Mechanism of action in CBT (MAC): methods of a multi-center randomized controlled trial in 369 patients with panic disorder and agoraphobia

Abstract

Cognitive behavioral therapy (CBT) is efficacious for panic disorder with agoraphobia (PD/A). Nevertheless, the active ingredients of treatment and the mechanisms through which CBT achieves its effects remain largely unknown. The mechanisms of action in CBT (MAC) study was established to investigate these questions in 369 patients diagnosed with PD/A. The MAC study utilized a multi-center, randomized controlled design, with two active treatment conditions in which the administration of exposure was varied, and a wait-list control group. The special feature of MAC is the way in which imbedded experimental, psychophysiological, and neurobiological paradigms were included to elucidate therapeutic and psychopathological processes. This paper describes the aims and goals of the MAC study and the methods utilized to achieve them. All aspects of the research design (e.g., assessments, treatment, experimental procedures) were implemented so as to facilitate the detection of active therapeutic components, and the mediators and moderators of therapeutic change. To this end, clinical, behavioral, physiological, experimental, and genetic data were collected and will be integrated.

Allelic variation in CRHR1 predisposes to panic disorder: evidence for biased fear processing

“…8) was obtained from the national research initive "Panic-Net" founded by the Federal Ministry of Education and Research 36 ; details on the sample as well as the study workflow were previously published 32,37 . The diagnosis of PD/AG (co-morbid AG was an inclusion criterion, so all patients suffered thereof) was established by a structured clinical interview (CIDI) according to DSM-IV criteria 35 .…”

Long-term stability of cognitive behavioral therapy effects for panic disorder with agoraphobia: A two-year follow-up study

“…Further details about the therapy and study design have already been published (Gloster et al, 2009;Lang et al, 2012).…”

“…This approach builds upon other studies that examine the global effects of CBT compared to another treatment modalities or treatment packages. Specifically, the treatment examined in this study utilized two procedural variations of CBT (i.e., exposure in situ in the presence of the therapist vs. planned in the therapy room), but were identical in content (Gloster et al, 2009;Lang et al, 2012).…”

Neuropeptide S receptor gene — converging evidence for a role in panic disorder

“…30 Patients with bipolar disorder, schizophrenia, mental retardation, neurological and neurodegenerative disorders were not included in this study, 35% of the patients suffered from a 12-month comorbid diagnosis of depression. 31 All patients were free of psychotropic medication. For categorical association studies, control subjects matched 1:1 by sex (n = 277, women 209, men 68; mean age 28.90 ± 7.67 years) were drawn from a larger number of screened healthy controls (n = 519, women 361, men 158; mean age 25.61±6.72 years).…”

“…The replication sample is a subsample of patients from the mechanisms of action in cognitive-behavioral therapy (MAC) study in patients with panic disorder with agoraphobia 31 obtained from the BMBF 'Panic Network' consisting of 277 of the total 369 included patients. In the patient sample (n = 277, women 209, men 68; mean age 36.40 ± 10.96 years), the diagnosis of panic disorder with agoraphobia was established by a structured clinical interview and verified by clinical interview (CIDI) according to DSM-IV criteria.…”