Marital Interactions in Predicting Treatment Outcome in Panic Disorder with Agoraphobia

Authors: Ghassan El-Baalbaki, Claude Bélanger, Michel Perreault, Steffany J. Fredman, Donald H. Baucom

Abstract:

This study had two goals. First, it investigated marital interaction variables as predictors of treatment outcome in panic disorder with agoraphobia (PDA) in sixty-five couples with one spouse suffering from PDA. Second, it analyzed the impact of PDA improvement, following therapy, on marital interaction patterns of both spouses. The partners were observed during a problem-solving task, before and after treatment. Negative behaviors at the outset of therapy, both in the PDA and the NPDA partners, predicted less improvement at post-test. It also appears that improvement in some PDA symptoms following therapy is linked to increase in the dominant behavior of the NPDA spouse and to an improvement in terms of his intrusiveness.

Keywords: Communication and problem-solving skills, Emotional overinvolvement, Marital relationship, Panic disorder withagoraphobia, Treatment outcome.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1084628

References:

[1] American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC, US: American Psychiatric Publishing, Inc, 1994.
[2] H.-U. Wittchen and C. A. Essau, "Epidemiology of panic disorder: Progress and unresolved issues," Journal of Psychiatric Research, vol. 27, pp. 47-68, 1993.
[3] W. Katon, "Panic disorder: Relationship to high medical utilization, unexplained physical symptoms, and medical costs," Journal of Clinical Psychiatry Vol 57(Suppl 10) 1996, 11-18.
[4] C. Brodbeck and L. Michelson, "Problem-solving skills and attributional styles of agoraphobics," Cognitive Therapy and Research. Special Issue: Anxiety: Cognitive factors and the anxiety disorders, vol. 11, pp. 593- 610, Oct 1987.
[5] R. Eher, et al., "Intimate relationships of patients meeting a diagnosis of panic disorder/agoraphobia: Evidence for submissive and nonassertive conflict styles," Zeitschrift fur Klinische Psychologie und Psychotherapie: Forschung und Praxis Vol 31(1) 2002, 14-21, 2002.
[6] L. McCarthy and G. Shean, "Agoraphobia and interpersonal relationships," Journal of Anxiety Disorders, vol. 10, pp. 477-487, Nov- Dec 1996.
[7] G. Shean and U. Uchenwa, "Interpersonal style and anxiety," Journal of Psychology: Interdisciplinary and Applied, vol. 124, pp. 403-408, Jul 1990.
[8] A. L. Clair, et al., "Personality and treatment response in agoraphobia with panic attacks," Comprehensive Psychiatry, vol. 33, pp. 310-318, Sep-Oct 1992.
[9] J. A. Fauerbach, "Marital interaction patterns of couples with and without an agoraphobic partner," Dissertation Abstracts International, vol. 52, pp. 5530-5531, Apr 1992.
[10] G. A. Fava, et al., "Hostility and irritable mood in panic disorder with agoraphobia," Journal of Affective Disorders, vol. 29, pp. 213-217, Dec 1993.
[11] D. L. Chambless, et al., "Marital interaction of agoraphobic women: A controlled, behavioral observation study," Journal of Abnormal Psychology, vol. 111, pp. 502-512, Aug 2002.
[12] D. L. Chambless and G. Steketee, "Expressed emotion and behavior therapy outcome: A prospective study with obsessive-compulsive and agoraphobic outpatients," Journal of Consulting and Clinical Psychology, vol. 67, pp. 658-665, Oct 1999.
[13] G. El-Baalbaki, et al., "Marital interaction in predicting panic disorder with agoraphobia symptom severity ", ed, 2009.
[14] J. A. Franklin and G. Andrews, "Stress and the onset of agoraphobia," Australian Psychologist Vol 24(2) Jul 1989, 203-219.
[15] L. Kleiner and W. Marshall, "Relationship difficulties and agoraphobia," Clinical Psychology Review, vol. 5, pp. 581-595, 1985.
[16] A. C. Page, "Nature and treatment of panic disorder," Current Opinion in Psychiatry Vol 15(2) Mar 2002, 149-155.
[17] D. H. Barlow and C. L. Lehman, "Advances in the psychosocial treatment of anxiety disorders: Implications for national health care," Archives of General Psychiatry, vol. 53, pp. 727-735, Aug 1996.
[18] A. Roth, et al., "What works for whom? A critical review of psychotherapy research," New York, NY, US: Guilford Press, vol. 484, 1996.
[19] D. H. Barlow and T. A. Brown, "Psychological treatments for panic disorder and panic disorder with agoraphobia," Mavissakalian, Matig R (Ed); Prien, Robert F (Ed), vol. (1996). Long-term treatments of anxiety disorders. (pp. 221-240). xii, pp. DC, US: American Psychiatric Association, 1996.
