title: Stepped care versus face-to-face cognitive behavior therapy for panic disorder and social anxiety disorder: Predictors and moderators of outcome.
abstract: OBJECTIVE
  To investigate predictors and moderators of treatment outcome by comparing immediate face-to-face cognitive behavioral therapy (FtF-CBT) to a Stepped Care treatment model comprising three steps: Psychoeducation, Internet-delivered CBT, and FtF-CBT for panic disorder (PD) and social anxiety disorder (SAD).
  
  
  METHODS
  Patients (N = 173) were recruited from nine public mental health out-patient clinics and randomized to immediate FtF-CBT or Stepped Care treatment. Characteristics related to social functioning, impairment from the anxiety disorder, and comorbidity was investigated as predictors and moderators by treatment format and diagnosis in multiple regression analyses.
  
  
  RESULTS
  Lower social functioning, higher impairment from the anxiety disorder, and a comorbid cluster C personality disorder were associated with significantly less improvement, particularly among patients with PD. Furthermore, having a comorbid anxiety disorder was associated with a better treatment outcome among patients with PD but not patients with SAD. Patients with a comorbid depression had similar outcomes from the different treatments, but patients without comorbid depression had better outcomes from immediate FtF-CBT compared to guided self-help.
  
  
  CONCLUSIONS
  In general, the same patient characteristics appear to be associated with the treatment outcome for CBT provided in low- and high-intensity formats when treated in public mental health care clinics. The findings suggest that patients with lower social functioning and higher impairment from their anxiety disorder benefit less from these treatments and may require more adapted and extensive treatment. CLINICALTRIALS.GOV: Identifier: NCT00619138.
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Clinical Psychology, University of Bergen, Postboks 7800, 5020 Bergen, Norway. Electronic address: Thomas.haug@psykp.uib.no.
authors.forename: Thomas
authors.initials: T
authors.lastname: Haug
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Clinical Psychology, University of Bergen, Postboks 7800, 5020 Bergen, Norway.
authors.forename: Tine
authors.initials: T
authors.lastname: Nordgreen
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Psychology, University of Stockholm, SE-106 91 Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institute, 171 77 Stockholm, Sweden.
authors.forename: Lars-Göran
authors.initials: LG
authors.lastname: Öst
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Clinical Psychology, University of Bergen, Postboks 7800, 5020 Bergen, Norway.
authors.forename: Gerd
authors.initials: G
authors.lastname: Kvale
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Psychiatry, University of Bergen, Postboks 7800, 5020 Bergen, Norway.
authors.forename: Tone
authors.initials: T
authors.lastname: Tangen
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, 171 77 Stockholm, Sweden.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Department of Psychology, University of Stockholm, SE-106 91 Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Carlbring
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway.
authors.forename: Einar R
authors.initials: ER
authors.lastname: Heiervang
authors.affiliation: Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Clinical Psychology, University of Bergen, Postboks 7800, 5020 Bergen, Norway.
authors.forename: Odd E
authors.initials: OE
authors.lastname: Havik
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000150:complications / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000150:complications / Q000628:therapy; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D016584:Panic Disorder / Q000150:complications / Q000628:therapy*; D010349:Patient Compliance; D010353:Patient Education as Topic; D010554:Personality Disorders / Q000150:complications / Q000628:therapy; D011361:Professional Competence; D057566:Self Report; D012919:Social Behavior; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cognitive behavioral therapy; Guided self-help; Internet-delivered CBT; Moderators; Predictors; Stepped care