An investigation of the differential effectiveness of bibliotherapy and self-regulatory treatments in individuals with panic attacks

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Virginia Tech


Several studies targeting individuals with panic disorder have demonstrated that Cognitive-behavioral treatment (CST) is the psychological treatment of choice. CST interventions that include exposure to panic symptoms, along with cognitive restructuring. breathing retraining, and relaxation training are more effective than any of these components administered alone. Past studies have demonstrated the efficacy of imparting the above CBT components in the form of bibliotherapy (BT) in the treatment of panic disorder. The present study examined the differential effectiveness of BT and self-regulatory treatments in the treatment of individuals with panic attacks. The present study examined a much purer version of a self-help bibliotherapy intervention by reducing therapist contact much more than prior studies had done. In addition, the present study examined the additive effectiveness of self-regulatory components-self-monitoring (SM) and feedback (FB)--to BT. Sixty-three participants who experienced a DSM-IV full-blown or limited symptom attack in the two weeks prior to beginning the Self-help Project were assigned via stratified randomization to 1 of 4 experimental conditions: 1) BT alone (N = 17); 2) ST plus DML (daily self-monitoring plus feedback; (N = 15); 3) DML (N = 13); or 4) WL (N = 18). The present study utilized a pre - post treatment assessment design with pre-treatment assessment occurring two weeks prior to treatment and post-treatment assessment occurring approximately two weeks after the end of treatment. Treatment was 8 weeks in duration. Participants were sent pre-treatment assessment and treatment materials via mail in order to minimize therapist contact. At post-treatment assessment, participants were assessed either in-person or via mail/phone depending upon their geographic location. It was expected that participants in all treatment conditions would experience less full-blown panic attacks, limited-symptom attacks, avoidance, fear of having a panic attack, panic cognitions. panic symptoms, state anxiety and depressive symptoms and increases in coping strategies and coping self-efficacy than participants in the WL condition. Furthermore, it was expected that participants in the BT plus DML condition would experience more change on the above dependent variables than participants in the BT alone and DML alone conditions from pre- to post-treatment assessment. A 4 X 2 repeated measures MANOVA revealep no Condition by Time interaction or Condition effect. However, a main effect for time across conditions emerged. Univariate tests revealed significant reductions from pre- to post-treatment assessment for full blown panic attacks, avoidance. fear of having a panic attack. panic cognitions, panic symptoms, depressive symptoms, and state anxiety. In addition, an exploratory 4 X 2 repeated measures ANOVA revealed a Condition by Time interaction with partiCipants in the BT and BT plus DML conditions increasing in coping self-efficacy from pre- to post-treatment. Partial correlations revealed that change in coping self-efficacy was related to lower scores on the Panic Attack Symptoms Questionnaire (PASQ) at post-treatment assessment for participants in the BT and BT plus DML conditions. The results of this study are discussed in terms of motivational issues and the effectiveness of such "pure" self-help interventions with individuals experiencing panic attacks.



panic disorders, bibliotherapy, self-regulation, panic attacks, self-help