A systematic review of predictors and moderators of improvement in cognitive-behavioral therapy for panic disorder and agoraphobia
Section snippets
Identification and selection of studies
Relevant studies were primarily identified though literature searches conducted in January 2014 using the PsycInfo and PubMed databases. The search required that at least one of two key terms related to diagnosis (panic or agoraphobi*) and one of eight key terms related to treatment (cognitive behavio*, CBT, cognitive therapy, behavio* therapy, CT, BT, exposure, or cognitive restructuring) appear in the abstract. Databases were searched from the beginning of the database through January 2014.
Characteristics of included studies
Characteristics of the 52 papers included in the present review are displayed in Table A1. Fifty-one papers were published, peer-reviewed journal articles, and one paper was an unpublished dissertation. These papers encompass 39 studies and include a total of 3466 participants. The vast majority of studies (n = 28; 71.7%) included patients with PD with or without agoraphobia. Of these 28 studies, four excluded individuals with severe agoraphobia, and two of these also excluded individuals with
Discussion
We identified several pre-treatment variables that appear to predict improvement in CBT for panic disorder and/or agoraphobia. Specifically, greater pre-treatment severity of agoraphobic avoidance appears to consistently predict decreased improvement in CBT according to the meta-analysis, the narrative review, and the box score analysis. Additionally, our meta-analysis also indicated that diagnosis of a Cluster C PD is associated with less improvement in CBT, and the two studies examining
Role of funding sources
This study was not funded by an external organization.
Contributors
The first author (Eliora Porter) designed the study with input from the second author (Dianne Chambless). The first author also conducted literature searches, screened potentially eligible studies for inclusion, extracted data on study characteristics, prediction analyses, and indicators of study quality, conducted statistical analyses, and wrote the first draft of the manuscript. Both authors have contributed to and have approved the final manuscript.
Conflicts of interest
Both authors declare that they have no conflicts of interest.
Acknowledgments
The authors thank Kelly Allred, Lorenzo Lorenzo-Luaces, Jack Keefe, and Hana Zickgraf for their assistance in coding studies and extracting data. We also thank the following individuals for providing us with additional details regarding the methods and results of their original papers on predictors of improvement in CBT for PD and/or agoraphobia: Cindy Aaronson, Per Carlbring, David Clark, David Dozois, Raymond Goetz, Gert-Jan. Hendriks, Michael Höfler, Mirjam Kampman, Ger Keijsers, Justin
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Note: Papers included in the systematic review are marked with an *. Papers included in the systematic review but discussed in appendices only are listed in Appendix F.