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Testing a Brief Treatment to Reduce the Frequency of Panic Attacks in a Clinical Outpatient Population Benjamin N

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Testing a Brief Treatment to Reduce the Frequency of Panic Attacks in a Clinical Outpatient Population Benjamin N Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Psychology Dissertations Student Dissertations, Theses and Papers 2014 Testing a Brief Treatment to Reduce the Frequency of Panic Attacks in a Clinical Outpatient Population Benjamin N. Daniels Philadelphia College of Osteopathic Medicine, [email protected] Follow this and additional works at: http://digitalcommons.pcom.edu/psychology_dissertations Part of the Clinical Psychology Commons Recommended Citation Daniels, Benjamin N., "Testing a Brief Treatment to Reduce the Frequency of Panic Attacks in a Clinical Outpatient Population" (2014). PCOM Psychology Dissertations. Paper 291. This Dissertation is brought to you for free and open access by the Student Dissertations, Theses and Papers at DigitalCommons@PCOM. It has been accepted for inclusion in PCOM Psychology Dissertations by an authorized administrator of DigitalCommons@PCOM. For more information, please contact [email protected]. Running head: PANIC TREATMENT Philadelphia College of Osteopathic Medicine Department of Psychology TESTING A BRIEF TREATMENT TO REDUCE THE FREQUENCY OF PANIC ATTACKS IN A CLINICAL OUTPATIENT POPULATION By Benjamin N. Daniels Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Psychology July 2014 PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE DEPARTMENT OF PSYCHOLOGY Dissertation Approval This is to certify that the thesis presented to us by G evy--1 CclN\..ivJ OcAVI,(:e.Js on the / ~ day of ¥'-'~~ , 20E{_, in partial fulfillment of the requirements for the degree of Doctor of Psychology, has been examined and is acceptable in both scholarship and literary quality. Committee Members' Signatures: Beverly White, PsyD, Chairperson Robert A DiTomasso, PhD, ABPP Jesus Salas, PsyD Robert A DiTomasso, PhD, ABPP, Chair, Department of Psychology PANIC TREATMENT iii Acknowledgements I would like to thank my committee that helped me through this journey: Dr. Brad Rosenfield, Dr. Robert DiTomasso, and Dr. Jesus Salas. Their feedback and guidance was instrumental in the success of this study. I would also like to thank Dr. Scott Glassman for his assistance with understanding and successfully completing the data analysis. This study relied heavily on the excellent work of Dr. Michelle Craske and Dr. David Barlow for developing the cognitive-behavioral treatment for panic disorder on which this study was largely based. They were also gracious enough to allow the use of their materials in this study. Dr. Brad Rosenfield in collaboration with Dr. J. Russell Ramsey, created the intervention protocol used in this study. If not for them, this would not have been possible. The assistance of Dr. Wendy Wild in ensuring protocol adherence is also greatly appreciated. Thanks to the staff and supervisors at WellSpan Health, including Dr. Allen Miller, Dr. Katrina Bakke-Friedland, and Dr. Michael Eshleman, for the support they provided. I would like to give special thanks to Gabriel Smith for her endless support and assistance throughout this journey. Finally, I would not be here today if not for the efforts and support of my parents, Jeffrey Daniels and Ann Daniels. PANIC TREATMENT iv Abstract Panic attacks, the key symptom of panic disorder and an associated feature of various anxiety disorders, are extremely distressing events that can negatively impact an individual’s mental health, physical health, and quality of life. This study validated a brief treatment for panic attacks, designed to reduce the frequency of panic attacks after the first session, in an outpatient clinical population. One participant was recruited to participate in this single case experimental ABA design with follow-up, where a reversal was not expected, due to the maintenance of positive effects. The treatment included both cognitive and behavioral techniques. The results were analyzed using simulation modeling analysis, as well as visual analysis. This treatment produced clinically significant effects by reducing the frequency and severity of panic attacks, reducing symptoms of anxiety and panic, decreasing the frequency of cognitive distortions, and increasing the level of functioning. Additionally, these gains were maintained at a 3- month follow-up. It is hoped that this intervention can help clinicians treat panic disorder and improve their effectiveness and efficiency by reducing the time needed to significantly decrease panic attacks. It is also hoped that this intervention might be expanded for use with other panic-related anxiety disorders. Finally, it is possible that this study will encourage efforts toward briefer treatments for other disorders. PANIC TREATMENT v Table of Contents Acknowledgements ........................................................................................................... iii Abstract ............................................................................................................................. iv List of Figures .................................................................................................................. vii Introduction ........................................................................................................................ 1 Statement of the Problem ............................................................................................... 1 Purpose of the Study ...................................................................................................... 4 Literature Review ........................................................................................................... 6 Cognitive behavioral model of panic disorder. .......................................................... 7 Prevalence. ................................................................................................................ 10 Comorbidity. ............................................................................................................. 14 Healthcare resource utilization. ................................................................................ 19 Treatments for panic disorder. .................................................................................. 25 Attrition rates. ........................................................................................................... 41 Treatment components. ............................................................................................ 42 Hypotheses ................................................................................................................... 65 Method ............................................................................................................................. 67 Participants ................................................................................................................... 67 Inclusion/Exclusion criteria.......................................................................................... 67 Recruitment at Clinic A................................................................................................ 69 Recruitment at Clinic B ................................................................................................ 69 Recruitment at Clinic C ................................................................................................ 70 Measures....................................................................................................................... 71 Beck Anxiety Inventory. ........................................................................................... 71 Beck Depression Inventory. ..................................................................................... 72 Panic Disorder Severity Scale–Self-Report. ............................................................. 72 Inventory of Cognitive Distortions. .......................................................................... 73 Mobility Inventory for Agoraphobia. ....................................................................... 74 Structured Clinical Interview for the DSM–IV–TR. ................................................. 75 Panic Attack Record. ................................................................................................ 75 Therapist ....................................................................................................................... 75 PANIC TREATMENT vi Procedure ...................................................................................................................... 76 Results .............................................................................................................................. 78 Data Analysis ............................................................................................................... 78 Simulation modeling analysis. .................................................................................. 78 Visual analysis. ......................................................................................................... 79 Protocol fidelity check. ............................................................................................. 79 Beck Anxiety Inventory. ........................................................................................... 79 Panic Disorder Severity Scale–Self-Report. ............................................................. 81 Inventory of Cognitive Distortions. .......................................................................... 83 Frequency of panic attacks. .....................................................................................
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