[20] G. A. Fava, et al., "Psychological well-being and residual symptoms in remitted patients with panic disorder and agoraphobia," Journal of Affective Disorders Vol 65(2) Jul 2001, 185-190, 2001.
[21] R. Noyes, Jr., et al., "Natural course of anxiety disorders," Mavissakalian, Matig R (Ed); Prien, Robert F (Ed), vol. (1996). Long-term treatments of anxiety disorders. (pp. 1-48). xii, pp. DC, US: American Psychiatric Association, 1996.
[22] M. Byrne, et al., "Power in relationships of women with depression," Journal of Family Therapy, vol. 26, pp. 407-429, Nov 2004.
[23] R. Marcaurelle, et al., "Marital relationship and the treatment of panic disorder with agoraphobia: A critical review," Clinical Psychology Review, vol. 23, pp. 247-276, Mar 2003.
[24] A. D. Daiuto, et al., "The application of behavioral couples therapy to the assessment and treatment of agoraphobia: Implications of empirical research," Clinical Psychology Review. Special Issue: Behavioral Couples Therapy, vol. 18, pp. 663-687, Sep 1998.
[25] C. Bélanger, et al., "Recent developments in the study of communication and marital distress: Evolution or revolution?/Les développements récents dans l'étude de la communication et de la détresse maritale: évolution ou révolution?," Canadian Psychology. Special Issue: 50 years of psychological research at the Psychology Department of the University of Montreal vol. 34, pp. 3-25, Jan 1993.
[26] C. Dehle and R. L. Weiss, "Associations between anxiety and marital adjustment," Journal of Psychology: Interdisciplinary and Applied Vol 136(3) May 2002, 328-338.
[27] D. J. Tillotson, "Connection, disconnection and intimacy in married agoraphobic women," Dissertation Abstracts International, vol. 52, p. pp, 1992.
[28] D. Winter and K. Gournay, "Construction and constriction in agoraphobia.," British Journal of Medical Psychology, vol. 60, pp. 233- 244, 1987.
[29] M. M. Carter, et al., "Interpersonal relationships in panic disorder with agoraphobia: A review of empirical evidence," Clinical Psychology: Science and Practice, vol. 1, pp. 25-34, Sum 1994.
[30] A. J. Goldstein and D. L. Chambless, "A reanalysis of agoraphobia," Behavior Therapy, vol. 9, pp. 47-59, Jan 1978.
[31] R. K. Goodstein and K. Swift, "Psychotherapy with phobic patients: The marriage relationship as the source of symptoms and focus of treatment," American Journal of Psychotherapy, vol. 31, pp. 284-293, Apr 1977.
[32] R. J. Hafner, "The husbands of agoraphobic women and their influence on treatment outcome," British Journal of Psychiatry, vol. 131, pp. 289-294, Sep 1977.
[33] R. J. Hafner, "The husbands of agoraphobic women: Assortative mating or pathogenic interaction?," British Journal of Psychiatry, vol. 130, pp. 233-239, Mar 1977.
[34] A. Hoffart, "Interpersonal problems among patients suffering from panic disorder with agoraphobia before and after treatment," British Journal of Medical Psychology, vol. 70, pp. 149-157, Jun 1997.
[35] A. S. Webster, "The development of phobias in married women," Psychological Monographs, vol. 67, p. 18, 1953.
[36] W. A. Arrindell, et al., "Marital quality and general life adjustment in relation to treatment outcome in agoraphobia," Advances in Behaviour Research & Therapy Vol 8(3) 1986, 139-185.
[37] J. A. Cerny, et al., "Couples treatment of agoraphobia: A two-year followup," Behavior Therapy, vol. 18, pp. 401-415, Fal 1987.
[38] W. G. Himadi and et al., "The relationship of marital adjustment to agoraphobia treatment outcome," Behaviour Research and Therapy, vol. 24, pp. 107-115, 1986.
[39] L. Kleiner, et al., "Training in problem-solving and exposure treatment for agoraphobics with panic attacks," Journal of Anxiety Disorders, vol. 1, pp. 219-238, 1987.
[40] P. T. Lelliott, et al., "Agoraphobics 5 years after imipramine and exposure: Outcome and predictors," Journal of Nervous and Mental Disease Vol 175(10) Oct 1987, 599-605.
[41] R. Marcaurelle, et al., "Effects of marital communication training on treatment outcome in panic disorder with agoraphobia," ed: unpublished work, 2004.
[42] P. A. DiNardo, et al., Anxiety Disorders Interview Schedule for DSM-IV: Lifetime Version (ADIS-IV-L). N.Y: Graywind Publications, 1994.
[43] K. S. White and D. H. Barlow, "Panic disorder and agoraphobia," in Anxiety and its disorders: the nature and treatment of anxiety and panic, D. H. Barlow, Ed., 2nd ed London: The Guilford Press, 2002, pp. 328- 379.
