title: The role of treatment delivery factors in exposure-based cognitive behavioral therapy for panic disorder with agoraphobia.
abstract: Treatment delivery factors (i.e., therapist adherence, therapist competence, and therapeutic alliance) are considered to be important for cognitive behavioral therapy (CBT) for panic disorder and agoraphobia (PD/AG). In the current study, four independent raters conducted process evaluations based on 168 two-hour videotapes of 84 patients with PD/AG treated with exposure-based CBT. Two raters evaluated patients' interpersonal behavior in Session 1. Two raters evaluated treatment delivery factors in Session 6, in which therapists provided the rationale for conducting exposure exercises. At the 6-month follow-up, therapists' adherence (r=0.54) and therapeutic alliance (r=0.31) were significant predictors of changes in agoraphobic avoidance behavior; therapist competence was not associated with treatment outcomes. Patients' interpersonal behavior in Session 1 was a significant predictor of the therapeutic alliance in Session 6 (r=0.17). The findings demonstrate that treatment delivery factors, particularly therapist adherence, are relevant to the long-term success of CBT for PD/AG.
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany. Electronic address: fweck@uni-potsdam.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Weck
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Grikscheit
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt, Germany.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Höfling
authors.affiliation: Christoph-Dornier-Foundation for Clinical Psychology, Bremen, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Kordt
authors.affiliation: Department of Psychology, Ernst Moritz Arndt University Greifswald, Greifswald, Germany.
authors.forename: Alfons O
authors.initials: AO
authors.lastname: Hamm
authors.affiliation: Department of Psychology, University of Cologne, Cologne, Germany.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Gerlach
authors.affiliation: Department of Psychology, University of Mannheim, Mannheim, Germany.
authors.forename: Georg W
authors.initials: GW
authors.lastname: Alpers
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Arolt
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Kircher
authors.affiliation: Department of Psychology, University of Würzburg, Würzburg, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Pauli
authors.affiliation: Department of Psychology, University of Marburg, Marburg, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Rief
authors.affiliation: Christoph-Dornier-Foundation for Clinical Psychology, Bremen, Germany; Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lang
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000150:complications / Q000523:psychology / Q000628:therapy*; D002983:Clinical Competence; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D010349:Patient Compliance; D011369:Professional-Patient Relations; D016896:Treatment Outcome; D055815:Young Adult
keywords: Interpersonal behavior; Panic disorder with agoraphobia; Therapeutic alliance; Therapist adherence; Therapist competence