An investigation into the matching of specific agoraphobic anxiety response characteristics with specific types of treatment

The mediational role of panic self-efficacy in cognitive behavioral therapy for panic disorder: a systematic review and meta-analysis

Cognitive models of panic disorder (PD) with or without agoraphobia have stressed the role of catastrophic beliefs of bodily symptoms as a central mediating variable of the efficacy of cognitive behavioral therapy (CBT). Perceived ability to cope with or control panic attacks, panic self-efficacy, has also been proposed to play a key role in therapeutic change; however, this cognitive factor has received much less attention in research. The aim of the present review is to evaluate panic self-efficacy as a mediator of therapeutic outcome in CBT for PD using descriptive and meta-analytic procedures. We performed systematic literature searches, and included and evaluated 33 studies according to four criteria for establishing mediation. Twenty-eight studies, including nine randomized waitlist-controlled studies, showed strong support for CBT improving panic self-efficacy (criterion 1); ten showed an association between change in panic self-efficacy and change in outcome during therapy (criterion 2); three tested, and one established formal statistical mediation of panic self-efficacy (criterion 3); while four tested and three found change in panic self-efficacy occurring before the reduction of panic severity (criterion 4). Although none of the studies fulfilled all of the four criteria, results provide some support for panic self-efficacy as a mediator of outcome in CBT for PD, generally on par with catastrophic beliefs in the reviewed studies.

Group therapy for pathological gamblers: a cognitive approach

This study evaluated the efficacy of a group cognitive treatment for pathological gambling. Gamblers, meeting DSM-IV criteria for pathological gambling, were randomly assigned to treatment (N=34) or wait-list control (N=24) conditions. Cognitive correction techniques were used first to target gamblers' erroneous perceptions about randomness, and then to address issues of relapse prevention. The dependent measures used were the DSM-IV criteria for pathological gambling, perceived self-efficacy, gamblers' perception of control, desire to gamble, and frequency of gambling. Post-treatment results indicated that 88% of the treated gamblers no longer met the DSM-IV criteria for pathological gambling compared to only 20% in the control group. Similar changes were observed on all outcome measures. Analysis of data from 6-, 12- and 24-month follow-ups revealed maintenance of therapeutic gains. Recommendations for group interventions are discussed, focusing on the cognitive correction of erroneous perceptions toward the notion of randomness.

Treatment Selection: What Do We Know?

In this article we review the main findings in psychotherapy research that can contribute to the two goals of the treatment-selection process: (1) facilitating the first phase of therapy and (2) enhancement of final outcome of therapy. Psychotherapy research that contributes directly to treatment selection is scarce since treatment selection as such is seldom the topic of study. Further, guidelines for the practitioner concerning treatment selection have rarely been formulated. In this review we make the explicit attempt to reformulate research findings into suggestions for the clinician for treatment selection.

"Cleaning-up cognition" in triple-response fear assessment through individualized functional behavior analysis

Improvements in behavioral assessment spurred by the triple-response concept have been overshadowed by a preoccupation with content of assessment and a lack of regard for the context of assessment. The aims of this article are to (a) clarify the imprecise use of the verbal-subjective-cognitive mode and to reinterpret cognitive events based on evidence and methods derived from clinical behavior analysis, (b) discuss the limitations of the triple-response assessment framework, and (c) suggest an alternative functional idiographic approach to assessment and treatment that may direct attention toward behavior relations understood functionally within the context of environmental contingencies; an approach that once was the hallmark of behavior therapy and the basis for therapeutic interventions.

Behavioral and cognitive treatment methods: a critical comparative review

Forty clinical outcome studies were selected using strict criteria in which standard behavior therapy (BT) procedures were compared with procedures considered cognitive. The question asked was whether the addition of cognitive therapy (CT) methods yielded more beneficial treatment outcomes. Most studies reflected an equivalence in outcome between cognitive-behavioral therapy (CBT) procedures and behavioral procedures alone. Behavior therapy was superior in two studies to treatments with a cognitive component. One finding was that cognitive therapy has shown promise in the areas of social anxiety. The behavioral aspect of CBT seemed central to its effectiveness, while the same cannot be said for the cognitive components. Given that only a modicum of clinical benefit has been added in twenty years of the cognitive therapy movement, it is suggested that the wholesale adoption of cognitive procedures is unmerited.

The triple response approach to assessment: a conceptual and methodological reappraisal

Despite its positive effects on the increased use of multiple assessments and improved assessment validity, the triple-response concept has led to some conceptual and practical confusion. This is mainly due to two problems: (1) a confounding of the content and method of assessment; and (2) an imprecise and vague use of the 'verbal-subjective mode' which has been expanded to include cognitive elements since the introduction of cognitive-behavioural theories and treatments. A new matrix is proposed that clearly distinguishes content and method of assessment. It also defines a separate cognitive/information-processing content area and introduces affect as an additional content area. Thus, four content areas are suggested: behavioural, physiological, cognitive, and affective, which can be measured in three different ways: by means of self-report, observation, and instruments or technical equipment. We point out the implications of these changes for (1) a more appropriate selection of assessment procedures and outcome measures in clinical research; (2) a more adequate individualization of treatment through matching individual response profiles to specific treatments; and (3) an improved understanding of the interrelationship between behavioural, physiological, cognitive, and affective processes in anxiety and depression. Finally, we suggest that the lack of agreement between measures of physiological, cognitive, behavioural and affective changes in some studies may be as much a reflection of the lack of agreement arising from spurious sources of variance within content areas as it is a reflection of the operation of different processes and systems.

Psychological approaches to the assessment and treatment of anxiety and depression

Clinical psychology offers a unique and often complementary approach to assessment and treatment of anxiety and depression. Current practices are examined for their scientific validity and clinical utility.