title: Cognitive models for panic disorder with agoraphobia: A study of disaggregated within-person effects.
abstract: OBJECTIVE
  The purpose of this study was to test 2 cognitive models of panic disorder with agoraphobia (PDA)-a catastrophic cognitions model and a low self-efficacy model-by examining the within-person effects of model-derived cognitive variables on subsequent anxiety symptoms.
  
  
  METHODS
  Participants were 46 PDA patients with agoraphobic avoidance of moderate to severe degree who were randomly allocated to 6 weeks of either cognitive therapy, based on the catastrophic cognitions model of PDA, or guided mastery (guided exposure) therapy, based on the self-efficacy model of PDA. Cognitions and anxiety were measured weekly over the course of treatment. The data were analyzed with mixed models, using person-mean centering to disaggregate within- and between-person effects.
  
  
  RESULTS
  All of the studied variables changed in the expected way over the course of therapy. There was a within-person effect of physical fears, loss of control fears, social fears, and self-efficacy when alone on subsequent state anxiety. On the other hand, within-person changes in anxiety did not predict subsequent cognitions. Loss of control and social fears both predicted subsequent self-efficacy, whereas self-efficacy did not predict catastrophic cognitions. In a multipredictor analysis, within-person catastrophic cognitions still predicted subsequent anxiety, but self-efficacy when alone did not.
  
  
  CONCLUSIONS
  Overall, the findings indicate that anxiety in PDA, at least in severe and long-standing cases, is driven by catastrophic cognitions. Thus, these cognitions seem to be useful therapeutic targets. (PsycINFO Database Record
authors.affiliation: Research Institute, Modum Bad Psychiatric Center.
authors.forename: Asle
authors.initials: A
authors.lastname: Hoffart
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000150:complications / Q000523:psychology* / Q000628:therapy; D001007:Anxiety / Q000150:complications / Q000523:psychology* / Q000628:therapy; D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D016584:Panic Disorder / Q000150:complications / Q000523:psychology* / Q000628:therapy; D020377:Self Efficacy; D016896:Treatment Outcome