A COMPARATIVE OUTCOME AND FOLLOW-UP INVESTIGATION OF PANIC DISORDER WITH AGORAPHOBIA - THE RELATIVE AND COMBINED EFFICACY OF COGNITIVE THERAPY, RELAXATION TRAINING, AND THERAPIST-ASSISTED EXPOSURE

The primary objective of this investigation was to examine the relativ e efficacy of Cognitive Therapy + Graded Exposure (CT + GE) vs. Relaxa tion Training + Graded Exposure (RT + GE) vs. Graded Exposure alone fo r subjects with moderate-severe panic disorder with agoraphobia (PDA). PDA is one of the most prevalent, severe, and clinically debilitating psychiatric disorders and shows high levels of Axis-I and Axis-II com orbidity. PDA is a complex disorder that leads to significant impair m ent in psychiatric, psychological, medical, social, occupational, inte rpersonal, and economic spheres. Hence, the impact of PDA mandates dev elopment of effective treatments In the present study, 92 patients wit h panic disorder with agoraphobia (PDAs) entered and 74 completed a 16 -session protocol of the above treatments. Significant within-group im provements were noted across treatments and most domains. CT + GE gene rated the most rapid, effective, and stable effects both at posttreatm ent and throughout the one-year follow-up. Analyses revealed: (a) both outcome and follow-up were mediated by changes on critical cognition measures during therapy; and, (b) the presence of residual panic attac ks, which was noted in 30%-60% of the PDAs following therapy, was sign ificantly associated with reemergence, relapse, or worsening of PDA ov er the course of the follow-up. Normative cont;bls were also used to e xamine the clinical significance of the treatments. Overall, findings indicated that cognitive therapy paired with exposure appears to be a relatively effective treatment for PDA. Yet, a significant proportion of subjects did not achieve remission and/or high endstate functioning and were left with residual panic attacks or nonnormative outcome. Th ese findings indicate that CT will need to be combined with other moda lities that specifically target panic, such as die Cognitive Model of Panic or similar panic-control treatments to enhance both outcome and longitudinal adjustment. Our results are reviewed and recommendations offered for future research.