[44] D. L. Chambless, et al., "Assessment of fear of fear in agoraphobics: The Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire," Journal of Consulting and Clinical Psychology, vol. 52, pp. 1090-1097, Dec 1984.
[45] D. L. Chambless, et al., "The Mobility Inventory for Agoraphobia," Behaviour Research and Therapy, vol. 23, pp. 35-44, 1985.
[46] S. Reiss, et al., "Anxiety sensitivity, anxiety frequency and the predictions of fearfulness," Behaviour Research and Therapy, vol. 24, pp. 1-8, 1986.
[47] A. T. Beck, et al., "An inventory for measuring clinical anxiety: Psychometric properties," Journal of Consulting and Clinical Psychology, vol. 56, pp. 893-897, Dec 1988.
[48] A. T. Beck, et al., Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation, 1996.
[49] S. Sabourin, et al., "Development and Validation of a Brief Version of the Dyadic Adjustment Scale With a Nonparametric Item Analysis Model," Psychological Assessment, vol. 17, pp. 15-27, Mar 2005.
[50] L. Bourgeois, et al., "Predictive validity of therapeutic alliance in group marital therapy," Journal of Consulting and Clinical Psychology, vol. 58, pp. 608-613, Oct 1990.
[51] C. Bélanger, et al., "Preliminary validation of a global system for coding marital interactions/Validation préliminaire d'un système global de cotation des interactions conjugales," Canadian Journal of Behavioural Science, vol. 25, pp. 483-498, Oct 1993.
[52] S. J. Fredman, et al., "Development and Validation of an Observational Coding System for Emotional Overinvolvement," Journal of Family Psychology, vol. 18, pp. 339-347, Jun 2004.
[53] J. Leff and C. Vaughn, Expressed emotion in families: Its significance for mental illness. New York: Guilford Press, 1985.
[54] P. E. Shrout and J. L. Fleiss, "Intraclass correlations: Uses in assessing rater reliability," Psychological Bulletin, vol. 86, pp. 420-428, Mar 1979.
[55] N. S. Jacobson and P. Truax, "Clinical significance: A statistical approach to defining meaningful change in psychotherapy research," Journal of Consulting and Clinical Psychology Vol 59(1) Feb 1991, 12-19.
[56] R. L. Weiss and R. E. Heyman, "A clinical-research overview of couples interactions," in Clinical handbook of marriage and couples intervention, W. K. Halford and H. J. Markman, Eds., ed Chichester, England: Wiley, 1997, pp. 13-41.
[57] D. H. Barlow and J. A. Cerny, Psychological treatment of panic. New York: Guilford Press, 1988.
[58] S. Guay, et al., "Title," unpublished|.
[59] H. J. Markman, et al., Premarital and relationship enhancement program: Leader's manual. Denver, CO: University of Denver, 1993.
[60] H. J. Markman, et al., Premarital and relationship enhancement program: consultant's manual. Denver, CO: University of Denver, 1993.
[61] J. Wright, La survie du couple. Montreal: Le jour, 1990.
[62] S. Guay and R. Marcaurelle, "Le patron d'interaction agoraphobique dans le couple," ed, 1999.
[63] P. P. Roy-Byrne, et al., "Coping in panic and major depressive disorder: Relative effects of symptom severity and diagnostic comorbidity," Journal of Nervous and Mental Disease, vol. 180, pp. 179-183, Mar 1992.
[64] J. Filak, et al., "Clients' pretherapy interpersonal attitudes and psychotherapy outcome," Professional Psychology: Research and Practice Vol 17(3) Jun 1986, 217-222.
[65] S. B. McCabe and I. H. Gotlib, "Interactions of couples with and without a depressed spouse: Self-report and observations of problem-solving situations.," Journal of Social & Personal Relationships, vol. 10, pp. 589- 599, 1993.
[66] K. R. Merikangas, et al., "Marital interaction in hospitalized depressed patients " Journal of Nervous & Mental Disease, vol. 167 pp. 689-695, 1979.
[67] M. Perez, et al., "The interpersonal consequences of inflated self-esteem in an inpatient psychiatric youth sample. ," Journal of Consulting & Clinical Psychology, vol. 69, pp. 712-716, 2001.
[68] C. Segrin, Interpersonal processes in psychological problems. New York, NY: Guilford Press, 2001.
[69] M. Hautzinger, et al., "Distressed couples with and without a depressed partner: an analysis of their verbal interaction. ," Journal of Behavior Therapy & Experimental Psychiatry, vol. 13, pp. 307-314, 1982
[70] J. M. Hooley and J. D. Teasdale, "Predictors of relapse in unipolar depressives: Expressed emotion, marital distress, and perceived criticism," Journal of Abnormal Psychology Vol 98(3) Aug 1989, 229- 235.