Predictors of Broad Dimensions of Psychopathology among Patients with Panic Disorder after Cognitive-Behavioral Therapy

By Ogawa, Sei; Kondo, Masaki et al. | Psychiatry Journal, Annual 2018 | Go to article overview

Predictors of Broad Dimensions of Psychopathology among Patients with Panic Disorder after Cognitive-Behavioral Therapy


Ogawa, Sei, Kondo, Masaki, Ino, Keiko, Imai, Risa, Ii, Toshitaka, Furukawa, Toshi A., Akechi, Tatsuo, Psychiatry Journal


1. Background

Panic disorder is associated with substantial reductions in social functions and lifetime prevalence rates are approximately 3% [1]. Generally, panic disorder has broad dimensions of psychopathology. Fifty to eighty percent of patients affected by panic disorder meet criteria for other psychiatric diagnoses, mainly other anxiety or mood disorders [2, 3]. This overlap among the disorders may occur owing to general distress or negative affectivity, a shared genetic predisposition and a common neurobiology [4]. The comorbidity between panic disorder and depression is considered to be related to symptom severity and poorer treatment outcome [5]. Panic disorder with comorbid psychiatric symptoms is regarded as a severe condition. Moreover, panic disorder shows subthreshold psychiatric symptoms such as somatization, phobic anxiety, interpersonal anxiety, and depression [6]. Successful treatment of panic disorder is associated with improvement in broad dimensions of psychopathology [7].

The efficacy of cognitive-behavioral therapy has been established for panic disorder [8, 9]. A number of studies presented that cognitive-behavioral therapy for a targeted anxiety disorder caused positive benefits upon comorbid psychiatric symptoms [3, 10]. In order to provide more effective treatments, it is useful to examine baseline predictive factors of wide range of psychopathology after cognitive-behavioral therapy for panic disorder. Predictors of less effective treatment may save patients' time by avoiding ineffective treatment, which may be sometimes associated with economic burden. The previous study found that low levels of panic disorder symptom severity predicted positive treatment response for cognitive-behavioral therapy [11]. We found that some cognitive factors predicted several dimensions of psychopathology after cognitive-behavioral therapy for panic disorder [6]. However, research to identify predictive factors has been limited in cognitive-behavioral therapy for panic disorder, especially broad dimensions of psychiatric symptoms.

Patient personality characteristics are important in the treatment formulations of clinicians and researchers. Knowledge of a patient's personality trait may be useful in determining where psychological intervention should be provided, which type of group would be effective, and which psychological techniques should be emphasized. Some studies suggest that personality traits mediate broad dimensions of psychopathology. Ogrodniczuk et al. (2003) found that extraversion, conscientiousness, and openness were associated with favorable outcomes in group psychotherapy without cognitive-behavioral therapy [13]. Whether personality characteristics have an impact on cognitive-behavioral therapy outcomes is an important question. We found that openness, agreeableness, and conscientiousness at baseline predicted broad dimensions of psychopathology in social anxiety disorder patients after cognitive-behavioral therapy [14]. From the point of view of group therapy, our findings concerning openness and conscientiousness are consistent with those of Ogrodniczuk et al. [13]. In cognitive-behavioral therapy for panic disorder, however, few studies identified predictive personality traits [15, 16].

The present study aimed to examine the predictive value of personality traits for broad dimensions of psychopathology in panic disorder after cognitive-behavioral therapy.

2. Methods

2.1. Participants. Two hundred patients affected by panic disorder who attended the group cognitive-behavioral therapy program participated in the present study between October 2001 and May 2015. Some patients were referrals from the general medical or psychiatric clinics and departments and others who sought treatment for panic disorder themselves. All patients met the following inclusion criteria: (i) principal Axis I diagnosis of panic disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, as assessed by the Structured Clinical Interview for DSM-IV(SCID) [17]; (ii) free from benzodiazepine use prior to cognitive-behavioral therapy entry, because these drugs may interact negatively with exposure treatments during cognitive-behavioral therapy [18, 19]; the established treatment manual that we used in this study contraindicated the benzodiazepine use in cognitive-behavioral therapy [20]; (iii) highly motivated to receive cognitive-behavioral therapy. …

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