title: Cognitive mediation of clinical improvement after intensive exposure therapy of agoraphobia and social phobia.
abstract: BACKGROUND
  The present study investigated cognitive mediation of clinical improvement in patients with agoraphobia (N=427) or social phobia (N=98) receiving high-density exposure therapy in a naturalistic clinical treatment setting.
  
  
  METHODS
  Patients were assessed before therapy, 6 weeks after the end of therapy, and 1 year thereafter, using a self-report assessment battery. Lower level mediation analyses provided support for the notion that cognitive changes partially mediate clinical improvement after exposure therapy.
  
  
  RESULTS
  Changes in cognitions relating to physical catastrophes mediated treatment outcome only for patients with agoraphobia, whereas changes in cognitions about loss of control mediated outcome for both agoraphobia and social phobia patients. Changes in relationship satisfaction did not mediate symptomatic improvement.
  
  
  CONCLUSIONS
  The results extend previous findings by demonstrating mediation in an unselected clinical sample and by providing evidence for the specificity of mediation effects. They further support the importance of cognitive changes in cognitive-behavior therapy.
authors.affiliation: Clinical and Health Psychology Research Centre, School of Human and Life Sciences, Roehampton University, Whitelands College, Holybourne Avenue, London, United Kingdom. c.vogele@roehampton.ac.uk
authors.forename: Claus
authors.initials: C
authors.lastname: Vögele
authors.forename: Anke
authors.initials: A
authors.lastname: Ehlers
authors.forename: Andrea H
authors.initials: AH
authors.lastname: Meyer
authors.forename: Monika
authors.initials: M
authors.lastname: Frank
authors.forename: Kurt
authors.initials: K
authors.lastname: Hahlweg
authors.forename: Jürgen
authors.initials: J
authors.lastname: Margraf
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000523:psychology / Q000628:therapy*; D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D017008:Negotiating; D016584:Panic Disorder / Q000523:psychology / Q000628:therapy*; D010549:Personal Satisfaction; D010698:Phobic Disorders / Q000523:psychology / Q000628:therapy*; D013997:Time Factors