<p>The present dissertation comprises four empirical studies within the area of behavioral treatment of panic disorder with agoraphobia. The focus is on studying issues pertaining to outcome, treatment process and determinants of change. The first study is a randomized controlled treatment study of 73 patients undergoing 16 sessions of either exposure in vivo (E), or cognitive behavior therapy (CBT). Both treatments showed clear improvements at post-treatment that were well maintained at 1-year follow up, and there were no significant differences between the treatments.</p><p>The second study concerned prediction of outcome in the same sample. From a variety of pre-treatment characteristics severity of avoidance was the one most related to outcome. Most predictors were found unrelated. Two approaches of prediction were also compared: treating outcome as a categorical vs. continuous variable. The different approaches yielded a somewhat dissimilar picture of the impact of pre-treatment severity of avoidance. The third study examined different aspects of the therapeutic relationship, and their relation to outcome. Clients’ perceptions of therapists and their ratings of the working alliance were generally not related to outcome at any point. On the other hand, therapists’ perceptions of patients as showing goal-direction and active participation were related to outcome from early on in therapy. The fourth study examined different aspects of change. It was found that change in indices of the frequency of panic attacks was not closely related to change in agoraphobic avoidance at post-treatment. Change in avoidance was also more related to other aspects of outcome. At one-year follow-up, a more unitary picture, regarding the different aspects of change was observed.</p>

The present dissertation comprises four empirical studies within the area of behavioral treatment of panic disorder with agoraphobia. The focus is on studying issues pertaining to outcome, treatment process and determinants of change. The first study is a randomized controlled treatment study of 73 patients undergoing 16 sessions of either exposure in vivo (E), or cognitive behavior therapy (CBT). Both treatments showed clear improvements at post-treatment that were well maintained at 1-year follow up, and there were no significant differences between the treatments. The second study concerned prediction of outcome in the same sample. From a variety of pre-treatment characteristics severity of avoidance was the one most related to outcome. Most predictors were found unrelated. Two approaches of prediction were also compared: treating outcome as a categorical vs. continuous variable. The different approaches yielded a somewhat dissimilar picture of the impact of pre-treatment severity of avoidance. The third study examined different aspects of the therapeutic relationship, and their relation to outcome. Clients’ perceptions of therapists and their ratings of the working alliance were generally not related to outcome at any point. On the other hand, therapists’ perceptions of patients as showing goal-direction and active participation were related to outcome from early on in therapy. The fourth study examined different aspects of change. It was found that change in indices of the frequency of panic attacks was not closely related to change in agoraphobic avoidance at post-treatment. Change in avoidance was also more related to other aspects of outcome. At one-year follow-up, a more unitary picture, regarding the different aspects of change was observed.

SammanfattningLångvarig smärta orsakar stort lidande för individen och belastar samhället ekonomiskt. Syftet med denna uppsats var att undersöka om en exponering in vivo-behandling inspirerad av Dialektisk beteendeterapi (DBT) för människor med långvarig ländryggssmärta var görbar samt om behandlingen gav effekt på smärtrelaterad problematik. Designen var en single case experimental design vilket är en beprövad design för att testa nya terapimetoder. Studien bestod av sex deltagare, alla med hög grad av smärtrelaterade katastroftankar, något som litteraturen visat predicera sämre behandlingsutfall. Behandlingen var DBT-inspirerad och indelad i tre faser; en första valideringsfas, en andra färdighetsfas och en tredje exponeringsfas. Fem av sex deltagare fick förbättringar på alla de primära utfallsmått, tre av sex deltagare fick förbättringar på samtliga primära- och sekundära utfallsmått. Framtida replikationer är motiverade. / AbstractChronic pain causes great suffering for the individual and burden society economically. The aim of this study was to examine whether an exposure in vivo treatment inspired by Dialectical Behavior Therapy (DBT) for people with chronic low back pain was feasible and whether the treatment had effect on pain-related problems. The design was a single case experimental design, which is a widely used design to test new therapy methods. The study consisted of six participants, all with high levels of pain catastrophizing, something that in the literature been linked to poor treatment outcomes. The treatment was inspired by DBT and divided into three phases: an initial validation phase, a second phase for skills training and a third exposure phase. The results were promising: five out of six participants had improved in all primary outcome measures. Three out of six participants had improvements in all primary and secondary outcome measures. Future replications are warranted.