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*

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
11-week inpatient, exposure 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 to test
half an hour
Education their newly
planning session
acquired
skills

Discontinued Wrote down their Reactions

Psychotropic during the exposure and rated
their anxiety level (0–10)
medication 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

STAI- ACQ-
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
WEAKNESS STRENGTH/SURPLUS?

 Higher frequency of  A very long-term follow-

avoidant personality 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.