Prediction and moderation of improvement in cognitive-behavioral and psychodynamic psychotherapy for panic disorder.

Abstract

Objective To identify variables predicting psychotherapy outcome for panic disorder or indicating which of two very different forms of psychotherapy - Panic-Focused Psychodynamic Psychotherapy (PFPP) or Cognitive-Behavioral Therapy (CBT) - would be more effective for particular patients. Method Data were from 161 adults participating in a randomized controlled trial including these psychotherapies. Patients included 104 women; 118 patients were White, 33 were Black, and 10 were of other races; 24 were Latino(a). Predictors/moderators measured at baseline or by Session 2 of treatment were used to predict change on the Panic Disorder Severity Scale. Results Higher expectancy for treatment gains (Credibility/Expectancy Questionnaire d= -1.05, CI95% [-1.50, -0.60]), and later age of onset (d= -0.65, CI95% [-0.98, -0.32]) were predictive of greater change. Both variables were also significant moderators: Patients with low expectancy of improvement improved significantly less in PFPP than their counterparts in CBT, whereas this was not the case for patients with average or high levels of expectancy. When patients had an onset of panic disorder later in life (≥27.5 yrs. old), they fared as well in PFPP as CBT. In contrast, at low and mean levels of onset age, CBT was the more effective treatment. Conclusions Predictive variables suggest possibly fruitful foci for improvement of treatment outcome. In terms of moderation, CBT was the more consistently effective treatment, but moderators identified some patients who would do as well in PFPP as in CBT, thereby widening empirically supported options for treatment of this disorder.

Predictors of outcome in guided self-help cognitive behavioural therapy for common mental disorders in primary care

“…It is, thus, recommended to involve the patients and consider their view on treatment when conducting a treatment plan. This finding is consistent with previous research supporting that patients are more likely to benefit from treatment if they believe in the treatment, and this may strengthen placebo components of treatment (Chambless et al, 2017;Chambless, Tran, & Glass, 1997;Hamilton & Dobson, 2002;Hedman et al, 2012;Wampold, 2015). For clinician's estimation of positive outcome (range 0-10), a rating of 10 was associated with a doubled probability of successful outcome compared to a clinician rating of 5.…”

Stepped care in primary care – guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial

“…Increasing emphasis has been put on the impact of treatment related variables on outcome (Brandenburg, 2017;Hedman et al, 2012;Meyer et al, 2002;Simon & Perlis, 2010). Some studies have shown that patients are more likely to benefit from treatment if they believe in the treatment, (Chambless et al, 2017;Chambless, Tran, & Glass, 1997;Hamilton & Dobson, 2002;Hedman et al, 2012;Wampold, 2015) or find the treatment logical (Carter et al, 2011). Research has also shown that adhering to treatment (Hedman et al, 2012) and conducting homework assignments (Mausbach, Moore, Roesch, Cardenas, & Patterson, 2010) are associated with better treatment outcome for both anxiety, depression (Cowan et al, 2008) and insomnia (Harvey, Inglis, & Espie, 2002).…”

Moderators and predictors of outcome in metacognitive and cognitive behavioural therapy for co‐morbid anxiety disorders

“…Personality problems did also not emerge as a predictor or a moderator. Other studies have also failed to find personality problems (Cluster C) as a predictor of treatment outcome for panic disorder (e.g., Chambless et al, 2017) or anxiety disorders in general (Schneider, Arch, & Wolitzky-Taylor, 2015). However, in a study of patients seeking low-threshold treatment in England (Improved Access to Psychological Therapies), personality problems were associated with worse outcome (Goddard et al, 2015).…”

“…Other studies have also failed to find personality problems (Cluster C) as a predictor of treatment outcome for panic disorder (e.g., Chambless et al, 2017) or anxiety disorders in general (Schneider, Arch, & Wolitzky-Taylor, 2015). Other studies have also failed to find personality problems (Cluster C) as a predictor of treatment outcome for panic disorder (e.g., Chambless et al, 2017) or anxiety disorders in general (Schneider, Arch, & Wolitzky-Taylor, 2015).…”

“…However, no single form of therapy is effective for all anxiety disorder patients. For instance, although cognitive behavioural therapy (CBT) for panic disorder has proven to be highly effective, about one third of the patients do not respond (Chambless et al, 2017). To promote clinical theory and practice, it is of interest to find personal characteristics that explain this variability in response (Kraemer, Wilson, Fairburn, & Agras, 2002).…”