Do Changes in Panic Appraisal Predict Improvement in Clinical Status Following Cognitive-Behavioral Treatment of Panic Disorder?

The effects of changes in panic appraisal dimensions during cognitive-behavioral treatment (CBT) on both short- and long-term improvement in panic disorder symptoms were examined. Panic disorder severity and panic appraisal measures were collected from 120 CBT-treated patients at pretreatment, post-treatment, and 6-month follow-up. Several panic appraisal dimensions investigated in panic disorder and agoraphobia include (a) perceived likelihood of panic occurrence (i.e., anticipated panic), (b) perceived negative consequences of panic occurrence, and (c) perceived panic coping efficacy. Of those panic appraisal dimensions studied, change in anticipated panic during treatment emerged as the most potent predictor of short-term improvement across each of the major clinical status measures (i.e., panic attack frequency, agoraphobic avoidance, and anxiety). Change in perceived consequences of panic uniquely contributed to short-term improvement in both anxiety and global disability, and reduction in perceived panic coping efficacy was unique predictor of short-term improvement in only agoraphobic avoidance. Both changes in perceived consequences of panic and in anticipated panic uniquely contributed to long-term improvement in agoraphobic avoidance and anxiety, respectively. In addition, only change in perceived consequences of panic uniquely contributed to long-term improvement in global disability. In contrast, perceived panic coping efficacy was generally a weak predictor of long-term improvement in any measures of clinical status. These results suggest that changes in cognitive appraisal factors predict both short- and long-term improvement during CBT of panic disorder.