22 – In Vivo Exposure for Panic Disorder and Agoraphobia: Does a Cognitive Rationale Enhance Treatment Efficacy?

Publisher Summary This chapter discusses whether a cognitive rationale enhances the efficacy of in vivo exposure. Clark's cognitive theory of panic suggests that a cognitive rationale should be more effective than a deconditioning rationale in treatment of panic disorder with agoraphobia (PDA). Contrary to expectation, the results of the studies uniformly fail to support the superiority of the cognitive rationale; the efficacy of in vivo exposure did not differ as a function of the type of rationale that patients received. Regardless of whether a cognitive or deconditioning rationale was given, patients achieved reductions in panic frequency, worry about panic, general anxiety, fear of arousal-related bodily sensations, and agoraphobic avoidance. The percentage of panic-free patients at 3-month follow-up was roughly equal in both conditions, and similar to that found in other studies. The efficacy of in vivo exposure therapy was not influenced by whether patients received a cognitive or a deconditioning rationale. Various CBT (cognitive-behavioral therapy) packages for PDA are roughly equal in efficacy; cognitive restructuring, in vivo exposure, and interoceptive exposure all seem to produce roughly the same results across a variety of symptom domains.