Am J Psychiatry 1993; 150:1491-1495
Copyright © 1993 by American Psychiatric Association
Chronic life stress and treatment outcome in agoraphobia with panic attacks
SL Wade, SM Monroe and LK Michelson
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
OBJECTIVE: Factors associated with response to treatment for agoraphobia
are as of yet poorly understood. The authors investigated the relationship
between chronic forms of life stress and clinical improvement and recovery
in subjects with agoraphobia. METHOD: Subjects meeting the DSM-III criteria
for agoraphobia with panic attacks (N = 73) completed measures of life
stress, agoraphobic symptoms, and depressive symptoms at the initiation and
completion of the 12-week treatment protocol. Chronic stressors were
assessed during intensive structured interviews 3-5 years after the
completion of treatment and were rated by using a reliable, and previously
validated, contextual rating system. The contextual life stress interview
was completed by 54 subjects. The relationship of chronic forms of stress
to treatment response was assessed by comparing symptomatic improvement in
the subjects who had and had not experienced chronic stressors. RESULTS: Of
the 54 subjects, 23 (43%) reported chronic stressors of marked or moderate
severity. Subjects experiencing chronic stressors evidenced less
improvement after treatment on both self-report and objective indexes of
agoraphobic symptoms. Additionally, more subjects identified as
nonrecovered experienced chronic stressors than did recovered subjects.
CONCLUSIONS: Chronic stressors appear to predict a relatively unfavorable
treatment outcome, as defined by higher levels of symptoms after treatment,
less improvement, and less likelihood of recovery. These results have
important implications for enhancing psychotherapeutic outcomes.
