Psychotherapeutic competence and adherence: Importance for the treatment of panic disorder with agoraphobia

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Panic disorder with agoraphobia is accompanied by serious impairments and burdens for the patient and is one of the psychological disorders associated with high costs. Exposure therapy is a highly effective, tried and tested treatment form, in which the successful implementation of exposure is connected to positive treatment outcome. However, little is known about how the factors within the treatment contribute to a successful course of the exposure. We believe that, during the preparation of exposure, the therapist plays a central role. The current research intention is to have two independent raters assess the adherence and competence of therapists during the preparation phase for exposure in 84 treatments of panic disorder with agoraphobia. These therapist characteristics are to be used for the prediction of treatment outcome, which is quantified on the one hand with self-assessment questionnaires (agoraphobic anxiety, panic attacks, and avoidance behavior) and on the other hand with objective behavior observations during the Behavioral Avoidance Test (a standardized situation that is adequate for the provocation of agoraphobic anxiety). Next to characteristics of the therapist (adherence and competence), characteristics of the patient (sociodemographic and psychopathological characteristics and interaction behavior) and the quality of the therapeutic relationship (assessed by two further independent raters) are to be considered for the prediction of treatment outcome. The basis for the planned study is a multicenter randomized controlled trial, in which 120 patients suffering from panic disorder with agoraphobia were treated with manualized exposure therapy.