title: Contribution of Group Therapeutic Factors to the Outcome of Cognitive-Behavioral Therapy for Patients with Panic Disorder.
abstract: Investigating the contribution of therapeutic factors arising from the collective nature or group therapy to treat mental disorders may help therapists maximize the outcome of therapy. Studies about the role of therapeutic factors in cognitive-behavioral group therapy (CBGT) for panic disorder (PD) patients are still scarce.
  
  
  
  To identify the therapeutic factors rated as the most useful by patients during CBGT. Also, we aimed to investigate the relationship between patient rating of therapeutic factors and specific stages of CBGT.
  
  
  
  Non-controlled clinical trial.
  
  
  
  A 12-session CBGT protocol was set up, covering psychoeducation, techniques for anxiety coping, cognitive restructuring, interoceptive and naturalistic exposure, and live exposure to avoidant behavior. PD symptom severity was assessed before and after the CBGT protocol. Yalom's Curative Factors Questionnaire was self-administered at the end of each session to evaluate the 12 therapeutic factors.
  
  
  
  The sample consisted of 16 patients, who produced 192 assessments of therapeutic factors. Severity of symptoms improved at the end of CBGT, with a large effect size (>1.0). Different ratings were attributed to therapeutic factors at different phases of CBGT. Seven factors were rated as significantly helpful: altruism, interpersonal learning/input, guidance, identification, family reenactment, self-understanding, and existential factors.
  
  
  
  Therapeutic factors are dynamic and interdependent. Therefore, recognizing the impact of these factors during CBGT may potentially contribute to a better understanding of the therapeutic process.
authors.affiliation: Graduate Program in Nursing, School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil.
authors.forename: Andressa
authors.initials: A
authors.lastname: Behenck
authors.affiliation: Graduate Program in Nursing, School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Wesner
authors.affiliation: Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil.
authors.forename: Débora
authors.initials: D
authors.lastname: Finkler
authors.affiliation: Graduate Program in Nursing, School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil. Electronic address: eliz.h@globo.com.
authors.forename: Elizeth
authors.initials: E
authors.lastname: Heldt
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D016584:Panic Disorder / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome