Transfer of exposure therapy effects to a threat context not considered during treatment in patients with panic disorder and agoraphobia: Implications for potential mechanisms of change.

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Publisher: Elsevier Science Publishers
Document Type: Report
Length: 515 words

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Keywords Transfer effects; Exposure therapy; Cognitive behavioral therapy; Panic disorder and agoraphobia Highlights * Exposure sessions during therapy lead to fear reduction in non-trained contexts. * Fear reduction varied for response systems suggesting different involved processes. * Transfer effects of exposure therapy is evident but limited. Abstract Further developments of exposure-based therapy (EBT) require more knowledge about transfer of treatment to non-trained everyday contexts. However, little is known about transfer effects of EBT. Using a standardized EBT protocol in 275 patients with panic disorder and agoraphobia we investigated the transfer of EBT to a highly standardized context during a Behavioral Avoidance Test (BAT; being entrapped in a small and dark test chamber) and not part of the exposure sessions. Patients of a treatment group underwent the BATs before treatment (t1), after a preparatory treatment phase (t2), and after an agoraphobic exposure phase (t3) and were compared with wait-list control patients, who repeated BAT assessments across the same time period. We found stronger reductions in avoidance behavior, reported fear, and autonomic arousal during the BAT from t1 to t3 in the treatment group patients who were anxious during t1 relative to the anxious but untreated patients. Fear reduction was related to treatment outcome indicating the contribution of transfer effects to successful EBT. Interestingly, reduction varied for different fear response systems suggesting different processes to may be involved in transfer effects. Importantly, final BAT assessment still evoked residual fear in the treatment group as compared to BAT non-anxious control patients, suggesting limited transfer effects -- one possible reason for the return of symptoms in new situations. Author Affiliation: (a) Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany (b) Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany (c) Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany (d) Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland (e) Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany (f) Christoph-Dornier-Foundation for Clinical Psychology, Institute for Clinical Psychology Bremen, Bremen, Germany (g) Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany (h) Department for Psychology & Methods, Jacobs University Bremen, Bremen, Germany (i) Department of Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany (j) Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Würzburg, Würzburg, Germany (k) Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany (l) Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany (m) Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany (n) Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany * Corresponding author. Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Franz-Mehring-Str. 47, 17487, Greifswald, Germany. Article History: Received 17 March 2020; Revised 14 April 2021; Accepted 4 May 2021 Byline: Jan Richter [jan.richter@uni-greifswald.de] (a,*), Christiane A. Pané-Farré (a,b), Alexander L. Gerlach (c), Andrew T. Gloster (d), Hans-Ulrich Wittchen (e), Thomas Lang (f,h), Georg W. Alpers (g), Sylvia Helbig-Lang (i), Jürgen Deckert (j), Thomas Fydrich (k), Lydia Fehm (k), Andreas Ströhle (l), Tilo Kircher (m), Volker Arolt (n), Alfons O. Hamm (a)

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Gale Document Number: GALE|A664259802