THE ROLE OF TRAUMA AND DISSOCIATION IN COGNITIVE-BEHAVIORAL PSYCHOTHERAPY OUTCOME AND MAINTENANCE FOR PANIC DISORDER WITH AGORAPHOBIA

The relationship between traumatic experiences and dissociation with p retreatment psychopathology and rates of recovery, relapse and mainten ance for patients receiving cognitive-behavioral treatments for panic disorder with agoraphobia (PDA) were investigated. One-hundred and for ty-seven subjects who met DSM-III criteria for agoraphobia with panic attacks and who completed participation in one of two previously condu cted treatment outcome studies were mailed packets containing measures to assess history of trauma, victimization and dissociation. Eighty-n ine of these were returned and completed sufficiently to be included i n the present study. It was hypothesized that a variety of trauma-rela ted variables (e.g. history of traumatic experience, type of trauma, a ge at which the trauma first occurred, perceived responsibility, socia l supports available, self-perceived severity, level of violence, and whether or not the traumatic event was followed by self-injurious or s uicidal thoughts and/or behaviors) and dissociative symptomatology wou ld be predictive of (1) greater psychopathology at pretreatment, (2) p oorer treatment response and (3) higher relapse rates and poorer maint enance over a 1 year longitudinal follow-up. These hypotheses were sup ported by the findings and the theoretical, empirical and clinical imp lications are discussed. (C) 1998 Elsevier Science Ltd. All rights res erved.