Prognostic factors in the behavioral treatment of panic disorder with and without agoraphobia

Abstract

Pretreatment and early treatment variables were evaluated as predictors of outcome for the behavioral treatment of panic disorder (PD) with and without agoraphobia. The following variables were examined: severity of agoraphobic complaints, catastrophic agoraphobic cognitions, level of depression, quality of the therapeutic relationship, motivation for treatment, personality psychopathology, and marital dissatisfaction. Sixty patients, diagnosed with PD, received a standardized exposure-based behavioral treatment program. Severity of agoraphobiccomplaints, level of depression, motivation for treatment, personality psychopathology, and catastrophic agoraphobic cognitions were related to treatment outcome, whereas the quality of the therapeutic relationship and marital dissatisfaction were not. Catastrophic agoraphobic cognitions were the strongest predictor of poorer outcome. Patients frequently distressed by maladaptive cognitions tended to improve less with an exposure-based treatment program. Based on several predictors taken together, 75% to 85% of the patients were correctly classified as treatment failures or treatment successes. A decision model based on multiple prognostic variables may lead to a reliable screening method of PD patients who are unlikely to improve. Treatment programs can then be adapted for these patients.