Agoraphobia With and Without

Panic Disorder
A 20-Year Follow-up of Integrated Exposure and Psychodynamic
Therapy

Asle Hoffart, PhD,*† Liv M. Hedley, PhD,* Karol Svanøe,

MSW,‡ Tomas Formo Langkaas, CandPsychol,*† and
Harold Sexton, MD*

Reviewed by Professor Knut Hagtvet

The Journal of Nervous and Mental Disease • Volume 204, Number 2, February 2016
The aim
To compare the 20-year outcome in panic disorder with
agoraphobia (PD with AG) and agoraphobia without panic
disorder (AG without PD) patients after inpatient psychological
treatment
Methods
• Participants  patients who had been treated at a Norwegian inpatient clinic
from January 1989 to November 1990 in an open trial according to following
inclusion criteria:
• a) satisfied DSM-III-R criteria for PD with AG or AG without PD,
• b) the patients considered the symptoms of AG as their main problem
• c) were 20 to 65 years old.

completed treatment?

Included in the present study

of long-term outcome
FIGURE 1. Flow of PD
with AG and AG
without PD patients
through the study.
• Treatment

Partisipants

First 5-week phase

consisted of exposure
11-week inpatient, therapy
standardized, and
medication-free
treatment Second 6-week phase
of psychodynamic
therapy
... 1st 5 week
exposure phase

1st week 2nd-4th week 5th

Returned home
half an hour to test their
Education
planning session newly acquired
skills

Discontinued Wrote down their Reactions during

Psychotropic the exposure and rated their
medication anxiety level (0–10) over time
...
second 6-week psychodynamic phase

Life problems & inner conflicts

Addressed during group sessions & individual

sessions according to psychodynamic
principles
 PARS-
Sep
BDI MI-AAL

STAI-Y2 Measure BSQ

ACQ-
STAI-Y1
Physical
ACQ-
control
RESULT
Conclusion
• PD with AG and AG without PD are two different disorders
• AG without PD patients improved less than PD with AG patients
• Exposure is the best documented treatment for PD with AG
 Strength/surplus
WEAKNESS ?
• Higher frequency of • A very long-term
avoidant personality follow-up study
disorder among the AG
without PD patients
could not explain the
poorer outcome
• 28.3% of the included
patients did not attend
long-term follow-
upgroup
• Do not know the
nonattendants' end
status.