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Utilization of learned skills in cognitive behavioural therapy for panic disorder

Published online by Cambridge University Press:  24 May 2019

Asala Halaj ,
Nitzan Yekutiel ,
Asher Y. Strauss  and
Jonathan D. Huppert Open the ORCID record for Jonathan D. Huppert [Opens in a new window]
Asala Halaj
Affiliation:
The Hebrew University of Jerusalem, Jerusalem, Israel
Nitzan Yekutiel
Affiliation:
The Hebrew University of Jerusalem, Jerusalem, Israel
Asher Y. Strauss
Affiliation:
The Hebrew University of Jerusalem, Jerusalem, Israel
Jonathan D. Huppert*
Affiliation:
The Hebrew University of Jerusalem, Jerusalem, Israel
*
*Corresponding author. Email: [email protected]
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Abstract

Background:

Research has long investigated the cognitive processes in the treatment of depression, and more recently in panic disorder (PD). Meanwhile, other studies have examined patients’ cognitive therapy skills in depression to gain insight into the link between acquiring such skills and treatment outcome.

Aims:

Given that no scale exists to examine in-session patient use of panic-related cognitive behavioural therapy (CBT) skills, the aim of this study was to develop a new measure for assessing patients’ cognitive and behavioural skills in CBT for PD.

Method:

This study included 20 PD patients who received 12 weekly individual therapy sessions. The Cognitive Behavioral Therapy Panic Skills (CBTPS) rating system was developed. Three independent raters coded tapes of therapy sessions at the beginning and end of treatment.

Results:

The coefficient alphas and inter-rater reliability were high for the cognitive and behavioural subscales. Improvement in the patients’ CBTPS scores on both subscales indicated overall symptom improvement, above improvement in anxiety sensitivity.

Conclusion:

To our knowledge, this is the first study examining the impact of patient acquisition of CBT PD skills on treatment outcome. A new measure was developed based on the observations and was deemed reliable and valid. The measure facilitates the examination of the mechanisms of change in treatment for PD. An in-depth examination of the CBTPS may refine our understanding of the impact of each skill on PD treatment outcome. Further research relating to acquiring CBT skills could shed light on the mechanisms of change in treatment.

Keywords

CBT skillscognitive behaviour therapymechanisms of changepanic disordertherapy assessmenttreatment outcome
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 47 , Issue 6 , November 2019 , pp. 645 - 658
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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Footnotes

§

The first two authors contributed equally to the manuscript.

