OBJECTIVE:Past studies show a strong association of the self-concept (SC) and symptom burden for many mental disorders including anxiety disorders. Cognitive behavioral therapy (CBT) is a highly effective treatment for anxiety disorders that has also been shown to improve SC in patients suffering from such. However, whilst CBT has been shown to be an effective intervention for treating panic disorder (PD), the effects of CBT on SC in patients with PD as well as the predictive role of SC for therapy outcome in these patients remain unclear. This is hence the first study investigating the effects of CBT on SC in patients with PD. METHODS:PD-patient's SC (N = 215) was assessed through the Frankfurter self-concept scales before and after a 5-week semi-residential manualized CBT intervention not specifically targeting SC. Therapy outcome was assessed through the Symptom Checklist and the Beck Depression Inventory. RESULTS:8 out of 10 SC scales including self-esteem (SE) significantly changed from pre- to posttreatment assessment (d = 0.12 to 0.36). Regarding symptom severity, patients showed reduced general symptom burden (d = 0.89) and depressive symptoms (d = 0.79) following CBT intervention. SE before receiving CBT predicted therapy outcome with regard to general symptom burden but not depressive symptoms. CONCLUSION:Results indicate that CBT enhances different facets of SC in patients with PD as a positive side-effect, suggesting that improving SC may offer the potential to optimize treatment outcome. Further studies are required to better understand the underlying mechanisms of CBT influencing SC and to identify what aspects of SC are key with respect to symptom burden in patients with PD.

Background: Patients with panic disorder (PD) show alterations of the immune reactivity to acute stress, which could serve as a marker for effective treatment. Nevertheless, the effect of immune reactivity under acute stress before treatment on therapy outcome remains unclear. Methods: A total of N = 16 PD patients performed the Trier Social Test. Blood sample collection of antiinflammatory cytokine IL-10 accompanied the TSST. The Mobility Inventory was handed out for the assessment of avoidance behavior before and after treatment. Area under the curve with respect to the ground (AUCG) and increase (AUCI) were calculated for assessed cytokine levels and were used as predictors for therapy outcome in regression analyses. Results: AUCG significantly predicts avoidance behavior in company after treatment (beta = -0.007, p = .033) but not avoidance behavior alone (beta = -0.003, p = .264). AUCI does not significantly predict therapy outcome. Conclusion: Higher concentrations of anti-inflammatory cytokine IL-10 under acute stress before treatment predicts less avoidance behavior in company after therapy. Immune markers seem to play a crucial role in the maintenance of mental disorders such as PD. Underlying mechanisms and IL-10 as a marker for individualized treatments should be investigated in future studies.

Hintergrund: Angststörungen sind häufig, oft chronifizierend, jedoch auch gut behandelbar. Leitlinienbehandlung ist die auf Exposition fokussierende Verhaltenstherapie. In der ambulanten Versorgungspraxis finden Expositionen jedoch selten statt. Die Angst-Tagesklinik am Universitätsklinikum Dresden realisiert die evidenzbasierte Behandlung von Angststörungen. In einer 5-wöchigen Kurzzeitbehandlung werden wöchentlich 4 begleitete und zeitoffene Expositionssitzungen durchgeführt. Untersucht wurden die Symptomverläufe und die Responder-Raten. Methoden: Zu Therapieaufnahme und -ende sowie zur Katamnese nach 3 Monaten und 1 Jahr wurde die Entwicklung der Symptombelastung bei n = 332 PatientInnen untersucht, die von 2009 bis 2015 behandelt wurden. Etwa zwei Drittel waren psychotherapeutisch vorbehandelt. Eingesetzt wurden spezifische etablierte Fragebögen. Berechnet wurden Mixed Models, Effektstärken und Responder-Raten. Ergebnisse: 90% der PatientInnen schlossen die Behandlung regulär ab. Es zeigten sich signifikante Linderungen bei Belastungen durch Angst- und depressive Symptome. Die höchsten Effektstärken um 0,9 ergaben sich bei verhaltensbezogenen Skalen und besonders bei den Agoraphobien und Panikstörungen, die die größte Störungsgruppe ausmachen. Die Responseraten lagen bei 60%. Zu den Katamnesezeitpunkten waren die Symptomverbesserungen stabil und bei den kognitiven Symptomen weiter steigend. Schlussfolgerungen: Die Behandlung in spezialisierten (teil)stationären Versorgungssettings mit Fokus auf hochfrequente Exposition, wie hier beispielhaft vorgestellt, zeigt eine gute Akzeptanz und gute bis sehr gute und längerfristig stabile Veränderungen der Symptombelastung. Diese Settings erfordern eine besondere strukturelle Ausstattung und Ressourcen.

