An Investigation of a Minimal-Contact Bibliotherapy Approach to Relapse Prevention for Individuals Treated for Panic Attacks

The present study was designed to test the efficacy of a bibliotherapy-relapse prevention (BT-RP) program for panic attacks in which the active BT-RP condition was compared to a waiting-list control condition. Prior to the administration of the six-month BT-RP program, all participants completed an initial BT intervention (Febbraro, 1997) based on the book Coping with Panic (Clum, 1990). The BT-RP program was designed to: (a) review major components of the initial intervention; (b) increase practice of panic coping skills and therapeutic self-exposure; (c) enhance social support for panic recovery; (d) teach cognitive restructuring skills related to relapse prevention; (e) provide a protocol to follow in the event of a setback; and (f) reduce overall levels of stress. Brief monthly phone contacts were included in the BT-RP condition. Thirty-six participants, 17 in the BT-RP condition and 19 in the WL control condition, completed the study. A 2 (Treatment condition: BT-RP versus WL control) X 2 (Time: Pre-BT-RP assessment versus Post-BT-RP assessment) mixed-model research design was used to analyze the results. Results indicted significant reductions from pre- to post-treatment in the BT-RP condition for panic cognitions, anticipatory anxiety, agoraphobic avoidance, and depression, but not in the WL condition. When statistically controlling for initial levels of these variables via analyses of covariance (ANCOVAs), significant post-treatment differences in the expected direction emerged for these four dependent measure and for state anxiety. In addition, the BT-RP group reported significantly fewer panic attacks during the six-month course of the treatment trial than the WL control group on a measure of retrospective recall of full-blown panic attacks. There was also a statistically significant proportional between-group difference in terms of clinically significant improvement for full-blown panic attacks and agoraphobic avoidance in favor of the BT-RP group. However, no significant between-group differences emerged for the maintenance of initial treatment gains for panic frequency, panic symptoms, panic cognitions, anticipatory anxiety, or agoraphobic avoidance. Results of the present study are discussed in the framework of benefits of the present BT-RP program, limitations of the findings, recommendations for future research in this area, and implications for BT treatments in general.