References

Arch, J. J. and Craske, M. G. (2008). Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders: different treatments, similar mechanisms? Clinical Psychology: Science and Practice, 15, 263–279. doi: 10.1111/j.1468-2850.2008.00137.x Google Scholar
Arntz, A. (2002). Cognitive therapy versus interoceptive exposure as treatment of panic disorder without agoraphobia. Behaviour Research and Therapy, 40, 325–341. doi: 10.1016/S0005-7967(01)00014-6 CrossRefGoogle ScholarPubMed
Austin, D. W. and Richards, J. C. (2001). The catastrophic misinterpretation model of panic disorder. Behaviour Research and Therapy, 39, 1277–1291. doi: 10.1016/S0005-7967(00)00095-4 CrossRefGoogle ScholarPubMed
Barber, J. P. and DeRubeis, R. J. (1992). The ways of responding: a scale to assess compensatory skills taught in cognitive therapy. Behavioral Assessment, 14, 93–115.Google Scholar
Barber, J. P. and DeRubeis, R. J. (2001). Change in compensatory skills in cognitive therapy for depression. Journal of Psychotherapy Practice & Research, 10, 8–13.Google Scholar
Barlow, D. H., Craske, M. G. and Meadows, E. A. (2007). Mastery of your Anxiety and Panic: Therapist Guide for Anxiety, Panic, and Agoraphobia. Oxford, UK: Oxford University Press.Google Scholar
Beck, A. T. and Emery, G. (1985). Anxiety Disorders and Phobias. New York, USA: Basic Books.Google Scholar
Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J. and Williams, C. (1985). The mobility inventory for agoraphobia. Behaviour Research and Therapy, 23, 35–44. doi: 10.1016/0005-7967(85)90140-8 CrossRefGoogle ScholarPubMed
Cheavens, J. S., Strunk, D. R., Lazarus, S. A. and Goldstein, L. A. (2012). The compensation and capitalization models: a test of two approaches to individualizing the treatment of depression. Behaviour Research and Therapy, 50, 699–706. doi: 10.1016/j.brat.2012.08.002 CrossRefGoogle ScholarPubMed
Clark, D. A. (2009). Cognitive behavioral therapy for anxiety and depression: possibilities and limitations of a transdiagnostic perspective. Cognitive Behaviour Therapy, 38, 29–34. doi: 10.1080/16506070902980745 CrossRefGoogle ScholarPubMed
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470. doi: 10.1016/0005-7967(86)90011-2 CrossRefGoogle ScholarPubMed
Clark, D. M. (1999). Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy, 37, S5–S27. doi: 10.1016/S0005-7967(99)00048-0 CrossRefGoogle Scholar
Clark, D. M., Salkovskis, P. M., Gelder, M., Koehler, C., Martin, M., Anastasiades, P., et al. (1988). Tests of cognitive theory of panic. In Hand, I., and Wittchen, H. (eds), Panic and Phobias II. Berlin, Germany: Springer Verlag. doi: 10.1007/978-3-642-73543-1_13 Google Scholar
Clark, D. M., Salkovskis, P. M., Öst, L. G., Breitholtz, E., Koehler, K. A., Westling, B. E., Jeavons, A. and Gelder, M. (1997). Misinterpretation of body sensations in panic disorder. Journal of Consulting and Clinical Psychology, 65, 203–213. doi: 10.1037/0022-006X.65.2.203 CrossRefGoogle ScholarPubMed
Craske, M. G., Rowe, M., Lewin, M. and Noriega Dimitri, R. (1997). Interoceptive exposure versus breathing retraining within cognitive behavioural therapy for panic disorder with agoraphobia. British Journal of Clinical Psychology, 36, 85–99. doi: 10.1111/j.2044-8260.1997.tb01233.x CrossRefGoogle ScholarPubMed
Craske, M. G. and Barlow, D. H. (2008). Panic disorder and agoraphobia. In Barlow, D. H. (ed), Clinical Handbook of Psychological Disorders (4th edn), pp. 1–59. New York, USA: Guilford Press.Google Scholar
Gloster, A. T., Klotsche, J., Gerlach, A. L., Hamm, A., Ströhle, A., Gauggel, S., et al. (2014). Timing matters: change depends on the stage of treatment in cognitive behavioral therapy for panic disorder with agoraphobia. Journal of Consulting and Clinical Psychology, 82, 141. doi: 10.1037/a0034555 CrossRefGoogle ScholarPubMed
Gould, R. A., Otto, M. W. and Pollack, M. H. (1995). A meta-analysis of treatment outcome for panic disorder. Clinical Psychology Review, 15, 819–844. doi: 10.1016/0272-7358(95)00048-8 CrossRefGoogle Scholar
Harvey, J. M., Richards, J. C., Dziadosz, T. and Swindell, A. (1993). Misinterpretation of ambiguous stimuli in panic disorder. Cognitive Therapy and Research, 17, 235–248. doi: 10.1007/bf01172948 CrossRefGoogle Scholar
Hofmann, S. G. and Hayes, S. C. (2018). The future of intervention science: process-based therapy. Clinical Psychological Science, 7, 37–50. doi: 10.1177/2167702618772296 CrossRefGoogle ScholarPubMed
Houck, P. R., Spiegel, D. A., Shear, M. K. and Rucci, P. (2002). Reliability of the self-report version of the Panic Disorder Severity Scale. Depression and Anxiety, 15, 183–185. doi: 10.1002/da.10049 CrossRefGoogle ScholarPubMed
Huppert, J. D. and Baker-Morissette, S. L. (2003). Going beyond the manual: an insider’s guide to panic control treatment. Cognitive and Behavioral Practice, 10, 2–12. doi: 10.1016/S1077-7229(03)80003-2 CrossRefGoogle Scholar
Jaeger, B. C., Edwards, L. J., Das, K. and Sen, P. K. (2017). An R 2 statistic for fixed effects in the generalized linear mixed model. Journal of Applied Statistics, 44, 1086–1105. doi: 10.1080/02664763.2016.1193725 CrossRefGoogle Scholar
Johnson, P. C. D. (2014). Extension of Nakagawa & Schielzeth’s R2GLMM to random slopes models. Methods in Ecology and Evolution, 5, 944–946.CrossRefGoogle ScholarPubMed
Kamieniecki, G. W., Wade, T. and Tsouritos, G. (1997). Interpretive bias for benign sensations in panic disorder with agoraphobia. Journal of Anxiety Disorders, 11, 141–156. doi: 10.1016/S0887-6185(97)00003-0 CrossRefGoogle ScholarPubMed
