Kelly Woolaway-Bickel

The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: quality versus quantity.

Cognitive-behavioral therapy (CBT) is skill based and assumes active patient participation in regard to treatment-related assignments. The effects of patient compliance in CBT outcome studies are equivocal, however, and 1 gap in the literature concerns the need to account for the quality versus the quantity of assigned work. In this study, both quality and quantity of home-based practice were assessed to better evaluate the effects of treatment compliance in patients with panic disorder (N = 48) who participated in a 12-session CBT protocol. Patient estimates of compliance were not significantly associated with most outcome measures. On the other hand, therapist ratings of compliance significantly predicted positive changes on most outcome measures. Moreover, therapist and independent rater estimates of the quality of the participants work, relative to the quantity of the work, were relatively better predictors of outcome.

Randomized Controlled Trial of False Safety Behavior Elimination Therapy: A Unified Cognitive Behavioral Treatment for Anxiety Psychopathology

We tested the efficacy of a unified cognitive-behavioral therapy protocol for anxiety disorders. This group treatment protocol, termed false safety behavior elimination therapy (F-SET), is a cognitive-behavioral approach designed for use across various anxiety disorders such as panic disorder (PD), social anxiety disorder (SAD), and generalized anxiety disorder (GAD). F-SET simplifies, as well as broadens, key therapeutic elements of empirically validated treatments for anxiety disorders to allow for easier delivery to heterogeneous groups of patients with anxiety psychopathology. Patients with a primary anxiety disorder diagnosis (N=96) were randomly assigned to F-SET or a wait-list control. Data indicate that F-SET shows good efficacy and durability when delivered to mixed groups of patients with anxieties (i.e., PD, SAD, GAD) by relatively inexperienced clinicians. Findings are discussed in the context of balancing treatment efficacy and clinical utility.

Evaluating panic-specific factors in the relationship between suicide and panic disorder.

Work during the past decade has suggested an association between panic disorder and suicide (i.e., suicidal ideation and suicide attempts) that cannot simply be accounted for by co-occurring depression symptoms. To clarify the linkage between panic disorder and suicide, the association between panic-specific clinical and cognitive variables and suicide indicators were evaluated in patients with panic disorder (N=146). Analyses predicting the presence of suicidal ideation (positive, negative) after covarying the effects of a current mood disorder diagnosis and depression symptoms indicated a number of significant predictors including: (1) overall anxiety symptoms; (2) level of anticipatory anxiety; (3) avoidance of bodily sensations; (4) attentional vigilance toward bodily perturbations; and (5) phrenophobia (i.e., fear of cognitive incapacitation). Anxiety-specific variables did not account for unique variance in predicting prior history of suicide attempts.

Effects of cognitive behavioral treatment on physical health status in patients with panic disorder

The relationship between panic disorder and nonpsychiatric medical illness is complex, but some evidence suggests that panic disorder increases risk for a variety of nonpsychiatric medical conditions. Given the demonstrated efficacy of cognitive behavioral therapy (CBT) for panic disorder, we were interested in evaluating the effects of CBT for panic disorder on nonpsychiatric medical symptoms among these patients. Patients were randomized to a 12-week group-administered CBT protocol (n = 22) or a delayed-treatment control (n = 24). Treated patients showed marked improvement in both anxiety symptoms and physical health symptom ratings that were evident at midtreatment and were maintained through a 6-month follow-up period. Despite comparable rates of change, changes in anxiety symptoms did not appear to mediate the relationship between treatment and improved physical health ratings. These findings indicate that CBT appears to have an immediate and long-term beneficial impact on physical health and that this effect is independent from its impact on anxiety symptoms.

Differential effects of safety in extinction of anxious responding to a CO2 challenge in patients with panic disorder

Safety-relevant parameters are hypothesized to be important to the maintenance of pathological anxiety. The authors examined the effects of safety information and safety cues on anxious responding to a repeated 35% CO2 challenge in 31 patients with panic disorder. Patients were randomly assigned to one of three conditions: (a) safety information, (b) safety information plus a safety cue, or (c) no safety information. In the safety information group, patients received accurate information regarding the benign effects of the CO2 challenge. In the combined group, patients also received a safety cue that is salient for many patients with panic disorder (i.e., access to an anxiolytic pill during the challenge). The experimental manipulations did not differentially affect anxious responding following an initial challenge. However, after access to the anxiolytic was removed and the challenge procedure was repeated, those in the safety information alone condition showed lower subjective anxiety compared to those in the combined safety information/safety cue group. Findings suggest that safety information facilitates extinction of anxiety but only in the absence of safety cues.

Imaginal provocation of panic in patients with panic disorder

An imaginal challenge was designed to determine the degree to which cognitive manipulations, in isolation from specific biological challenge agents, might be sufficient for the production of panic in patients with panic disorder. Patients with panic disorder (n = 20) and nonclinical controls (n = 18) were exposed to four audiotaped vignettes (physical threat, social threat, loss of control threat, control). In relation to a composite measure of panic, the experimental vignettes produced panic in 30% of the patient sample compared to 0% of the control sample. There was also evidence for increased subjective reactivity to personally relevant panicogenic stimuli.