Stepped care versus face-to-face cognitive behavior therapy for panic disorder and social anxiety disorder: Predictors and moderators of outcome

Thomas Haug; Tine Nordgreen; Lars-Göran Öst; Gerd Kvale; Tone Tangen; Gerhard Andersson; Per Carlbring; Einar R Heiervang; Odd E Havik

doi:10.1016/j.brat.2015.06.002

Stepped care versus face-to-face cognitive behavior therapy for panic disorder and social anxiety disorder: Predictors and moderators of outcome

Behav Res Ther. 2015 Aug:71:76-89. doi: 10.1016/j.brat.2015.06.002. Epub 2015 Jun 9.

Authors

Thomas Haug¹, Tine Nordgreen², Lars-Göran Öst³, Gerd Kvale², Tone Tangen⁴, Gerhard Andersson⁵, Per Carlbring⁶, Einar R Heiervang⁷, Odd E Havik²

Affiliations

¹ Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Clinical Psychology, University of Bergen, Postboks 7800, 5020 Bergen, Norway. Electronic address: Thomas.haug@psykp.uib.no.
² Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Clinical Psychology, University of Bergen, Postboks 7800, 5020 Bergen, Norway.
³ Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Psychology, University of Stockholm, SE-106 91 Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institute, 171 77 Stockholm, Sweden.
⁴ Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Psychiatry, University of Bergen, Postboks 7800, 5020 Bergen, Norway.
⁵ Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, 171 77 Stockholm, Sweden.
⁶ Department of Psychology, University of Stockholm, SE-106 91 Stockholm, Sweden.
⁷ Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway.

PMID: 26081010
DOI: 10.1016/j.brat.2015.06.002

Abstract

Objective: To investigate predictors and moderators of treatment outcome by comparing immediate face-to-face cognitive behavioral therapy (FtF-CBT) to a Stepped Care treatment model comprising three steps: Psychoeducation, Internet-delivered CBT, and FtF-CBT for panic disorder (PD) and social anxiety disorder (SAD).

Method: Patients (N = 173) were recruited from nine public mental health out-patient clinics and randomized to immediate FtF-CBT or Stepped Care treatment. Characteristics related to social functioning, impairment from the anxiety disorder, and comorbidity was investigated as predictors and moderators by treatment format and diagnosis in multiple regression analyses.

Results: Lower social functioning, higher impairment from the anxiety disorder, and a comorbid cluster C personality disorder were associated with significantly less improvement, particularly among patients with PD. Furthermore, having a comorbid anxiety disorder was associated with a better treatment outcome among patients with PD but not patients with SAD. Patients with a comorbid depression had similar outcomes from the different treatments, but patients without comorbid depression had better outcomes from immediate FtF-CBT compared to guided self-help.

Conclusions: In general, the same patient characteristics appear to be associated with the treatment outcome for CBT provided in low- and high-intensity formats when treated in public mental health care clinics. The findings suggest that patients with lower social functioning and higher impairment from their anxiety disorder benefit less from these treatments and may require more adapted and extensive treatment. CLINICALTRIALS.GOV: Identifier: NCT00619138.

Keywords: Cognitive behavioral therapy; Guided self-help; Internet-delivered CBT; Moderators; Predictors; Stepped care.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anxiety Disorders / complications
Anxiety Disorders / therapy*
Cognitive Behavioral Therapy / methods*
Depression / complications
Depression / therapy
Female
Humans
Internet
Male
Panic Disorder / complications
Panic Disorder / therapy*
Patient Compliance
Patient Education as Topic
Personality Disorders / complications
Personality Disorders / therapy
Professional Competence
Self Report
Social Behavior
Therapy, Computer-Assisted*
Treatment Outcome
Young Adult

Associated data

ClinicalTrials.gov/NCT00619138