Kivity, Y. and Huppert, J. D. (2018). Are individuals diagnosed with social anxiety disorder successful in regulating their emotions? A mixed-method investigation using self-report, subjective, and event-related potentials measures. Journal of Affective Disorders, 236, 298–305.CrossRefGoogle ScholarPubMed
Lorenzo-Luaces, L., Keefe, J. R. and DeRubeis, R. J. (2016). Cognitive-behavioral therapy: nature and relation to non-cognitive behavioral therapy. Behavior Therapy, 47, 785–803. doi: 10.1016/j.beth.2016.02.012 CrossRefGoogle ScholarPubMed
Margraf, J. and Schneider, S. (1991). Outcome and active ingredients of cognitive-behavioural treatments for panic disorder. Paper presented at the 25th conference of the Association for Advancement of Behavior Therapy, New York, NY, USA.Google Scholar
McMillan, D. and Lee, R. (2010). A systematic review of behavioral experiments vs. exposure alone in the treatment of anxiety disorders: a case of exposure while wearing the emperor’s new clothes?. Clinical Psychology Review, 30, 467–478. doi: 10.1016/j.cpr.2010.01.003 CrossRefGoogle ScholarPubMed
McNally, R. J. and Foa, E. B. (1987). Cognition and agoraphobia: bias in the interpretation of threat. Cognitive Therapy and Research, 11, 567–581. doi: 10.1007/bf01183859 CrossRefGoogle Scholar
Milrod, B., Chambless, D. L., Gallop, R., Busch, F. N., Schwalberg, M., McCarthy, K. S., et al. (2015). Psychotherapies for panic disorder: a tale of two sites. Journal of Clinical Psychiatry, 77, 927–935. doi: 10.4088/JCP.14m09507 CrossRefGoogle Scholar
Nakagawa, S. and Schielzeth, H. (2013). A general and simple method for obtaining R2 from generalized linear mixed-effects models. Methods in Ecology and Evolution, 4, 133–142. doi: 10.1111/j.2041-210x.2012.00261.x CrossRefGoogle Scholar
Overholser, J. C. (2000). Cognitive behavioral treatment of panic disorder. Psychotherapy: Theory/Research/Practice/Training, 37, 247–256. doi: 10.1037/h0087692 CrossRefGoogle Scholar
Pinheiro, J., Bates, D., DebRoy, S., Sarkar, D. and R Core Team (2017). R package version 3.1–131.Google Scholar
Salkovskis, P. M., Clark, D. M. and Gelder, M. G. (1996). Cognition-behaviour links in the persistence of panic. Behaviour Research and Therapy, 34, 453–453. doi: 10.1016/0005-7967(95)00083-6 CrossRefGoogle Scholar
Schmidt, N. B., Woolaway-Bickel, K., Trakowski, J., Santiago, H., Storey, J., Koselka, M. and Cook, J. (2000). Dismantling cognitive-behavioral treatment for panic disorder: questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology, 68, 417–424. doi: 10.1037/0022-006X.68.3.417 CrossRefGoogle ScholarPubMed
Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., et al. (1997). Multicenter collaborative Panic Disorder Severity Scale. American Journal of Psychiatry, 154, 1571–1575. doi: 10.1176/ajp.154.11.1571 CrossRefGoogle ScholarPubMed
Shear, M. K., Rucci, P., Williams, J., Frank, E., Grochocinski, V., Vander Bilt, J., et al. (2001). Reliability and validity of the Panic Disorder Severity Scale: replication and extension. Journal of Psychiatric Research, 35, 293–296. doi: 10.1016/S0022-3956(01)00028-0 CrossRefGoogle Scholar
Sheehan, D., Lecrubier, Y., Sheehan, K. H., Sheehan, K., Amorim, P., Janavs, J., et al. (1998). The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33. doi: 10.1016/S0924-9338(97)83296-8 Google ScholarPubMed
Strauss, A. Y., Kivity, Y. and Huppert, J. D. (in press). Emotion regulation strategies in cognitive behavioral therapy for panic disorder. Behavior Therapy (available online).Google Scholar
Strunk, D. R., DeRubeis, R. J., Chiu, A. W. and Alvarez, J. (2007). Patients’ competence in and performance of cognitive therapy skills: relation to the reduction of relapse risk following treatment for depression. Journal of Consulting and Clinical Psychology, 75, 523–530. doi: 10.1037/0022-006X.75.4.523 CrossRefGoogle ScholarPubMed
Strunk, D. R., Hollars, S. N., Adler, A. D., Goldstein, L. A. and Braun, J. D. (2014). Assessing patients’ cognitive therapy skills: initial evaluation of the competencies of cognitive therapy scale. Cognitive Therapy and Research, 38, 559–569. doi: 10.1007/s10608-014-9617-9 CrossRefGoogle ScholarPubMed
Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., et al. (2007). Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19, 176–188. doi: 10.1037/1040-3590.19.2.176 CrossRefGoogle ScholarPubMed
Teachman, B. A., Marker, C. D. and Smith-Janik, S. B. (2008). Automatic associations and panic disorder: trajectories of change over the course of treatment. Journal of Consulting and Clinical Psychology, 76, 988–1002. doi: 10.1037/a0013113 CrossRefGoogle ScholarPubMed
Wang, L. P. and Maxwell, S. E. (2015). On disaggregating between-person and within-person effects with longitudinal data using multilevel models. Psychological Methods, 20, 63.CrossRefGoogle ScholarPubMed
Weiss, M., Kivity, Y. and Huppert, J. D. (2014). How does the therapeutic alliance develop throughout cognitive-behavioral therapy for panic disorder? Sawtooth patterns, sudden gains, and stabilization. Psychotherapy Research, 24, 407–418.CrossRefGoogle ScholarPubMed
Wolf, A. W. and Goldfried, M. R. (2014). Clinical experiences in using cognitive-behavior therapy to treat panic disorder. Behavior Therapy, 45, 36–46. doi: 10.1016/j.beth.2013.10.002 CrossRefGoogle ScholarPubMed
Zalaznik, D., Weiss, M. and Huppert, J. D. (2019). Improvement in adult anxious and avoidant attachment during cognitive behavioral therapy for panic disorder. Psychotherapy Research, 29, 337–353.CrossRefGoogle ScholarPubMed
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