RESUMEN
The effects of self-directed in vivo exposure in the treatment of panic disorder with agoraphobia were examined. Seventy-four chronic and severe agoraphobic subjects were randomly assigned to Cognitive Therapy plus graded exposure. Relaxation Training plus graded exposure, or therapist-assisted graded exposure alone. Treatment consisted of 16 weekly 2.5-hour sessions. All subjects received programmed practice instructions for engaging in self-directed exposure as a concomitant strategy to their primary treatment. All subjects were instructed to keep systematic behavioral diary recordings of all self-directed exposure practice. The diary data were analyzed across and within treatments and assessment phases. Statistically significant findings were obtained across all diary measure domains with powerful repeated measures effects observed across all treatments. Significant between group effects and treatment x repeated measures interactions were obtained across the diary measure domains. Multiple linear regressions of in vivo anxiety levels and, to a lesser extent, frequency of self-directed exposure practice were found to be significantly associated with global assessment of severity at posttreatment and 3-month follow-up assessments. Furthermore, depression and marital satisfaction were significantly associated with in vivo anxiety. These and other findings are discussed with regard to their conceptual and clinical implications.
Asunto(s)
Agorafobia/terapia , Terapia Cognitivo-Conductual , Habituación Psicofisiológica , Trastorno de Pánico/terapia , Terapia por Relajación , Autocuidado , Adulto , Agorafobia/complicaciones , Agorafobia/psicología , Análisis de Varianza , Enfermedad Crónica , Terapia Cognitivo-Conductual/métodos , Terapia Combinada , Femenino , Humanos , Modelos Lineales , Masculino , Trastorno de Pánico/complicaciones , Trastorno de Pánico/psicología , Relaciones Profesional-Paciente , Autocuidado/métodos , Índice de Severidad de la EnfermedadRESUMEN
The present study examined the relationship of attributional style, as measured with a revised version of the Attributional Style Questionnaire (ASQ) and measures of agoraphobia severity, depression, and treatment outcome in 73 Ss who met DSM-III criteria for agoraphobia with panic attacks and participated in one of three 13-week treatment conditions: paradoxical intention, graduated exposure, or progressive deep muscle relaxation training. Subjects completed assessments at four periods: pretreatment, midtreatment, posttreatment, and at 3 month follow-up. In addition to the three dimensions typically examined on the ASQ, this revised version also measured Ss' estimates of the perceived importance, and future likelihood for both positive and negative events. Congruent with previous research, moderate but somewhat inconsistent associations were observed between attributional style and depression both within and across assessment periods. Predictions about associations between attributional style and agoraphobic severity were not supported; however, an interaction was observed between depression and attributional style with respect to severity of agoraphobia. There was no evidence of group differences across treatment types, although there were several significant changes in attributional style across time. Attributions for health related events were also examined. Conceptual, clinical, and research issues related to the findings are discussed.
Asunto(s)
Agorafobia/terapia , Trastorno Depresivo/terapia , Control Interno-Externo , Adolescente , Adulto , Anciano , Agorafobia/complicaciones , Agorafobia/diagnóstico , Terapia Cognitivo-Conductual , Trastorno Depresivo/complicaciones , Trastorno Depresivo/diagnóstico , Humanos , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Terapia por Relajación , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVE: Factors associated with response to treatment for agoraphobia are as of yet poorly understood. The authors investigated the relationship between chronic forms of life stress and clinical improvement and recovery in subjects with agoraphobia. METHOD: Subjects meeting the DSM-III criteria for agoraphobia with panic attacks (N = 73) completed measures of life stress, agoraphobic symptoms, and depressive symptoms 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 contextual life stress interview was completed by 54 subjects. The relationship of chronic forms of stress to treatment response was assessed by comparing symptomatic improvement in the subjects who had and had not experienced chronic stressors. RESULTS: Of the 54 subjects, 23 (43%) reported chronic stressors of marked or moderate severity. Subjects experiencing chronic stressors evidenced less improvement after treatment on both self-report and objective indexes of agoraphobic symptoms. Additionally, more subjects identified as nonrecovered experienced chronic stressors than did recovered subjects. CONCLUSIONS: Chronic stressors appear to predict a relatively unfavorable treatment outcome, as defined by higher levels of symptoms after treatment, less improvement, and less likelihood of recovery. These results have important implications for enhancing psychotherapeutic outcomes.
Asunto(s)
Agorafobia/terapia , Acontecimientos que Cambian la Vida , Trastorno de Pánico/terapia , Psicoterapia , Adulto , Agorafobia/diagnóstico , Agorafobia/psicología , Protocolos Clínicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastorno de Pánico/diagnóstico , Trastorno de Pánico/psicología , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Theoretical, methodologic, and clinical research issues pertaining to these treatments are examined as are their strengths, limitations, and possible interactions. Attrition, outcome, and maintenance effects are compared. Composite indices of clinically significant improvement, endstate functioning, and longitudinal adjustment are presented. The article also highlights emerging models, theoretical advances, and promising interventions. Advantages and limitations of current treatments are discussed, with recommendations for future research. It is concluded that significant advances have been made in the conceptualization and treatment of panic disorder with agoraphobia.