Perceived criticism predicts outcome of psychotherapy for panic disorder: Replication and extension.

Abstract

Objective We tested the relation of perceived criticism from a parent or spouse/romantic partner to outcome of psychotherapy for panic disorder. Method Participants were 130 patients with panic disorder (79% with agoraphobia) who received 24 twice weekly sessions of Panic-Focused Psychodynamic Psychotherapy, Cognitive-Behavioral Therapy, or Applied Relaxation Therapy. Patients were predominantly White (75%), female (64%), and non-Hispanic (85%). At baseline, Week 5 of treatment, termination, and at 6- and 12-month follow-up, patients rated perceived criticism from the relative with whom they lived. Independent evaluators assessed the severity of panic disorder at baseline, Weeks 1, 5, and 9 of treatment, termination, and the two follow-up points. Data were analyzed with piecewise (treatment phase, follow-up phase) latent growth curve modeling. Results The latent intercept for perceived criticism at baseline predicted the latent slope for panic severity in the follow-up (p = .04) but not the active treatment phase (p = .50). In contrast, the latent intercept for panic disorder severity at baseline did not predict the latent slope on perceived criticism in either phase (ps ≥ .29). Nor did the slopes of perceived criticism and panic disorder severity covary across treatment (p = .31) or follow-up (p =.13). Indeed, perceived criticism did not change significantly across treatment (p =.45), showing the stability of this perception regardless of significant change in severity of patients’ panic disorder (p < .001). Conclusions Because perceived criticism predicts worse long-term treatment outcome for panic disorder, study findings argue for interventions to address perceived criticism in treatment.

Compassionate and self‐image goals as interpersonal maintenance factors in clinical depression and anxiety

“…Whereas previous research has linked negative social perceptions (e.g., Chambless et al., ; Gotlib et al., ; Rodebaugh et al., ) and unsupportive social reactions from others (e.g., Heerey & Kring, ; Starr & Davila, ) to clinical dysphoria and anxiety, the present findings implicate interpersonal goals as relatively unexplored factors that may shape social perceptions, relationship satisfaction, and distress symptoms. First, our results support hypothesized links between goals and symptoms: Participants experienced higher dysphoria and anxiety on days that they pursued high self‐image goals relative to the sample, but lower symptoms when they pursued relatively high compassionate goals.…”

“…In contrast, interpersonal processes are common in both anxiety and depression and may represent such a mechanism, for several reasons. For instance, threatening thoughts about others or maladaptive interpersonal perceptions are common in depression (Cruwys, Haslam, Dingle, Haslam, & Jetten, ; Gotlib, Krasnoperova, Neubauer Yue, & Joorman, ), generalized anxiety disorder (GAD; Erickson & Newman, ), social anxiety (Alden & Taylor, ; Rodebaugh et al., ), and panic disorder/agoraphobia (PD/A; Chambless et al., ). Interpersonal models of these disorders (e.g., Alden & Taylor, ; Hames, Hagan, & Joiner, ; Newman & Erickson, ), while not identical, posit that problematic social perceptions lead to dysfunctional social behavior, which subsequently evokes negative responses from others and undermines social support, thereby perpetuating one's own depression or anxiety.…”

“…Interpersonal difficulties and perceived conflict, in turn, predict worse response to cognitive behavioral therapy (CBT) for both anxiety and depression (e.g., Borkovec, Newman, Pincus, & Lytle, ; Chambless et al., ; Renner et al., ), whereas perceived social support predicts lower symptoms over time (e.g., Crocker, Canevello, Breines, & Flynn, ; Stice, Ragan, & Randall, ), suggesting prospective interpersonal effects on symptom maintenance. However, most studies have collected only one‐time, cross‐sectional data.…”

Perceived Criticism in the Treatment of a High‐Risk Adolescent

“…Approaches designed to reduce criticism and the perception of criticism may have the potential to reduce the heat of the emotional climate in the family and provide benefits for patients and relatives alike. Chambless and colleagues (2017) have recently shown that higher levels of PC predict worse treatment outcomes in patients with panic disorder. As a result of their findings, they argue that interventions should involve a more specific focus on perceptions of criticism.…”

Social support, negative social exchange, and response to case formulation-based cognitive behavior therapy

“…As with social support, the literature on negative social exchange and related constructs suggests a complex relationship to treatment response. For instance, a higher level of perceived criticism has been found to be associated with poorer anxiety treatment outcomes (Chambless et al, 2017;Renshaw, Chambless, & Steketee, 2003). Yet, there is evidence that increased pressure from family members is associated with increased likelihood of treatment completion (Fogler, Tompson, Steketee, & Hofmann, 2007;Hansen, Hoogduin, Schaap & de Haan, 1992).…”