, Faculty of Social Sciences, Department of Psychology. Haukeland University Hospital, Bergen, Norway; Department of Clinical Neuroscience, Karolinska Institutet.
Haukeland University Hospital and University of Bergen, Bergen, Norway.
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2015 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 71, 76-89 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate predictors and moderators of treatment outcome by comparing immediate face-to-face cognitive behavioral therapy (FtF-CBT) to a Stepped Care treatment model comprising three steps: Psychoeducation, Internet-delivered CBT, and FtF-CBT for panic disorder (PD) and social anxiety disorder (SAD).

Method: Patients (N = 173) were recruited from nine public mental health out-patient clinics and randomized to immediate FtF-CBT or Stepped Care treatment. Characteristics related to social functioning, impairment from the anxiety disorder, and comorbidity was investigated as predictors and moderators by treatment format and diagnosis in multiple regression analyses.

Results: Lower social functioning, higher impairment from the anxiety disorder, and a comorbidcluster C personality disorder were associated with significantly less improvement, particularly among patients with PD. Furthermore, having a comorbid anxiety disorder was associated with a better treatment outcome among patients with PD but not patients with SAD. Patients with a comorbid depression had similar outcomes from the different treatments, but patients without comorbid depression had better outcomes from immediate FtF-CBT compared to guided self-help.

Conclusions: In general, the same patient characteristics appear to be associated with the treatment outcome for CBT provided in low- and high-intensity formats when treated in public mental health care clinics. The findings suggest that patients with lower social functioning and higher impairment from their anxiety disorder benefit less from these treatments and may require more adapted and extensive treatment.

Identifier: NCT00619138.

Place, publisher, year, edition, pages
Elsevier, 2015. Vol. 71, 76-89 p.
Keyword [en]
cognitive behavioral therapy, stepped care, guided self-help, internet-delivered CBT, predictors, moderators
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Research subject
URN: urn:nbn:se:su:diva-119609DOI: 10.1016/j.brat.2015.06.002ISI: 000358391400010PubMedID: 26081010ScopusID: 2-s2.0-84931260290OAI: diva2:846968

This study is a part of the adult part of the research project “Assessment and Treatment -Anxiety in Children and Adults. Adult part” (ATACA) and has received support from the Western Norway Regional Health Authority, through project no. 911366 and project no. 911253.

Available from: 2015-08-18 Created: 2015-08-18 Last updated: 2015-08-21Bibliographically approved

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Öst, Lars-GöranCarlbring, Per
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