In Vivo Sessions Better with Therapist Present: Panic Disorder and Agoraphobia Patients Can Improve without Strict Adherence to CBT Manual

By Helwick, Caroline | Clinical Psychiatry News, October 2010 | Go to article overview

In Vivo Sessions Better with Therapist Present: Panic Disorder and Agoraphobia Patients Can Improve without Strict Adherence to CBT Manual


Helwick, Caroline, Clinical Psychiatry News


AMSTERDAM -- Cognitive-behavioral therapy for panic disorder and agoraphobia seems to work better when the therapist accompanies the patient during the in vivo exposure sessions.

Investigators from Technische Universitat in Dresden, Germany, made this finding, and, additionally, found that therapists need not adhere strongly to a CBT manual to produce symptomatic changes.

The two studies were reported at the congress by Andrew T. Gloster, Ph.D., and Christina Hauke of the Institute of Clinical Psychology and Psychotherapy.

The first was a multicenter study of 369 patients with panic disorder and agoraphobia as well as a high rate of co-morbid disorders (41%-73%). The study's primary aim was to determine whether variations in treatment delivery affect outcomes of CBT.

The patients were randomized to two active variations of CBT. In one, the therapist was present during in vivo exposure exercises (n = 163); in the other, the therapist planned and discussed the exercises but did not accompany the patient (n = 138). A third group (control) was assigned to a wait list (n = 68).

"Leaving the room is crucial for the patient, and we explored whether there is a benefit for the therapist being with the patient for these exposures. Data suggest you can do the therapy both ways, but you absolutely must prepare the patient as to what will occur," Dr. Gloster explained.

"We have this conversation many times with the patient. If the therapist is going with the patient, then the conversation can occur as it is needed."

Attaining Better Response Rates

At the end of treatment, both active treatment groups were superior to the wait list group, but the therapist-present group obtained more favorable results on nearly every index. The largest differences were noted on agoraphobic avoidance and global functioning, he reported.

"We found there are additive effects when the therapist goes with the patient on all five exposure sessions," Dr. Gloster said.

On global functioning, the mean baseline value was 5.4 for the therapist-present group, and 5.2 for both the therapist-not-present and the wait-list groups. From baseline to end of treatment (last observation carried forward), scores were reduced by nearly 2.5 points with the therapist present and 2.0 points without the therapist present (P less than .05). Patients continued to improve over time, and at the 6-month follow-up, these scores were further reduced (nonsignificantly) by another 1.0 and 0.75 points, respectively.

These numbers represented response rates post treatment of 49.7% for the therapist-present condition and 39.1% for therapist-not-present condition.

At the 6-month follow-up, response rates rose to 68. …

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