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Prognostic indices with brief and standard CBT for panic disorder: II. Moderators of outcome




Despite the growth of reduced therapist-contact cognitive behavioural therapy (CBT) programmes, there have been few systematic attempts to determine prescriptive indicators for such programmes vis-à-vis more standard forms of CBT delivery. The present study aimed to address this in relation to brief (6-week) and standard (12-week) therapist-directed CBT for panic disorder (PD) with and without agoraphobia. Higher baseline levels of severity and associated disability/co-morbidity were hypothesized to moderate treatment effects, in favour of the 12-week programme.


Analyses were based on outcome data from two out of three treatment groups (n=72) from a recent trial of three forms of CBT delivery for PD. The dependent variables were a continuous composite panic/anxiety score and a measure of clinical significance. Treatment×predictor interactions were examined using multiple and logistic regression analyses.


As hypothesized, higher baseline severity, disability or co-morbidity as indexed by strength of dysfunctional agoraphobic cognitions; duration of current episode of PD; self-ratings of panic severity; and the 36-item Short Form Health Survey (SF-36) (Mental component) score were all found to predict poorer outcome with brief CBT. A similar trend was apparent in relation to baseline level of depression. With high and low end-state functioning as the outcome measure, however, only the treatment×agoraphobic cognitions interaction was found to be significant.


While there was no evidence that the above variables necessarily contraindicate the use of brief CBT, they were nevertheless associated with greater overall levels of post-treatment improvement with the 12-week approach.


Corresponding author

*Address for correspondence: Dr Michael G. T. Dow, Department of Psychology, University of Stirling, Stirling FK9 4LA, UK. (Email:


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Aiken, L. S. & West, S. G. (1991). Multiple Regression: Testing and Interpreting Interactions. Sage Publications: Newbury Park.
Beck, A. T., Steer, R. A. & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review 8, 77100.
Carlbring, P., Westling, B. E., Ljungstand, P., Ekselius, L. & Andersson, G. (2001). Treatment of panic disorder via the internet: a randomized trial of a self-help program. Behavior Therapy 32, 751764.
Chambless, D. L., Caputo, G. C., Bright, P. & Gallagher, R. (1984). Assessment of fear in agoraphobics: the Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. Journal of Consulting and Clinical Psychology 52, 10901097.
Chambless, D. L., Caputo, C. G., Jasin, S. E., Gracely, E. J. & Williams, C. (1985). The Mobility Inventory for Agoraphobia. Behaviour Research and Therapy 23, 3544.
Clark, D. M., Salkovskis, P. M., Hackmann, A., Wells, A., Ludgate, J. & Gelder, M. (1999). Brief cognitive therapy for panic disorder: a randomized controlled trial. Journal of Consulting and Clinical Psychology 67, 583589.
Cohen, J. & Cohen, P. (1983). Applied Multiple Regression/Correlation Analyses for the Behavioural Sciences (2nd edn). Lawrence Erlbaum: Hillsdale, NJ.
Côte, G., Gauthier, J. G., Laberge, B., Cormier, H. J. & Plamondon, J. (1994). Reduced therapist contact in the cognitive behavioural treatment of panic disorder. Behavior Therapy 25, 123145.
Dow, M. G. T. (1982). Behavioural bibliotherapy: theoretical and methodological issues in outcome research into self-help programs. In Clinical Psychology and Medicine (ed. Main, C. J.), pp. 177204. Plenum Press: New York.
Dow, M. G. T. (1983). A Controlled Comparative Evaluation of Conjoint Counselling and Behavioural Self-help Treatment for Sexual Dysfunction. Unpublished Ph.D. dissertation, University of Glasgow, UK.
Durham, R. C., Fisher, P. L., Dow, M. G. T., Sharp, D., Power, K. G., Swan, J. S. & Morton, R. V. (2004). Cognitive behaviour therapy for good and poor prognosis generalised anxiety disorder: a clinical effectiveness study. Clinical Psychology and Psychotherapy 11, 145157.
Febbraro, G. A. S. R., Clum, G. A., Roodman, A. A. & Wright, J. H. (1999). The limits of bibliotherapy: a study of self-administered interventions in individuals with panic attacks. Behavior Therapy 30, 209222.
Gould, R. A., Clum, G. A. & Shapiro, D. (1993). The use of bibliotherapy in the treatment of panic: a preliminary investigation. Behavior Therapy 24, 241252.
Hollon, S. D. & Najavits, L. (1988). Review of empirical studies on cognitive therapy. In Psychiatry Update: American Psychiatric Association Annual Review, Vol. 7 (ed. Frances, A. J. and Hales, R. E.), pp. 643666. American Psychiatric Press: Washington, DC.
Kenardy, J. A., Dow, M. G. T., Johnston, D. W., Newman, M. G., Thomson, A. & Taylor, C. B. (2003). A comparison of delivery methods of congnitive-behavioral therapy for panic disorders: an international multicenter trial. Journal of Consulting and Clinical Psychology 71, 10681075.
Kenwright, M. & Marks, I. M. (2004). Computer aided self-help for phobia/panic via internet at home: a pilot study. British Journal of Psychiatry 184, 448449.
Kraemer, H. C., Wilson, G. T., Fairburn, C. G. & Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry 59, 877883.
Lange, A., Rietdijk, D., Hudcovicova, M., van de Ven, J.-P., Schrieken, B & Emmelkamp, P. M. G. (2003). Interapy: a controlled randomized trial of standardized treatment of posttraumatic stress through the internet. Journal of Consulting and Clinical Psychology 71, 910–909.
Marks, I. M. (2002). The maturing of therapy. British Journal of Psychiatry 180, 200204.
Marks, I. M. & Mathews, A. M. (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy 17, 263267.
Mathews, A., Bancroft, J., Whitehead, A., Hackmann, A., Julier, D., Greenwood, J., Goth, D. & Shaw, P. (1976). The behavioural treatment of sexual inadequacy: a comparative study. Behaviour Research and Therapy 14, 427436.
Mathews, A. M., Gelder, M. G. & Johnston, D. W. (1981). Agoraphobia: Nature and Treatment. Tavistock Publications: London.
McClelland, G. H. & Judd, C. M. (1993). Statistical difficulties of detecting interactions and moderator effects. Psychological Bulletin 114, 376390.
Newman, M. G., Kenardy, J., Herman, S. & Taylor, C. B. (1997). Comparison of palmtop-computer-assisted brief cognitive-behavioral treatment to cognitive-behavioral treatment for panic disorder. Journal of Consulting and Clinical Psychology 65, 178183.
Paul, G. L. (1967). Strategy of outcome research in psychotherapy. Journal of Consulting and Clinical Psychology 31, 109118.
RUPP (Research on Pediatric Psychopharmacology) Anxiety Study Group (2003). Searching for moderators and mediators of pharmacological treatment effects in children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry 42, 1321.
Shadish, W. R. & Sweeney, R. B. (1991). Mediators and moderators in meta-analysis: there's a reason we don't let dodo birds tell us which psychotherapies should have prizes. Journal of Consulting and Clinical Psychology 59, 883893.
Sheehan, D. V. (1986). The Anxiety Disease. Bantam Books: New York.
Spielberger, C. D., Gorsuch, R. & Lushene, R. E. (1970). The State-Trait Anxiety Inventory (Self-Evaluation Questionnaire). Consulting Psychologists Press: Palo Alto, CA.
Ware, J. E. & Sherbourne, C. D. (1992). The MOS 36-item Short Form Health Survey (SF-36): conceptual framework and item selection. Medical Care 30, 473483.
Whisman, M. A. (1993). Mediators and moderators of change in cognitive therapy of depression. Psychological Bulletin 114, 248265.
White, J., Jones, R. & McGarry, E. (2000). Cognitive behavioural computer therapy for the anxiety disorders: a pilot study. Journal of Mental Health 9, 505516.
Whitfield, G. & Williams, C. (2004). If the evidence is so good – why doesn't anyone use them? A national survey of the use of computerised cognitive behaviour therapy. Behavioural and Cognitive Psychotherapy 32, 5765.
Wilson, G. T., Vitousek, K. M. & Loeb, K. L. (2000). Stepped care treatment for eating disorders. Journal of Consulting and Clinical Psychology 68, 564572.

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Prognostic indices with brief and standard CBT for panic disorder: II. Moderators of outcome



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