Panic Disorder with Agoraphobia : Cognitive-behavioral treatment and theory

Sammanfattning:  Psychological treatments for Panic disorder with agoraphobia (PDA) currently havingempirical support are treatments including cognitive-behavioral interventions, e.g. cognitive therapy and exposure in-vivo. However, our knowledge about the additional efficacy when combining interventions is still limited. In study I, the contribution of cognitive therapy in the treatment of PDA-patients was investigated, by examining the relative efficacy of exposure in-vivo alone and exposure in combination with cognitive therapy. The addition of cognitive therapy was not found to enhance the treatment outcome effects for PDA-patients. Cognitive therapy is based on the cognitive models, which assume that panic attacks are caused by catastrophic misinterpretations(catastrophic cognitions) of bodily sensations. In study II, the cognitive reports of PDApatients when highly anxious were examined and the findings only partly supported the cognitive models for PDA. In study III, the congruence of the cognitive reports obtained with different measures for PDA-patients were examined. Poor congruence was found, and a higher frequency of cognitions in line with cognitive models was reported retrospectively than prospectively. In study IV, the memory bias for psychopathological relevant information in PDA-patients was examined. PDA-patients were found to have a memory bias towards faces rated as safe. The findings from study I-III in the present dissertation are in line with previous research, and consequently, the addition of cognitive therapy and the assumptions from the cognitive models have to be questioned. The finding of a memory bias for safe faces in study IV implies that cognitive distortions in anxiety disorders may be better investigated with psychopathologically relevant information.