Universität zu Köln

Gloster, Andrew T., Klotsche, Jens, Gerlach, Alexander L. ORCID: 0000-0001-6794-5349, Hamm, Alfons, Stroehle, Andreas, Gauggel, Siegfried ORCID: 0000-0002-2742-4917, Kircher, Tilo ORCID: 0000-0002-2514-2625, Alpers, Georg W. ORCID: 0000-0001-9896-5158, Deckert, Juergen and Wittchen, Hans-Ulrich ORCID: 0000-0002-6311-7711 (2014). Timing Matters: Change Depends on the Stage of Treatment in Cognitive Behavioral Therapy for Panic Disorder With Agoraphobia. J. Consult. Clin. Psychol., 82 (1). S. 141 - 154. WASHINGTON: AMER PSYCHOLOGICAL ASSOC. ISSN 1939-2117

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Abstract

Objective: The mechanisms of action underlying treatment are inadequately understood. This study examined 5 variables implicated in the treatment of panic disorder with agoraphobia (PD/AG): catastrophic agoraphobic cognitions, anxiety about bodily sensations, agoraphobic avoidance, anxiety sensitivity, and psychological flexibility. The relative importance of these process variables was examined across treatment phases: (a) psychoeducation/interoceptive exposure, (b) in situ exposure, and (c) generalization/follow-up. Method: Data came from a randomized controlled trial of cognitive behavioral therapy for PD/AG (n = 301). Outcomes were the Panic and Agoraphobia Scale (Bandelow, 1995) and functioning as measured in the Clinical Global Impression scale (Guy, 1976). The effect of process variables on subsequent change in outcome variables was calculated using bivariate latent difference score modeling. Results: Change in panic symptomatology was preceded by catastrophic appraisal and agoraphobic avoidance across all phases of treatment, by anxiety sensitivity during generalization/follow-up, and by psychological flexibility during exposure in situ. Change in functioning was preceded by agoraphobic avoidance and psychological flexibility across all phases of treatment, by fear of bodily symptoms during generalization/follow-up, and by anxiety sensitivity during exposure. Conclusions: The effects of process variables on outcomes differ across treatment phases and outcomes (i.e., symptomatology vs. functioning). Agoraphobic avoidance and psychological flexibility should be investigated and therapeutically targeted in addition to cognitive variables.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gloster, Andrew T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Klotsche, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Gerlach, Alexander L. UNSPECIFIED orcid.org/0000-0001-6794-5349 UNSPECIFIED Hamm, Alfons UNSPECIFIED UNSPECIFIED UNSPECIFIED Stroehle, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Gauggel, Siegfried UNSPECIFIED orcid.org/0000-0002-2742-4917 UNSPECIFIED Kircher, Tilo UNSPECIFIED orcid.org/0000-0002-2514-2625 UNSPECIFIED Alpers, Georg W. UNSPECIFIED orcid.org/0000-0001-9896-5158 UNSPECIFIED Deckert, Juergen UNSPECIFIED UNSPECIFIED UNSPECIFIED Wittchen, Hans-Ulrich UNSPECIFIED orcid.org/0000-0002-6311-7711 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-447653
DOI:	10.1037/a0034555
Journal or Publication Title:	J. Consult. Clin. Psychol.
Volume:	82
Number:	1
Page Range:	S. 141 - 154
Date:	2014
Publisher:	AMER PSYCHOLOGICAL ASSOC
Place of Publication:	WASHINGTON
ISSN:	1939-2117
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RANDOMIZED CONTROLLED-TRIAL; ANXIETY SENSITIVITY INDEX; COMMITMENT THERAPY; MEDIATION; FEAR; QUESTIONNAIRE; ACCEPTANCE; SENSATIONS; INTERVENTION; DIMENSIONS Multiple languages Psychology, Clinical Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/44765