Background: Nonresponsiveness to therapy is generally acknowledged, but only a few studies have tested switching to psychotherapy. This study is one of the first to examine the malleability of treatment-resistant patients using acceptance and commitment therapy (ACT). Methods: This was a randomized controlled trial that included 43 patients diagnosed with primary panic disorder and/or agoraphobia (PD/A) with prior unsuccessful state-of-the-art treatment (mean number of previous sessions = 42.2). Patients were treated with an ACT manual administered by novice therapists and followed up for 6 months. They were randomized to immediate treatment (n = 33) or a 4-week waiting list (n = 10) with delayed treatment (n = 8). Treatment consisted of eight sessions, implemented twice weekly over 4 weeks. Primary outcomes were measured with the Panic and Agoraphobia Scale (PAS), the Clinical Global Impression (CGI), and the Mobility Inventory (MI). Results: At post-treatment, patients who received ACT reported significantly more improvements on the PAS and CGI (d = 0.72 and 0.89, respectively) than those who were on the waiting list, while improvement on the MI (d = 0.50) was nearly significant. Secondary outcomes were consistent with ACT theory. Follow-up assessments indicated a stable and continued improvement after treatment. The dropout rate was low (9%). Conclusions: Despite a clinically challenging sample and brief treatment administered by novice therapists, patients who received ACT reported significantly greater changes in functioning and symptomatology than those on the waiting list, with medium-to-large effect sizes that were maintained for at least 6 months. These proof-of-principle data suggest that ACT is a viable treatment option for treatment-resistant PD/A patients. Further work on switching to psychotherapy for nonresponders is clearly needed.
RCT Entities:
Background: Nonresponsiveness to therapy is generally acknowledged, but only a few studies have tested switching to psychotherapy. This study is one of the first to examine the malleability of treatment-resistant patients using acceptance and commitment therapy (ACT). Methods: This was a randomized controlled trial that included 43 patients diagnosed with primary panic disorder and/or agoraphobia (PD/A) with prior unsuccessful state-of-the-art treatment (mean number of previous sessions = 42.2). Patients were treated with an ACT manual administered by novice therapists and followed up for 6 months. They were randomized to immediate treatment (n = 33) or a 4-week waiting list (n = 10) with delayed treatment (n = 8). Treatment consisted of eight sessions, implemented twice weekly over 4 weeks. Primary outcomes were measured with the Panic and Agoraphobia Scale (PAS), the Clinical Global Impression (CGI), and the Mobility Inventory (MI). Results: At post-treatment, patients who received ACT reported significantly more improvements on the PAS and CGI (d = 0.72 and 0.89, respectively) than those who were on the waiting list, while improvement on the MI (d = 0.50) was nearly significant. Secondary outcomes were consistent with ACT theory. Follow-up assessments indicated a stable and continued improvement after treatment. The dropout rate was low (9%). Conclusions: Despite a clinically challenging sample and brief treatment administered by novice therapists, patients who received ACT reported significantly greater changes in functioning and symptomatology than those on the waiting list, with medium-to-large effect sizes that were maintained for at least 6 months. These proof-of-principle data suggest that ACT is a viable treatment option for treatment-resistant PD/A patients. Further work on switching to psychotherapy for nonresponders is clearly needed.
Authors: Andrew T Gloster; Marcel Miché; Hanna Wersebe; Thorsten Mikoteit; Jürgen Hoyer; Christian Imboden; Klaus Bader; Andrea H Meyer; Martin Hatzinger; Roselind Lieb Journal: Int J Methods Psychiatr Res Date: 2017-09 Impact factor: 4.035
Authors: Jörg Wiltink; Jürgen Hoyer; Manfred E Beutel; Christian Ruckes; Stephan Herpertz; Peter Joraschky; Susan Koranyi; Matthias Michal; Björn Nolting; Karin Pöhlmann; Simone Salzer; Bernhard Strauss; Eric Leibing; Falk Leichsenring Journal: PLoS One Date: 2016-01-19 Impact factor: 3.240
Authors: Jeanette Villanueva; Andrea H Meyer; Marcia T B Rinner; Victoria J Firsching; Charles Benoy; Sandra Brogli; Marc Walter; Klaus Bader; Andrew T Gloster Journal: BMC Psychiatry Date: 2019-06-10 Impact factor: 3.630
Authors: Wicher A Bokma; Guido A A M Wetzer; Jurriaan B Gehrels; Brenda W J H Penninx; Neeltje M Batelaan; Anton L J M van Balkom Journal: Depress Anxiety Date: 2019-06-23 Impact factor: 6.505
Authors: Hanna Wersebe; Roselind Lieb; Andrea H Meyer; Marcel Miche; Thorsten Mikoteit; Christian Imboden; Jürgen Hoyer; Klaus Bader; Martin Hatzinger; Andrew T Gloster Journal: Int J Clin Health Psychol Date: 2018-08-06