Background: Research showed an impact of attachment style on the therapy success of psychotherapy patients. Anxiety patients often show a demanding need in care challenging confrontation therapy, e.g. due to seeking safety signals or assistance of the therapist. The current study aimed at testing the hypothesis that an insecure attachment style of the patient is associated with less improvement from psychotherapy. Methods: Fifty-five Panic Disorder (PD) patients received five weeks of manual-based Cognitive Behavioral Psychotherapy (CBT) with focus on confrontation therapy. Established questionnaires assessed self-evaluated attachment style. Psychotherapy outcome measures were global disease severity, panic-related symptoms and depressiveness. Results: Psychotherapy showed strong effects (ηp2 ≥ .335). 94.5% of the patients reported an insecure attachment style. Patients with characteristics of a secure attachment style (high readiness for self-disclosure, low level of problems feeling accepted) showed more benefit from CBT than patients who reported characteristics of an insecure attachment style. Conclusions: Our results suggest an impact of attachment style on therapy success: characteristics of a secure attachment style promoted a successful outcome. Therapeutic implications will be discussed.

This study tested whether the hormonal stress response to the DEX–CRH test may be predictive of the psychotherapy success for panic disorder (PD). Thirty-four patients diagnosed either with agoraphobia with PD or PD without agoraphobia were subjected to cognitive behavioural therapy (CBT). Patients (pre-therapy) and healthy volunteers were exposed to the DEX–CRH test. Blood samples were taken for cortisol and adrenocorticotropic hormone (ACTH) assessment. Established panic-specific questionnaires were handed out for the pre-therapy and post-therapy evaluation of disease severity (with reference to panic beliefs and agoraphobic cognitions, fear of bodily sensations, agoraphobic avoidance behaviour). Repeated measures ANCOVA were conducted for the analysis of the pre-therapy hormonal response, and Pearson’s correlation analysis to test for associations with the psychotherapy outcome. Data analyses revealed large effect sizes for CBT in the clinical measures (η2 ≥ 0.321), main effects of time for cortisol and ACTH with no differences between both groups, and significant associations between cortisol release and agoraphobic cognitions for the patients. PD diagnosis had no impact on the hormonal response. However, those patients with higher cortisol release showed less improvement after CBT (significantly for agoraphobic cognitions). Clinical implications of these findings are the prediction of the therapy success from a potential endocrine correlate whose persistency (if assessed repeatedly) during the treatment may predict (non-)response to the current treatment, possibly representing a decision support for a change in treatment to avoid the continuation of an inefficient treatment.

BACKGROUND:A proportion of patients with panic disorder (PD) fail to show a remission after psychotherapy. Biological correlates of psychotherapy non-response have rarely been described in the literature. The aim of the present study was to research the relationship between the cortisol stress response and the psychotherapy outcome in PD patients. METHODS:Twenty-eight PD patients (20 females, mean age±SD: 35.71±13.18) seeking psychological treatment for PD and n=32 age- and sex-matched healthy control participants (21 females, aged 34.66±12.07) participated in this study. The patients underwent five weeks of cognitive behavioural therapy (CBT). Within the first two weeks of the CBT, both study groups were confronted with the Trier Social Stress Test (TSST). Blood sampling for cortisol and adrenocorticotropic hormone (ACTH) evaluation as well as fear-rating (Visual Analogue Scale; Primary Appraisal and Secondary Appraisal Questionnaire, PASA) accompanied the TSST. The global severity of PD (Panic & Agoraphobia Scale; PAS), agoraphobic cognitions (Agoraphobic Cognitions Questionnaire; ACQ), fear of bodily sensations (Bodily Sensations Questionnaire; BSQ), agoraphobic avoidance (Mobility Inventory; MI), and depressiveness (Beck Depression Inventory; BDI) were assessed before and after the CBT (except the BDI). RESULTS:The statistical analysis revealed significant main effects of time for cortisol and the ACTH concentration in response to the TSST, independently of the study group. 42.9% of the PD patients and 65.6% of the healthy control participants showed a cortisol stress response to the TSST≥55.2nmol/l (descriptive finding). The data showed a significant inverse association of the TSST cortisol stress response with the MI total score when accompanied. Further, a significant association of the PASA subjective level of fear and the BSQ as well as a trend for an association of the PASA with the ACQ were observed. CONCLUSION:Consistent with prior research, we could replicate findings of decreased cortisol concentrations in the PD patients in comparison to the healthy control participants. Furthermore, our findings agree with previous data showing an association of the attenuated cortisol stress response with the psychotherapy non-response. In the present sample, those patients with the lowest cortisol concentrations showed the least improvement in agoraphobic avoidance after psychotherapy. The patients with the highest level of fear showed the most improvement in fear of bodily sensations. Study limitations as well as implications for future studies will be discussed.