Mechanism of Change in Cognitive-Behavioral Treatment of Panic Disorder: Evidence for the Fear of Fear Mediational Hypothesis.
Abstract
Numerous clinical trials have demonstrated the efficacy of cognitive-behavioral treatment (CBT) for panic disorder. However, studies investigating the mechanisms responsible for improvement with CBT are lacking. The authors used regression analyses outlined by R. M. Baron and D. A. Kenny (1986) to test whether a reduction in fear of fear (FOF) underlies improvement resulting from CBT. Pre- and posttreatment measures were collected from 90 CBT-treated patients and 40 wait-list control participants. Overall, treatment accounted for 31% of the variance in symptom reduction. The potency of FOF as a mediator varied as a function of symptom facet, as full mediation was observed for the change in global disability, whereas the effects of CBT on agoraphobia, anxiety, and panic frequency were partially accounted for by reductions in FOF. Clinical implications and future research directions are discussed.
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A fearful reaction toward bodily sensations or other private events previously associated with panic or anxiety is a well-known mediator of the anxiety process.
“A fearful reaction toward bodily sensations or other private events that have been previously associated with panic or anxiety is a well-known mediator of the anxiety process (Smits, Powers, Cho, & Telch, 2004).”
From How Exactly Do I “Let Go”? The Potential of Using ACT to Overcome the Relaxation Paradox (2014) · cites this paper as Smits, Powers, Cho, & Telch, 2004
Where relaxation has been proven effective, some of the mechanisms for change that facilitate positive outcomes with the approach are largely present in the RT as well.
“However, it could be argued that where relaxation has been proven to be effective, some of the mechanisms for change that facilitate positive outcomes with the approach are largely present in the RT as well (Smits et al., 2004).”
From How Exactly Do I “Let Go”? The Potential of Using ACT to Overcome the Relaxation Paradox (2014) · cites this paper as Smits et al., 2004
In CBT treatments of panic disorder, a reduction in fear of fear accounted for the largest variance in symptom reduction.
“In an attempt determine the mechanism of change in cognitive behavioral therapy (CBT) treatments of panic disorder, Smits et al. (2004) found that a reduction in fear of fear accounted for the largest variance in symptom reduction.”
From How Exactly Do I “Let Go”? The Potential of Using ACT to Overcome the Relaxation Paradox (2014) · cites this paper as Smits et al. (2004)
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“In an attempt to determine the mechanism of change in cognitive behavioral therapy (CBT) treatments of panic disorder, Smits et al. (2004) found that a reduction in fear of fear (FOF) accounted for the largest variance in symptom reduction.”
Background
- Authors
- Smits, J. A. J., Powers, M. B., Cho, Y., & Telch, M. J.
- Affiliations
- The University of Texas at Austin (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2004
- Volume
- 72
- Issue
- 4
- Pages
- 646-652
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W1963706389
- Cited by
- 203
- References
- 10
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 3 · 2022: 6 · 2021: 6 · 2020: 7 · 2019: 10 · 2018: 11 · 2017: 6 · 2016: 10 · 2015: 12 · 2014: 10 · 2013: 18 · 2012: 19
- FWCI
- 15.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- National Institute of Mental Health (MH74-600-203)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- panic disorder, cognitive behavioral therapy, fear of fear, mediation, mechanisms of change, agoraphobia, anxiety, global disability, treatment outcomes
- MeSH terms
- Adolescent, Adult, Aged, Disability Evaluation, Fear, Female, Humans, Male, Middle Aged, Prospective Studies, Psychological Theory, Psychometrics, Surveys and Questionnaires, Severity of Illness Index, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome, Negotiating
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