Archival ReportChanges in Automatic Threat Processing Precede and Predict Clinical Changes with Exposure-Based Cognitive-Behavior Therapy for Panic Disorder
Section snippets
Participants
Twenty-eight patients with DSM-IV PD with or without agoraphobia, naïve to exposure-based CBT, were recruited. They were randomly assigned to one of two experimental conditions, either receiving a single session of exposure-based CBT (treatment group [TG]) or no intervention (until after the study procedures and assessments; waiting group [WG]). Diagnoses were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders Clinician Version (20). Patients had to present with at
Group Matching
The two groups were not different with respect to gender [χ21 = .70, p = .68], age, years of education, and verbal intelligence; and they experienced similar degrees of panic severity and panic attack frequency at baseline [all t26<1.04, all p>.31] (Table 1). Furthermore, they were well-matched in terms of primary diagnosis [panic disorder with agoraphobia: 14 TG, 12 WG; panic disorder without agoraphobia: 0 TG, 2 WG; χ21 = 2.15, p = .48] or comorbid diagnoses (depression: 1 TG, 1 WG; anxiety
Discussion
This study shows that a single session of exposure-based CBT has rapid effects on automatic emotional processing. Although on the day after treatment symptoms of panic and anxiety were still unaffected, TG patients already showed significantly reduced hyper-vigilance for fear faces compared with the WG. Moreover, greater reduction in fear bias in TG patients on the day after treatment was associated with greater improvement in agoraphobic avoidance during the 4-week follow-up period, with over
References (40)
- et al.
The empirical status of cognitive-behavioral therapy: A review of meta-analyses
Clin Psychol Rev
(2006) - et al.
Fluvoxamine, placebo, and cognitive behaviour therapy used alone and in combination in the treatment of panic disorder and agoraphobia
J Anxiety Disord
(1996) - et al.
Attentional bias in untreated panic disorder
Psych Res
(2011) - et al.
A follow-up study of cognitive bias in generalized anxiety disorder
Behav Res Ther
(1995) - et al.
Cognitive-behavior therapy resolves implicit fear associations in generalized anxiety disorder
Behav Res Ther
(2013) - et al.
The mobility inventory for agoraphobia
Behav Res Ther
(1985) - et al.
An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia
Behav Res Ther
(1999) Cognitive processes during fear acquisition and extinction in animals and humans: Implications for exposure therapy of anxiety disorders
ClinPsychol Rev
(2008)- et al.
Efficacy of CBT for benzodiazepine discontinuation in patients with panic disorder
Behav Res Ther
(2010) Behavior Therapy and Beyond
(1971)
Empirically supported treatments for panic disorder: Costs, benefits, and stepped care
J Consult Clin Psych
Why do antidepressants take so long to work? A cognitive neuropsychological model of antidepressant drug action
Br J Psychiatry
Attentional bias in emotional disorders
J Abnorm Psychol
Cognitive Psychology and Emotional Disorders
Management of Anxiety in Adults in Primary, Secondary and Community Care. Nice Guideline CG22
Automatic associations and panic disorder: Trajectories of change over the course of treatment
J Consult Clin Psych
Acute SSRI administration affects the processing of social cues in healthy volunteers
Neuropsychopharmacology
Acute antidepressant administration remediates negative affective bias in depressed patients
Am J Psych
Increased positive versus negative affective perception and memory in healthy volunteers following selective serotonin and norepinephrine reuptake inhibition
Am J Psychiatry
Toward a neuropsychological theory of antidepressant drug action: Increase in positive emotional bias after potentiation of norepinephrine activity
Am J Psychiatry
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2020, Journal of Behavior Therapy and Experimental PsychiatryCitation Excerpt :In a waiting-list controlled study investigating single-session CBT for panic disorder, attentional bias towards threat stimuli improved one day post-treatment and prior to any symptomatic changes. These early reductions in attentional bias towards threat were found to predict better symptomatic improvement at 1-month follow-up (FU), explaining about 50% of the variance in symptom change (Reinecke, Waldenmaier, Cooper, & Harmer, 2013). Other findings also include changes in attentional biases following treatment in specific phobia (van den Hout, Tenney, Huygens, & De Jong, 1997), generalised anxiety disorder (Mogg, Bradley, Millar, & White, 1995), and social anxiety disorder (Calamaras, Tone, & Anderson, 2012).