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    Klan, Timo Jasper, Fabian and Hiller, Wolfgang 2015. Predictors of the application of exposurein vivoin the treatment of agoraphobia in an outpatient clinic: An exploratory approach. Psychotherapy Research, p. 1.


Prognostic indices with brief and standard CBT for panic disorder: I. Predictors of outcome

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  • Published online: 01 May 2007

Although the effectiveness of cognitive behavioural therapy (CBT) in the management of panic disorder (PD) is now well established, there have been few studies of predictors of outcome with this patient group using clinical effectiveness trial data, a hypothesis-testing model, and a dependent measure of clinically significant change.


The data for this study came from a randomized controlled trial of three forms of CBT delivery for PD with and without agoraphobia (two 6-week CBT programmes, one of which was computer assisted, and one therapist-directed 12-week CBT programme), comprising a total of 186 patients across two sites. Based on previous related research, five hypothesized predictors of post-treatment and follow-up outcome were identified and examined, using a series of bivariate and multivariate analyses.


The results in general supported the hypotheses. Strength of blood/injury fears, age of initial onset of panic symptoms, co-morbid social anxieties and degree of agoraphobic avoidance were predictive of both measures of post-treatment outcome. Degree of residual social difficulties and the continued use of anxiolytics at post-treatment were also shown to predict poor outcome at the 6-month follow-up. However, strength of continuing dysfunctional agoraphobic cognitions by the end of active treatment did not predict outcome at follow-up for the sample as a whole.


The identification of consistent predictors of outcome with CBT has many clinical and research benefits. As CBT, however, is being delivered increasingly in a variety of brief formats, further research is required to identify moderators of response to these ‘non-standard’ treatment formats.

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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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

M. Basoglu , I. M. Marks , C. Kilic , C. R. Brewin & R. P. Swinson (1994). Alprazolam and exposure for panic disorder with agoraphobia: attribution of improvement to medication predicts subsequent relapse. British Journal of Psychiatry 164, 652659.

A. T. Beck , R. A. Steer & M. G. Garbin (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review 8, 77100.

T. A. Brown & D. H. Barlow (1995). Long-term outcome in cognitive-behavioral treatment of panic disorder: clinical predictors and alternative strategies for assessment. Journal of Consulting and Clinical Psychology 63, 754765.

D. L. Chambless , G. C. Caputo , P. Bright & R. Gallagher (1984). Assessment of fear in agoraphobics: the Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. Journal of Consulting and Clinical Psychology 52, 10901097.

D. L. Chambless , C. G. Caputo , S. E. Jasin , E. J. Gracely & C. Williams (1985). The Mobility Inventory for Agoraphobia. Behaviour Research and Therapy 23, 3544.

D. M. Clark (1986). A cognitive approach to panic. Behaviour and Research Therapy 24, 461470.

D. M. Clark , P. M. Salkovskis , A. Hackmann , H. Middleton , P. Anastasiades & M. Gelder (1994). A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. British Journal of Psychiatry 164, 759769.

D. M. Clark , P. M. Salkovskis , A. Hackmann , A. Wells , J. Ludgate & M. Gelder (1999). Brief cognitive therapy for panic disorder: a randomised controlled trial. Journal of Consulting and Clinical Psychology 67, 583589.

D. M. Clark , P. M. Salkovskis , L.-G. Öst , E. Breitholtz , K. A. Koehler , B. E. Westling , A. Jeavons & M. Gelder (1997). Misinterpretation of body sensations in panic disorder. Journal of Consulting and Clinical Psychology 65, 203213.

C. K. Conners , J. N. Epstein , J. S. March , A. Angold , K. C. Wells , J. Klaric , J. M. Swanson , H. B. Abikoff , L. E. Arnold , G. R. Elliott , L. L. Greenhill , L. Hechtman , S. P. Hinshaw , B. Hoza , P. S. Jensen , H. C. Kraemer , J. Newcorn , W. E. Pelham , J. B. Severe , B. Vitiello & T. Wigal (2001). Multimodal treatment of ADHD in the MTA: an alternative outcome analysis. Journal of the American Academy of Child and Adolescent Psychiatry 40, 159167.

M. G. Craske , T. A. Brown & D. H. Barlow (1991). Behavioral treatment of panic disorder: a two year follow-up study. Behavior Therapy 22, 289304.

D. Dewey & J. Hunsley (1990). The effects of marital adjustment and spouse involvement on the behavioral treatment of agoraphobia: a meta-analytic review. Anxiety Research 2, 6983.

R. C. Durham , T. Allan & C. A. Hackett (1997). On predicting improvement and relapse in generalised anxiety disorder following psychotherapy. British Journal of Clinical Psychology 36, 101119.

P. M. G. Emmelkamp & C. Gerlsma (1994). Marital functioning and the anxiety disorders. Behavior Therapy 25, 407429.

P. M. G. Emmelkamp , R. van Dyck , M. Bitter , R. Heins , E. J. Onstein & B. Eisen (1992). Spouse-aided therapy with agoraphobics. British Journal of Psychiatry 160, 151156.

G. A. Fava (1999). Subclinical symptoms in mood disorders: pathophysiological and therapeutic implications. Psychological Medicine 29, 4761.

G. A. Fava , C. Rafanelli , S. Grandi , S. Conti , C. Ruini , L. Mangelli & P. Bellvardo (2001). Long-term outcome of panic disorder with agoraphobia treated by exposure. Psychological Medicine 31, 891898.

M. Fischer , I. Hand , J. Angenendt , H. Büttner-Westphal & C. Manecke (1988). Failures in exposure treatment of agoraphobia: evaluation and prediction. In Panic and Phobias II: Treatment and Variables Affecting Course and Outcome (ed. I. Hand and H. U. Wittchen ), pp. 195208. Springer: New York.

