A pilot study of sensation-focused intensive treatment for panic disorder with moderate to severe agoraphobia: Preliminary outcome and benchmarking data

MA, Center for Anxiety and Related Disorders, Boston University, Botson, MA 02215, USA.
Behavior modification (Impact Factor: 2.23). 04/2008; 32(2):196-214. DOI: 10.1177/0145445507309019
Source: PubMed

ABSTRACT This report presents results of a treatment for panic disorder with moderate to severe agoraphobia (PDA-MS) called sensation-focused intensive treatment (SFIT). SFIT is an 8-day intensive treatment that combines features of cognitive- behavioral treatment for panic disorder, such as interoceptive exposure and cognitive restructuring with ungraded situational exposure. SFIT focuses on feared physical sensations as well as agoraphobic avoidance. Preliminary data support the utility of SFIT in improving PDA-MS. The goal of this exploratory study was to further investigate the effectiveness of SFIT and evaluate factors related to treatment outcome, including severity of panic symptoms, gender, comorbidity, self-efficacy, and place of residence (local vs. remote). SFIT was found to be effective in decreasing panic symptoms from pre- to posttreatment, with treatment gains maintained at follow-up. The implications of these findings for the treatment of PDA are discussed.

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    Chapter: Agoraphobia
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    ABSTRACT: The term agoraphobia was first coined by Westphal (1871) in his description of three males who experienced intense anxiety when walking across open spaces. Westphal also noted the physiological symptoms of anxiety (i.e., palpitations, blushing, trembling, and sensations of heat) and the intense subjective anxiety that is elicited upon anticipating entering a feared situation. Today, agoraphobia remains one of the most disabling phobias and one of the most challenging to treat (Wittchen, Gloster, Beesdo-Baum, Fava, & Craske, 2010). In the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association [APA], 1980), agoraphobia was char-acterized as a "marked fear and avoidance of being alone, or in public places from which escape might be difficult, or help not available in case of sudden incapacitation" (p. 227). However, even the DSM-III recognized the linkage between agoraphobia and panic attacks by stipulating that a diagnosis of agoraphobia with panic attacks should be coded if the onset of the disorder included recurring panic attacks. In the third revised edition of the DSM (DSM-III-R; APA, 1987) and subsequently in the fourth edition (DSM-IV; APA, 1994; DSM-IV-TR; APA, 2000), agoraphobia was reconceptualized as a common complicating feature of panic, thus relegating agora-phobia to a panic disorder "subtype" status. In the DSM-IV, the diagnosis "agorapho-bia" no longer exists; rather, in cases of "pure" agoraphobia, clinicians are instructed to use the diagnosis "agoraphobia without history of panic disorder." It is interesting to note that the diagnostic criteria for agoraphobia in the International Statistical Clas-sification of Diseases and Related Health Problems (10th ed.; ICD-10; World Health Organization, 1992)—the diagnostic system used in many other countries outside the United States—still recognizes agoraphobia as taking precedence over panic disorder. There continues to be considerable controversy surrounding the current diagnostic status of agoraphobia. The crux of this controversy concerns whether agoraphobia The Wiley Handbook of Cognitive Behavioral Therapy, First Edition..wbcbt40 942 Specific Disorders should be conceptualized as a complication of panic attacks/panic disorder as outlined in the DSM-IV-TR or whether agoraphobia should be treated as a distinct, phobic syndrome independent of panic disorder as outlined in the ICD-10. The interested reader is referred to Wittchen et al. (2010) for an excellent review of this controversial issue, which has profound implications for both researchers and clinicians.
    The Wiley Handbook of Cognitive Behavioral Therapy, First edited by S. Hofmann, 01/2014: chapter 40: pages 941-978; John Wiley & SOns, Ltd., ISBN: 9781118533208


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