A systematic review of predictors and moderators of improvement in cognitive-behavioral therapy for panic disorder and agoraphobia
Background: Despite the considerable efficacy of cognitive-behavioral therapy (CBT) for panic disorder (PD) and agoraphobia, a substantial minority of patients fail to improve for reasons that are poorly understood. Objective: The aim of this study was to identify consistent predictors and moderator...
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Veröffentlicht in: | Clinical psychology review 2015-12, Vol.42, p.179-192 |
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Sprache: | eng |
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Zusammenfassung: | Background: Despite the considerable efficacy of cognitive-behavioral therapy (CBT) for panic disorder (PD) and agoraphobia, a substantial minority of patients fail to improve for reasons that are poorly understood.
Objective: The aim of this study was to identify consistent predictors and moderators of improvement in CBT for PD and agoraphobia.
Data sources: A systematic review and meta-analysis of articles was conducted using PsycInfo and PubMed. Search terms included panic, agoraphobi*, cognitive behavio*, CBT, cognitive therapy, behavio* therapy, CT, BT, exposure, and cognitive restructuring.
Study selection: Studies were limited to those employing semi-structured diagnostic interviews and examining change on panic- or agoraphobia-specific measures.
Data extraction: The first author extracted data on study characteristics, prediction analyses, effect sizes, and indicators of study quality. Interrater reliability was confirmed.
Synthesis: 52 papers met inclusion criteria. Agoraphobic avoidance was the most consistent predictor of decreased improvement, followed by low expectancy for change, high levels of functional impairment, and Cluster C personality pathology. Other variables were consistently unrelated to improvement in CBT, understudied, or inconsistently related to improvement.
Limitations: Many studies were underpowered and failed to report effect sizes. Tests of moderation were rare.
Conclusions: Apart from agoraphobic avoidance, few variables consistently predict improvement in CBT for PD and/or agoraphobia across studies.
•Agoraphobic avoidance predicted less improvement from pre- to post-treatment.•Functional impairment and low expectancy for change predicted less improvement.•Comorbid depression and medication use consistently did not predict improvement.•Few studies examined moderators of improvement in CBT vs. other treatments. |
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ISSN: | 0272-7358 1873-7811 |
DOI: | 10.1016/j.cpr.2015.09.004 |