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
Hauptverfasser: Porter, Eliora, Chambless, Dianne L.
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description 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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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.</description><identifier>ISSN: 0272-7358</identifier><identifier>EISSN: 1873-7811</identifier><identifier>DOI: 10.1016/j.cpr.2015.09.004</identifier><identifier>PMID: 26443228</identifier><language>eng</language><publisher>United States: Elsevier Ltd</publisher><subject>Agoraphobia ; Agoraphobia - therapy ; CBT ; Cognitive Therapy - methods ; Humans ; Moderators ; Outcome Assessment (Health Care) - methods ; Panic disorder ; Panic Disorder - therapy ; Predictors ; Treatment outcome</subject><ispartof>Clinical psychology review, 2015-12, Vol.42, p.179-192</ispartof><rights>2015 Elsevier Ltd</rights><rights>Copyright © 2015 Elsevier Ltd. 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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. 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subjects Agoraphobia
Agoraphobia - therapy
CBT
Cognitive Therapy - methods
Humans
Moderators
Outcome Assessment (Health Care) - methods
Panic disorder
Panic Disorder - therapy
Predictors
Treatment outcome
title A systematic review of predictors and moderators of improvement in cognitive-behavioral therapy for panic disorder and agoraphobia
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