The extant outcome literature indicates that CT and CMP as unitary modalities are both relatively effective for PDA, yet about 40 percent of treated patients do not achieve normative status or high endstate functioning. Given their different yet complementary therapeutic foci, their integration is hypothesized to be highly synergistic, significantly enhancing outcome and longitudinal adjustment. Overaraching theoretical, methodologic, and clinic-research issues of the proposed psychotherapy outcome study include examining the relative efficacy, speed, tolerability, maintenance, and generalizability effects of the treatments across psychiatric, psychological, clinical, self-report, psychophysiological, information-processing, cognitive, and behavioral domains. Clinical phenomena including attrition, treatment process, outcome, improvement, and relapse will be empirically delineated across the psychotherapies. The potency, durability, and efficacy of the treatments in reducing or eliminating concomitant AXIS I and AXIS II disorders and associated symptomatology will also be examined. The clinical and social significance of the psychotherapies will be evaluated by comparing the 80 treated PDA patients to 80 matched, normative controls. The mediating role of information processing, psychophysiological processes, self-directed exposure, dissociation, stressful life events, and therapeutic alliance will be studied to advance current theoretical and clinical models of PDA etiopathogenesis and psychotherapy. PDA is one of the most prevalent, chronic, and clinically debilitating psychiatric disorders, accounting for 60 percent of all anxiety disorders seen for professional treatment. NIMH studies indicate high lifetime prevalence rates for PDA and sequelae include: depression, suicide attempts, social phobia, generalized anxiety disorder, sexual and marital dysfunction, alcoholism, substance abuse, tranquilizer addiction, peptic ulcer disease, hypertension, unemployment, economic hardship, and overuse of medical care systems. The NIMH study found that panic disorders were the most common reason patients sought treatment. These finding highlight the critical importance of developing more powerful and integrative models and treatments for PDA, as proposed herein.
| Murphy, M T; Michelson, L K; Marchione, K et al. (1998) The role of self-directed in vivo exposure in combination with cognitive therapy, relaxation training, or therapist-assisted exposure in the treatment of panic disorder with agoraphobia. J Anxiety Disord 12:117-38 |
| Michelson, L K; Bellanti, C J; Testa, S M et al. (1997) The relationship of attributional style to agoraphobia severity, depression, and treatment outcome. Behav Res Ther 35:1061-73 |
