Sl. Wade et al., CHRONIC LIFE STRESS AND TREATMENT OUTCOME IN AGORAPHOBIA WITH PANIC ATTACKS, The American journal of psychiatry, 150(10), 1993, pp. 1491-1495
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.