The Effectiveness and Attrition of Brief Group Cognitive Behavior Therapy for Outpatients with Panic Disorder: A Retrospective Study

門診恐慌症短期認知行為團體治療之成效與流失因素的探討：一種回溯性研究

10.29478/TJP.201212.0007

溫錦真(Chin-Chen Wen)；蘇筱雯(Hsiao-Wen Su)；林美珠(Meei-Ju Lin)；王迺燕(Nai-Yen Wang)

attrition ； cognitive behavior therapy ； effectiveness of treatment ； panic disorder

台灣精神醫學

26卷4期（2012 / 12 / 01）

290 - 300

英文

Objectives: In this study, the authors did a retrospective study to examine effectiveness and attrition of brief group cognitive behavior therapy (CBT) for panic disorder (PD) routinely practiced in the psychiatric outpatient clinic at a general hospital. Methods: A total of 53 patients (37 females and 16 males, with mean age of 44.72 years) had accepted the 8-weekly 1.5 hour group CBT separately during 2005-2010. The data of effectiveness and dropout variables were reviewed from documents of patients' medical and group records as well as their psychological measures. Results: The brief group CBT was found to have significant improvements in patients' disaster belief and anxiety level at the end of treatment (p ＜ 0.01), and to decrease their severity of panic attacks (p ＜ 0.01), agoraphobic avoidance (p ＜ 0.01), fear of body sensation (p ＜ 0.05), and depression symptoms (p ＜ 0.05) at 6-month follow-up. But high attrition rate of 45.3% was found. The significant negative predictor of attrition was recent panic attacks recorded before the first group sessions (p ＜ 0.05). Recent panic attacks motivated them to complete group sessions. Reasons of their discontinuing treatment included practice problems and treatment being not needed. Conclusion: These study results suggest the brief group CBT for PD is an effective and feasible treatment in the psychiatric outpatient clinic. Strategies to prevent and to reduce attrition, such as setting up recruitment criteria, doing orientation interview, or adapting alternative modes of delivering CBT should be considered in the future.