E. B. Foa , M. E. Franklin & J. Moser (2002). Context in the clinic: how well do cognitive-behavioral therapies and medications work in combination? Biological Psychiatry 52, 987997.

E. B. Foa & M. J. Kozak (1986). Emotional processing of fear: exposure to corrective information. Psychological Bulletin 99, 2035.

S. B. Green (1991). How many subjects does it take to do a regression analysis? Multivariate Behavioral Research 26, 499510.

A. Hackmann (2004). Panic disorder and agoraphobia. In Oxford Guide to Behavioural Experiments in Cognitive Therapy (ed. J. Bennett-Levy , G. Butler , M. Fennell , A. Hackmann , M. Mueller and D. Westbrook ), pp. 5978. Oxford University Press: Oxford.

R. J. Hafner & M. W. Ross (1983). Predicting the outcome of behaviour therapy for agoraphobia. Behaviour Research and Therapy 21, 375382.

H. Katschnig & M. Amering (1998). The long-term course of panic disorder and its predictors. Journal of Clinical Psychopharmacology 18, 6S11S.

G. P. J. Keijsers , C. A. L. Hoogduin & C. P. D. R. Schaap (1994). Prognostic factors in the behavioural treatment of panic disorder with and without agoraphobia. Behavior Therapy 25, 689708.

J. Kenardy , M. G. T. Dow , D. W. Johnston , M. G. Newman , A. Thomson & C. B. Taylor (2003 a). A comparison of delivery methods of cognitive-behavioral therapy for panic disorders: an international multicenter trial. Journal of Consulting and Clinical Psychology 71, 10681075.

I. M. Marks & A. M. Mathews (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy 17, 263267.

I. M. Marks , R. P. Swinson , M. Basoglu , K. Kuch , H. Noshirvani , G. O'Sullivan , P. Lelliott , M. Kirby , G. McNamee , S. Sengun & K. Wickwire (1993). Alprazolam and exposure alone and combined in panic disorder with agoraphobia. British Journal of Psychiatry 162, 776787.

J. McCusker , J.-P. Boiulenger , F. Bellavance , R. Boyer & J.-M. Miller (2000). Outcomes in a referral cohort of patients with anxiety disorders. Journal of Nervous and Mental Disease 188, 312.

M. G. Newman (2000). Recommendations for a cost-offset model of psychotherapy allocation using generalised anxiety disorder as an example. Journal of Consulting and Clinical Psychology 68, 549555.

G. R. Norton , S. R. Pidlubny & P. J. Norton (1999). Prediction of panic attacks and related variables. Behavior Therapy 30, 319330.

T. P. S. Oei , M. Llamams & L. Evans (1997). Does concurrent drug intake affect the long-term outcome of group cognitive behaviour therapy in panic disorder with or without agoraphobia? Behaviour Research and Therapy 35, 851857.

D. O'Rourke , T. J. Fahy , J. Brophy & P. Prescott (1996). The Galway study of panic disorder. III. Outcome at 5 to 6 years. British Journal of Psychiatry 168, 462469.

M. W. Otto , M. H. Pollack & S. A. Sabatino (1996). Maintenance of remission following cognitive behavior therapy for panic disorder: possible deleterious effects of concurrent medication treatment. Behavior Therapy 27, 473482.

J. Ramnerö & L.-G. Öst (2004). Prediction of outcome in the behavioural treatment of panic disorder with agoraphobia. Cognitive Behaviour Therapy 33, 176180.

V. Reed & H.-U. Wittchen (1998). DSM-IV panic attacks and panic disorder in a community sample of adolescents and young adults: how specific are panic attacks? Journal of Psychiatric Research 32, 335345.

C. Ronalds , F. Creed , K. Stone , S. Webb & B. Tomenson (1997). Outcome of anxiety and depressive disorders in primary care. British Journal of Psychiatry 171, 427433.

G. Scheibe & M. Albus (1997). Predictors and outcome in panic disorders: a 2-year prospective follow-up study. Psychopathology 30, 177184.

N. B. Schmidt , D. R. Lerew & R. J. Jackson (1997). The role of anxiety sensitivity in the pathogenesis of panic: prospective evaluation of spontaneous panic attacks during acute stress. Journal of Abnormal Psychology 106, 355364.

D. M. Sharp & K. G. Power (1999). Predicting treatment outcome for panic disorder and agoraphobia in primary care. Clinical Psychology and Psychotherapy 6, 336348.

N. Shinoda , K. Kodama , T. Sakamoto , N. Yamanouchi , T. Takahashi , S. Okada , S. Noda , N. Komatsu & T. Sato (1999). Predictors of 1-year outcome for patients with panic disorder. Comprehensive Psychiatry 40, 3943.

G. Steketee & D. L. Chambless (1992). Methodological issues in prediction of treatment outcome. Clinical Psychology Review 12, 387400.

G. Steketee & L. J. Shapiro (1995). Predicting behavioral treatment outcome for agoraphobia and obsessive compulsive disorder. Clinical Psychology Review 15, 317346.

J. E. Ware & C. D. Sherbourne (1992). The MOS 36-item Short Form Health Survey (SF-36): conceptual framework and item selection. Medical Care 30, 473483.

A. C. Wells , D. M. Clark , P. Salkovskis , J. Ludgate , A. Hackmann & M. G. Gelder (1995). Social phobia: the role of in-situation safety behaviors in maintaining anxiety and negative beliefs. Behavior Therapy 26, 153161.

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