Fundamental frequency during cognitive preparation and its impact on therapy outcome for panic disorder with Agoraphobia.

BACKGROUND

Cognitive preparation plays a crucial role in CBT with exposure for panic disorder and agoraphobia. High emotional arousal while developing the exposure rationale might impair patients' cognitive capacities for processing information about treatment and impede therapeutic outcome.

OBJECTIVE

This study investigates whether patients' vocally encoded emotional arousal, assessed by fundamental frequency (f), during rationale development is associated with premature treatment dropout, insight into the rationale, and symptom reduction.

METHODS

Patients' (N = 197, mean age 36.1 years, 79.2% female) f during rationale development was measured based on treatment videos from a randomized controlled trial of CBT for panic disorder and agoraphobia. Insight was rater assessed. Symptom severity was self- and rater assessed at the beginning and end of therapy.

RESULTS

Higher f mean during rationale development was associated with lower probability of insight and less reduction in avoidance behavior. f was not associated with dropout. Insight was associated with lower probability of dropout and partially mediated the association between f and avoidance reduction.

DISCUSSION

This study highlights the importance of emotional arousal during cognitive preparation for exposure. Therapists should ensure that patients are not too highly aroused while learning about the exposure rationale as an important step in treatment.