1. (2006).APA Presidential Task Force on Evidence-based practice: Evidence-based practice in psychology.Am Psychol,61,271-85.
2. Addis, M. E.(2002).Methods for disseminating research products and increasing evidence-based practice: promises, obstacles, and future directions.Clin Psychol Sci Prac,9,367-78.
3. Addis, M. E.,Hatgis, C.,Krasnow, A. D.,Jacob, K.,Bourne, L.,Mansfield, A.(2004).Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting.J Consult Clin Psychol,72,625-35.
4. Addis, M. E.,Krasnow, A. D.(2000).A national survey of practicing psychologists' attitudes toward psychotherapy treatment manuals.J Consult Clin Psychol,68,331-9.
5. Andersen, R. M.(1995).Revisiting the behavioral model and access to medical care: does it matter?.J Health Soc Behav,36,1-10.
6. Andrews, C.,Creamer, M.,Crino, R.,Hunt, C.,Lampe, L.,Page, A.(2003).The Treatment of Anxiety Disorders: Clinical Guides and Patient Manuals.New York:Cambridge University Press.
7. Bakker, A.,van Balkom, A. J.,Spinhoven, P.(2002).SSSRIs vs. TCAs in the treatment of panic disorder: a meta-analysis.Acta Psychiatr Scand,106,163-7.
8. Ballenger, J. C.(1997).Panic disorder in the medical center.J Clin Psychiatry,58,13-7.
9. Bandelow, B.(1995).Assessing the efficacy of treatment for panic disorder and agoraphobia II: the panic and ago-raphobia scale.Int Clin Psychopharmacol,10,73-81.
10. Barlow, D. H.(Ed.)(2002).Anxiety and its disorders: The nature and treatment of anxiety and panic.New York:Guildford Press.
11. Barrett, M. S.,Chua, W.,Crits-Christoph, P.,Gibbons, M. B.,Casiano, D.,Thompson, D.(2008).Early withdrawal from mental helth treatment: implications for psychotherapy ractice.Psychotherapy,45,247-67.
12. Batelaan, N.,Smit, F.,Graaf, R. D.,Balkom, A. V.,Vollebergh, W.,Beekman, A.(2007).Economic costs of full-blown and subthreshold panic disorder.J Affect Disord,104,127-36.
13. Bergin, A. E.(Ed.),Garfield, S. L.(Ed.)(1994).Handbook of Psychotherapy and Behavior Change.New York:Wiley.
14. Bergstrom, J.,Andersson, G.,Ljotsson, B.(2010).Internet-versus group-administered ognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial.BMC Psychiatry,10,54.
15. Bohni, M. K.,Spindler, H.,Arendt, M.,Hougaard, E.,Rosenberg, N. K.(2009).A randomized study of massed three-week cognitive behavioral therapy schedule for panic disorder.Acta Psychiatr Scand,120,187-95.
16. Chambless, D. L.,Caputo, G.,Bright, P.,Gallagher, R.(1984).Assessment for Fear of fear in agoraphobic: the body sensations questionnaire and the agoraphobic cognitions questionnaire.J Consult Clin Psychol,52,1090-7.
17. Che, H. H.,Lu, M. L.,Chen, H. C.,Chang, S. W.,Lee, Y. J.(2006).Validation of the chinese Version of the Beck Anxiety Inventory.Formos J Med,10,447-54.
18. Clark, D. M.,Salkovskis, P. M.(1987).Cognitive Therapy for Panic Attack: Therapists Manual.Department of Psychiatry, University of Oxford.
19. Cohen, J.(1988).Statistical Power Analysis for the Behavioral Sciences.New York:Lawrence Erlbaum Associates.
20. Graske, M. G.,Meadows, E. A.,Barlow, D. H.(1994).Master Your Anxiety and Panic II and Agoraphobia Supplement: Therapist Guide.San Antonio, Texas, USA:Psychological Corporation.
21. Grilo, C. M.,Money, R.,Barlow, D. H.(1998).Pretreatment patient factors predicting attrition: from a multicenter randomized controlled treatment study for panic disorder.Compr Psychiatry,39,323-32.
22. Gunter, R. W.,Whittal, M. L.(2010).Dissemination of cognitive-behavioral treatments for anxiety disorders: overcoming barriers and improving patient access.Clin Psychol Rev,30,194-202.
23. Ham, P.,Waters, D. B.,Oliver, M. N.(2005).Treatment of panic disorder.Am Fam Physician,71,733-8.
24. Katernadahl, D. A.,Realini, J. P.(1995).Where do panic attack sufferers seek care?.J Fam Pract,40,237-43.
25. Keijsers, G. P. J.,Kampman, M.,Hoogduin, C. A. L.(2001).Dropout prediction in cognitive behavior therapy for panic disorder.Behav Ther,32,739-49.
26. Kessler, R. C.,Berglund, P.,Demler, O.,Jin, R.,Merikangas, K. R.,Walters, E. E.(2005).Lifetime prevalence and age-of-on-set distributions of DSM-IV disorders in the national comorbidity survey replication.Arch Gen Psychiatry,62,593-603.
27. Kessler, R. C.,Chiu, W. T.,Jin, R.,Rusico, A. M.,Shear, K.,Walters, E. E.(2006).The epidemiology of panic attacks, panic disorder, and agoraphobia in the national comorbidity survey replication.Arch Gen Psychiatry,63,415-24.
28. Landon, T. M.,Barlow, D. H.(2004).Cognitive-behavioral treatment for panic disorder: current status.J Psychiatr Pract,10,211-26.
29. Lu, M. L.,Che, H. H.,Chang, S. W.,Shen, W. W.(2002).Reliability and validity of the Chinese Version of the Beck Depression Inventory-II.Taiwanese Journal of Psychiatry,16,301-10.
30. Owens, P. L.,Hoagwood, K.,Horwitz, S. M.(2002).Barriers to children's mental health services.J Am Acad Child Adolesc Psychiatry,41,731-8.
31. Rappe, R. M.,Craske, M. G.,Barlow, D. H.(1990).Subject-described features of panic attacks using self-moni-toring.J Anxiety Disord,4,171-81.
32. Salkovskis, P. M.(Ed.)(1996).Frontiers of Cognitive Therapy.New York:Guildford.
33. Schweizer, E.,Rickels, K.,Case, W. G.,Greenblatt, D. J.(1990).Long-term therapeutic use of benzodiazepines: effects of gradual taper.Arch Gen Psychiatry,47,908-15.
34. Shafran, R.,Clark, D. M.,Fairburn, C. G.(2009).Mind the gap: improving the dissemination of CBT.Behav Res Ther,47,902-9.
35. Shen, W. W.(2011)。Clinical Psychopharmacology for the Twenty-first Century。Taipei:Ho-Chi Publishing Company。
36. Taylor, C. B.,Hayward, C.,King, R.(1990).Cardiovascular and symptomatic reduction effects of alprazolam and imipramine in patients with panic disorder: results of a double-blind, placebo-controlled trial.J Clin Psychopharmacol,10,112-8.
37. Taylor, S.(2000).Understanding and Treating panic Disorder: Cognitive-behavioral Approaches.New York:John Wiley & Sons.
38. Taylor, S.,Koch, W. J.,McNally, R. J.(1992).How does anxiety sensitivity var across the anxiety disorders?.J Anxiety Disord,6,249-59.
39. Wade, W. A.,Treat, T. A.,Stuart, G. L.(1998).Transporting an empirically supported treatment for panic disorder to a service clinic setting: a benchmarking strategy.J Consult Clin Psychol,66,231-9.
40. White, K. S.,Allen, L. B.,Barlow, D. H.,Shear, M. K.,Woods, S. W.(2010).Attrition in a multicenter clinical trial for panic disorder.J Nerv Ment Dis,198,665-71.