Clinical psychology review · 2015
A systematic review of predictors and moderators of improvement in cognitive-behavioral therapy for panic disorder and agoraphobia.
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Porter Eliora, Chambless Dianne L
Аннотация
BACKGROUND: Despite the considerable efficacy of cognitive-behavioral therapy (CBT) for panic disorder (PD) and agoraphobia, a substantial minority of patients fail to improve for reasons that are poorly understood.
OBJECTIVE: The aim of this study was to identify consistent predictors and moderators of improvement in CBT for PD and agoraphobia.
DATA SOURCES: A systematic review and meta-analysis of articles was conducted using PsycInfo and PubMed. Search terms included panic, agoraphobi*, cognitive behavio*, CBT, cognitive therapy, behavio* therapy, CT, BT, exposure, and cognitive restructuring.
STUDY SELECTION: Studies were limited to those employing semi-structured diagnostic interviews and examining change on panic- or agoraphobia-specific measures.
DATA EXTRACTION: The first author extracted data on study characteristics, prediction analyses, effect sizes, and indicators of study quality. Interrater reliability was confirmed.
SYNTHESIS: 52 papers met inclusion criteria. Agoraphobic avoidance was the most consistent predictor of decreased improvement, followed by low expectancy for change, high levels of functional impairment, and Cluster C personality pathology. Other variables were consistently unrelated to improvement in CBT, understudied, or inconsistently related to improvement.
LIMITATIONS: Many studies were underpowered and failed to report effect sizes. Tests of moderation were rare.
CONCLUSIONS: Apart from agoraphobic avoidance, few variables consistently predict improvement in CBT for PD and/or agoraphobia across studies.
OBJECTIVE: The aim of this study was to identify consistent predictors and moderators of improvement in CBT for PD and agoraphobia.
DATA SOURCES: A systematic review and meta-analysis of articles was conducted using PsycInfo and PubMed. Search terms included panic, agoraphobi*, cognitive behavio*, CBT, cognitive therapy, behavio* therapy, CT, BT, exposure, and cognitive restructuring.
STUDY SELECTION: Studies were limited to those employing semi-structured diagnostic interviews and examining change on panic- or agoraphobia-specific measures.
DATA EXTRACTION: The first author extracted data on study characteristics, prediction analyses, effect sizes, and indicators of study quality. Interrater reliability was confirmed.
SYNTHESIS: 52 papers met inclusion criteria. Agoraphobic avoidance was the most consistent predictor of decreased improvement, followed by low expectancy for change, high levels of functional impairment, and Cluster C personality pathology. Other variables were consistently unrelated to improvement in CBT, understudied, or inconsistently related to improvement.
LIMITATIONS: Many studies were underpowered and failed to report effect sizes. Tests of moderation were rare.
CONCLUSIONS: Apart from agoraphobic avoidance, few variables consistently predict improvement in CBT for PD and/or agoraphobia across studies.