CHRONIC LIFE STRESS AND TREATMENT OUTCOME IN AGORAPHOBIA WITH PANIC ATTACKS

Objective: Factors associated with response to treatment for agoraphob ia are as of yet poorly understood. The authors investigated the relat ionship between chronic forms of life stress and clinical improvement and recovery in subjects with agoraphobia. Method: Subjects meeting th e DSM-III criteria for agoraphobia with panic attacks (N=73) completed measures of life stress, agoraphobic symptoms, and depressive symptom s at the initiation and completion of the 12-week treatment protocol. Chronic stressors were assessed during intensive structured interviews 3-5 years after the completion of treatment and were rated by using a reliable, and previously validated, contextual rating system. The con textual life stress interview was completed by 54 subjects. The relati onship of chronic forms of stress to treatment response was assessed b y comparing symptomatic improvement in the subjects who had and had no t experienced chronic stressors. Results: Of the 54 subjects, 2.3 (43% ) reported chronic stressors of marked or moderate severity. Subjects experiencing chronic stressors evidenced less improvement after treatm ent on both self-report and objective indexes of agoraphobic symptoms. Additionally, more subjects identified as nonrecovered experienced ch ronic stressors than did recovered subjects. Conclusions: Chronic stre ssors appear to predict a relatively unfavorable treatment outcome, as defined by higher levels of symptoms after treatment, less improvemen t, and less likelihood of recovery. These results have important impli cations for enhancing psychotherapeutic outcomes.