The benefit of an insight-oriented and experiential approach on panic and agoraphobia symptoms. Results of a controlled comparison of client-centered therapy alone and in combination with behavioral exposure

Abstract

Background: It is a common view that psychodynamic treatment does not help much to ameliorate the symptoms of panic and agoraphobia. The effects of an insight-oriented treatment on central anxiety symptoms are the subject of the present controlled study.

Methods: Forty patients with severe panic and agoraphobia were admitted to an inpatient anxiety treatment program. Most of the patients had been treated by pharmacological means unsuccessfully. The patients were randomly assigned to pure client-centered therapy or to additional behavioral exposure treatment. Client-centered and behavioral agoraphobia manuals were used. The patients were examined on admission, at discharge and at 3, 6, and 12 months follow-up for panic (Structured Clinical Interview for DSM III-R--SCID), anxiety (Hamilton Anxiety Scale), agoraphobia (SCID, Fear Survey Schedule), and depressive (Hamilton Depression Scale) symptoms.

Results: Both client-centered treatment and a combination with exposure treatment reduced panic, avoidance and depressive symptoms significantly. For a short period the combined treatment was superior in patients' coping actively with anxiety and improving agoraphobic symptoms. However, at 1-year follow-up there was no further difference in the reduction of anxiety and depressive symptoms.

Conclusions: The results are discussed with regard to the combination of these forms of therapy and to widespread skepticism about the efficacy of insight-oriented treatment.