Chambless Dianne L, Milrod Barbara, Porter Eliora, Gallop Robert, McCarthy Kevin S, Graf Elizabeth, Rudden Marie, Sharpless Brian A, Barber Jacques P
Department of Psychology, University of Pennsylvania.
Department of Psychiatry, Weill Cornell Medical College.
J Consult Clin Psychol. 2017 Aug;85(8):803-813. doi: 10.1037/ccp0000224. Epub 2017 Jun 26.
To identify variables predicting psychotherapy outcome for panic disorder or indicating which of 2 very different forms of psychotherapy-panic-focused psychodynamic psychotherapy (PFPP) or cognitive-behavioral therapy (CBT)-would be more effective for particular patients.
Data were from 161 adults participating in a randomized controlled trial (RCT) including these psychotherapies. Patients included 104 women; 118 patients were White, 33 were Black, and 10 were of other races; 24 were Latino(a). Predictors/moderators measured at baseline or by Session 2 of treatment were used to predict change on the Panic Disorder Severity Scale (PDSS).
Higher expectancy for treatment gains (Credibility/Expectancy Questionnaire d = -1.05, CI [-1.50, -0.60]), and later age of onset (d = -0.65, CI [-0.98, -0.32]) were predictive of greater change. Both variables were also significant moderators: patients with low expectancy of improvement improved significantly less in PFPP than their counterparts in CBT, whereas this was not the case for patients with average or high levels of expectancy. When patients had an onset of panic disorder later in life (≥27.5 years old), they fared as well in PFPP as CBT. In contrast, at low and mean levels of onset age, CBT was the more effective treatment.
Predictive variables suggest possibly fruitful foci for improvement of treatment outcome. In terms of moderation, CBT was the more consistently effective treatment, but moderators identified some patients who would do as well in PFPP as in CBT, thereby widening empirically supported options for treatment of this disorder. (PsycINFO Database Record
确定预测惊恐障碍心理治疗结果的变量，或指明两种截然不同的心理治疗形式——惊恐聚焦心理动力心理治疗（PFPP）或认知行为疗法（CBT）——对特定患者而言哪种更有效。
数据来自161名参与包含这些心理治疗的随机对照试验（RCT）的成年人。患者包括104名女性；118名患者为白人，33名是黑人，10名属于其他种族；24名是拉丁裔。在基线或治疗第2阶段测量的预测因素/调节因素用于预测惊恐障碍严重程度量表（PDSS）上的变化。
对治疗收益的更高期望（可信度/期望问卷d = -1.05，CI [-1.50, -0.60]）以及较晚的发病年龄（d = -0.65，CI [-0.98, -0.32]）可预测更大的变化。这两个变量也是显著的调节因素：改善期望较低的患者在PFPP中的改善显著低于其在CBT中的对应者，而对于期望水平中等或较高的患者则并非如此。当患者在生命后期（≥27.5岁）出现惊恐障碍时，他们在PFPP中的表现与CBT中一样好。相比之下，在低发病年龄和中等发病年龄水平，CBT是更有效的治疗方法。
预测变量表明可能是改善治疗结果的富有成效的重点。在调节方面，CBT是更一致有效的治疗方法，但调节因素确定了一些在PFPP中与在CBT中表现一样好的患者，从而拓宽了该疾病治疗的实证支持选项。（PsycINFO数据库记录）
