title: The mediational role of panic self-efficacy in cognitive behavioral therapy for panic disorder: a systematic review and meta-analysis.
abstract: Cognitive models of panic disorder (PD) with or without agoraphobia have stressed the role of catastrophic beliefs of bodily symptoms as a central mediating variable of the efficacy of cognitive behavioral therapy (CBT). Perceived ability to cope with or control panic attacks, panic self-efficacy, has also been proposed to play a key role in therapeutic change; however, this cognitive factor has received much less attention in research. The aim of the present review is to evaluate panic self-efficacy as a mediator of therapeutic outcome in CBT for PD using descriptive and meta-analytic procedures. We performed systematic literature searches, and included and evaluated 33 studies according to four criteria for establishing mediation. Twenty-eight studies, including nine randomized waitlist-controlled studies, showed strong support for CBT improving panic self-efficacy (criterion 1); ten showed an association between change in panic self-efficacy and change in outcome during therapy (criterion 2); three tested, and one established formal statistical mediation of panic self-efficacy (criterion 3); while four tested and three found change in panic self-efficacy occurring before the reduction of panic severity (criterion 4). Although none of the studies fulfilled all of the four criteria, results provide some support for panic self-efficacy as a mediator of outcome in CBT for PD, generally on par with catastrophic beliefs in the reviewed studies.
authors.affiliation: Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Bartholins Alle' 9, 8000 Aarhus C, Denmark; Clinic for Anxiety Disorders and OCD, Aarhus University Hospital, Tretommervej 1, 8240 Risskov, Denmark. Electronic address: hanneno@psy.au.dk.
authors.forename: Hanne N
authors.initials: HN
authors.lastname: Fentz
authors.affiliation: Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Bartholins Alle' 9, 8000 Aarhus C, Denmark; Clinic for Anxiety Disorders and OCD, Aarhus University Hospital, Tretommervej 1, 8240 Risskov, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Arendt
authors.affiliation: Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Bartholins Alle' 9, 8000 Aarhus C, Denmark; Clinic for Anxiety Disorders and OCD, Aarhus University Hospital, Tretommervej 1, 8240 Risskov, Denmark.
authors.forename: Mia S
authors.initials: MS
authors.lastname: O'Toole
authors.affiliation: Research Institute, Modum Bad, N-3370, Vikersund, Norway; Department of Psychology, University of Oslo, Norway.
authors.forename: Asle
authors.initials: A
authors.lastname: Hoffart
authors.affiliation: Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Bartholins Alle' 9, 8000 Aarhus C, Denmark.
authors.forename: Esben
authors.initials: E
authors.lastname: Hougaard
mesh_terms: D000223:Adaptation, Psychological; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D010200:Panic; D016584:Panic Disorder / Q000523:psychology / Q000628:therapy*; D020377:Self Efficacy
keywords: Catastrophic beliefs; Cognitive behavioral therapy; Mediation; Panic disorder; Panic self-efficacy; Treatment mechanisms