Assessing the efficacy of treatments for panic disorder and agoraphobia. I. Methodological problems
Abstract
An assessment of the efficacy of treatments in panic disorder and agoraphobia (PDA) is complicated by methodological problems resulting from the complexity of these disorders. In this paper, commonly used anxiety scales are discussed with regard to their relevance in the assessment of PDA. Although there are already many scales for assessing anxiety and agoraphobia, a qualified instrument for measuring the severity of PDA is still lacking. A survey of the instruments used in recent treatment studies of PDA shows that rather inhomogeneous efficacy criteria were applied. Most often, panic attack frequency was taken as a severity criterion, although this measure showed little power to differentiate between treatments. To deal with the special features of PDA, a battery of different scales was usually employed and non-standardized scales were sometimes used additionally. A new rating scale designed to overcome the methodological problems associated with the assessment of severity in PDA was introduced. The use of the psychiatrist-rated Panic and Agoraphobia (P&A) scale in patients with DSM-III-R panic disorder and/or agoraphobia (n = 235) shows that this scale has the highest correlation with the psychiatrists' clinical global impression of PDA patients (r = 0.79, p < 0.0001), compared with other commonly used observer-rated anxiety scales. The self-rating version of the P&A again had the highest correlation with a patient-rated clinical global impression (r = 0.82, p < 0.0001), whereas the other patient-rated anxiety questionnaires correlated only moderately or poorly. By means of logistic regression, it was shown that the five subscores of the scale contribute independently and almost equally to the prediction of PDA severity.
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The Panic and Agoraphobia Scale has satisfactory psychometric properties, with a Cronbach's alpha of 0.86.
“The psychometric properties of the scale are satisfactory, with a Cronbach’s alpha of 0.86 [49].”
From Efficacy of a hybrid online training for panic symptoms and agoraphobia: study protocol for a randomized controlled trial. (2014) · cites this paper as [49]
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BackgroundAn integrated cognitive model of panic disorder: The role of positive and negative cognitions
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Newman, M. G., Holmes, M., Zuellig, A. R., Kachin, K. E., & Behar, E. (2006) · Psychological Assessment · doi:10.1037/1040-3590.18.1.49 · Cited by 67 · see citing works
Sobanski, T., Wagner, G., Peikert, G., Gruhn, U., Schluttig, K., Sauer, H., & Schlösser, R. G. M. (2010) · Psychological Medicine · doi:10.1017/s0033291709991930 · Cited by 67 · see citing works
“Several investigations performed by PET and SPECT have revealed changes in the regional cerebral blood flow (rCBF) and regional cerebral metabolic rate (rCMR) in the temporal lobes (Reiman et al. 1986 ; Nordahl et al. 1990 ; De Cristofaro et al. 1993 ; Bisaga et al. 1998 ; Meyer et al. 2000).”
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Foster, R. H., & Goa, K. L. (1997) · CNS Drugs · doi:10.2165/00023210-199708020-00010 · Cited by 36 · see citing works
Moylan, S., Staples, J., Ward, S. A., Rogerson, J., Stein, D. J., & Berk, M. (2011) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e31822d0012 · Cited by 34 · see citing works
Wu, Y., Zhong, Y., Ma, Z., Lu, X., Zhang, N., Fox, P. T., & Wang, C. (2018) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2018.09.009 · Cited by 34 · see citing works
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MethodEbenfeld, L., Kleine Stegemann, S., Lehr, D., Ebert, D. D., Jazaieri, H., van Ballegooijen, W., Funk, B., Riper, H., & Berking, M. (2014) · Trials · doi:10.1186/1745-6215-15-427 · Cited by 20 · see citing works
“A score of between 0 and 8 indicates no clinically relevant symptoms, scores of between 9 and 28 indicate moderate symptoms, and a score of 29 or higher indicates a severe level of symptoms [49].”
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“…and Snaith, 1983), Hamilton Depression Rating Scale (HDRS; Akdemir et al., 1996; Williams, 1988), Panic Agoraphobia Scale (PAS; Bandelow, 1995; Bandelow et al., 1995; Tural et al., 2000), and Beck Anxiety Inventory (BAI; Beck et al., 1988; Ulusoy et al., 1998) tests were administered to the…”
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van Duinen, M. A., Schruers, K. R. J., Kenis, G., Wauters, A., Delanghe, J., Griez, E. J. L., & Maes, M. H. J. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.10.004 · Cited by 23 · see citing works
Braun, L., Titzler, I., Terhorst, Y., Freund, J., Thielecke, J., Ebert, D. D., & Baumeister, H. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.066 · Cited by 24 · see citing works
Vigne, P., Simões, B., de Menezes, G. B., Fortes, P., Dias, R. V., Laurito, L. D., Loureiro, C. P., Moreira-de-Oliveira, M. E., Albertella, L., Lee, R. S. C., et al. (2019) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2019.152116 · Cited by 12 · see citing works
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MethodAssessing the severity of panic disorder and agoraphobia:
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“The panic and agoraphobia scale (52, 53) will be assessed to measure severity of panic and agoraphobic symptoms.”
MethodPlanert, J., Machulska, A., Hildebrand, A. S., Roesmann, K., Otto, E., & Klucken, T. (2022) · Trials · doi:10.1186/s13063-022-06366-x · Cited by 10 · see citing works
“The primary outcome measure will be the PD and AG symptom severity, as measured by the German version of the Panic and Agoraphobia Scale (PAS) [48].”
MethodShioiri, T., Kojima, M., Hosoki, T., Kitamura, H., Tanaka, A., Bando, T., & Someya, T. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2004.03.008 · Cited by 10 · see citing works
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Bandelow, B., Hajak, G., & Rüther, E. (1994) · European Neuropsychopharmacology · doi:10.1016/0924-977x(94)90168-6 · Cited by 1 · see citing works
Self-citationDie Panik- und Agoraphobieskala: Validierung an 235 Patienten
Bandelow, B., Hajak, G., & Rüther, E. (1996) · Springer eBooks · doi:10.1007/978-3-7091-6889-9_95 · Cited by 1 · see citing works
Self-citationPanic disorder and agoraphobia
Sinha, S. S., & Klein, D. F. (2010) · Cambridge University Press eBooks · doi:10.1017/cbo9780511777578.027
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Simpson, H. B., Neria, Y., Lewis-Fernández, R., & Schneier, F. (2010) · Cambridge University Press eBooks · doi:10.1017/cbo9780511777578.024
- Authors
- Bandelow, B., Hajak, G., Holzrichter, S., Kunert, H. J., & Rüther, E.
- Affiliations
- University of Göttingen (DE)
- Venue
- International Clinical Psychopharmacology
- Published
- 1995-06
- Volume
- 10
- Issue
- 2
- Pages
- 83-94
- ISSN
- 0268-1315 (ISSN-L)
- OpenAlex
- W2072302115
- Cited by
- 35
- References
- 0
- Citations by year
- 2022: 1 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 1 · 2014: 1 · 2013: 1
- FWCI
- 3.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Clinical Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- panic disorder, agoraphobia, treatment efficacy assessment, severity measurement, anxiety rating scales, clinical global impression, self-report questionnaire
- MeSH terms
- Adult, Agoraphobia, Clinical Trials as Topic, Female, Humans, Male, Probability, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, Research Design, Severity of Illness Index, Reproducibility of Results, Logistic Models, Panic Disorder
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