Panic disorder is associated with substantial reductions in social functions and lifetime prevalence rates are approximately 3% [
The efficacy of cognitive-behavioral therapy has been established for panic disorder [
Patient personality characteristics are important in the treatment formulations of clinicians and researchers. Knowledge of a patient’s personality trait may be useful in determining where psychological intervention should be provided, which type of group would be effective, and which psychological techniques should be emphasized. Some studies suggest that personality traits mediate broad dimensions of psychopathology. Ogrodniczuk et al. (2003) found that extraversion, conscientiousness, and openness were associated with favorable outcomes in group psychotherapy without cognitive-behavioral therapy [
The present study aimed to examine the predictive value of personality traits for broad dimensions of psychopathology in panic disorder after cognitive-behavioral therapy.
Two hundred patients affected by panic disorder who attended the group cognitive-behavioral therapy program participated in the present study between October 2001 and May 2015. Some patients were referrals from the general medical or psychiatric clinics and departments and others who sought treatment for panic disorder themselves. All patients met the following inclusion criteria: (i) principal Axis I diagnosis of panic disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, as assessed by the Structured Clinical Interview for DSM-IV(SCID) [
This cognitive-behavioral therapy program for the treatment of panic disorder was based on the established treatment manual developed by the Clinical Research Unit for Anxiety and Depression at the University of New South Wales, Sydney, Australia [
At baseline all the patients were assessed with the NEO Five Factor Index (NEO-FFI) to measure patient personality characteristics.
All subjects were assessed with the following instruments at pre- and posttreatment.
All statistical analyses were performed using SPSS 18.0 for Windows [
We conducted statistical analyses for these treatment outcomes based on the intention-to-treat principle with the baseline scores used as the last observations carried forward.
Table
Baseline characteristics of the patients.
Characteristics | Completers | Dropouts | |
---|---|---|---|
Female, number (%) | 122 (70.9) | 19 (67.9) | 0.82 |
Mean age (SD) | 36.1 (10.8) | 33.8 (10.6) | 0.30 |
Onset of panic disorder (SD) | 29.1 (10.2) | 28.3 (10.3) | 0.68 |
Antidepressant use at baseline (%) | 99 (57.6) | 17 (60.7) | 0.84 |
Current mood disorder (%) | 9 (5.2) | 3 (10.7) | 0.38 |
Current anxiety disorder (%) | 22 (12.8) | 4 (14.3) | 0.77 |
Current agoraphobia (%) | 164 (95.3) | 27 (96.4) | 1.00 |
PDSS (SD) | 13.2 (4.7) | 12.4 (5.6) | 0.44 |
ACQ (SD) | 28.3 (9.4) | 28.5 (10.4) | 0.91 |
BSQ (SD) | 46.3 (14.2) | 42.8 (15.1) | 0.24 |
NEO-FFI neuroticism (SD) | 26.8 (9.1) | 28.1 (6.9) | 0.47 |
NEO-FFI extraversion (SD) | 25.8 (8.2) | 27.5 (7.0) | 0.30 |
NEO-FFI openness (SD) | 28.1 (6.2) | 28.7 (6.2) | 0.63 |
NEO-FFI agreeableness (SD) | 32.6 (6.9) | 32.2 (5.6) | 0.76 |
NEO-FFI conscientiousness (SD) | 27.3 (7.7) | 28.0 (7.0) | 0.68 |
Pretreatment and posttreatment rating scale scores
Community | Pretreatment | Posttreatment | | |
---|---|---|---|---|
PDSS (SD) | 13.1 (4.8) | 7.1 (4.7) | <0.05 | |
ACQ (SD) | 28.3 (9.5) | 23.3 (7.9) | <0.05 | |
BSQ (SD) | 45.8 (14.3) | 36.4 (13.7) | <0.05 | |
SCL-90-R | ||||
Somatization (SD) | 0.63 (0.48) | 1.18 (0.82) | 0.84 (0.77) | <0.05 |
Obsessive-compulsive (SD) | 0.72 (0.56) | 1.14 (0.82) | 0.85 (0.72) | <0.05 |
Interpersonal sensitivity (SD) | 0.56 (0.52) | 1.03 (0.79) | 0.76 (0.68) | <0.05 |
Depression (SD) | 0.73 (0.53) | 1.15 (0.84) | 0.82 (0.76) | <0.05 |
Anxiety (SD) | 0.38 (0.39) | 1.24 (0.87) | 0.87 (0.80) | <0.05 |
Hostility (SD) | 0.47 (0.50) | 0.68 (0.68) | 0.50 (0.57) | <0.05 |
Phobic anxiety (SD) | 0.16 (0.30) | 1.41 (0.92) | 0.86 (0.85) | <0.05 |
Paranoid ideation (SD) | 0.52 (0.52) | 0.63 (0.69) | 0.42 (0.51) | <0.05 |
Psychoticism (SD) | 0.28 (0.38) | 0.57 (0.57) | 0.36 (0.44) | <0.05 |
Global Severity Index (SD) | - | 1.04 (0.67) | 0.73 (0.60) | <0.05 |
Table
In multiple regression analysis (Table
Unique predictors of change in broad dimensions of psychopathology
SOM | OC | INT | DEP | ANX | HOS | PHOB | PAR | PSY | GSI | |
---|---|---|---|---|---|---|---|---|---|---|
Sex | −.02 | −.01 | .03 | −.01 | −.02 | .06 | −.01 | .02 | .01 | −.00 |
Age | .13 | .07 | .01 | .06 | .13 | .03 | .16 | −.06 | .02 | .09 |
Onset | −.07 | −.01 | .00 | .00 | −.11 | −.05 | | .08 | .03 | −.05 |
PDSS | .04 | | .11 | | | | | | | |
ACQ | .04 | .04 | −.04 | −.02 | | −.09 | .01 | −.04 | .07 | .05 |
BSQ | .07 | .08 | .05 | .07 | −.02 | .12 | −.04 | −.01 | −.05 | .04 |
NEO-FFI | ||||||||||
Neuroticism | −.00 | .05 | .13 | .10 | .10 | .05 | −.00 | .10 | .07 | .08 |
Extraversion | −.00 | .02 | .04 | .06 | .06 | .09 | −.04 | .05 | .09 | .04 |
Openness | .02 | .06 | .04 | .06 | −.08 | −.03 | −.01 | .04 | .03 | .02 |
Agreeableness | .03 | −.01 | −.01 | .04 | .05 | −.06 | .10 | −.02 | −.01 | 03 |
Conscientiousness | −.11 | | −.08 | | −.09 | −.12 | | −.10 | −.09 | |
(Baseline score) | | | | | | | | | | |
| ||||||||||
Adjusted | .49 | .50 | .46 | .43 | .42 | .38 | .49 | .43 | .51 | .49 |
This study examined the relationship of personal traits at baseline and broad dimensions of psychopathology in patients with panic disorder after group cognitive-behavioral therapy using multiple regression analysis. The results showed that NEO-FFI conscientiousness score at baseline may predict some dimensions of psychiatric symptoms after treatment.
From the point of view of group therapy, our findings concerning conscientiousness are consistent with those of Ogrodniczuk et al. [
As mentioned above, patients affected by panic disorder commonly have broad psychiatric symptoms. From the clinical point of view, it may be useful to focus on conscientiousness at baseline for the purpose of improving broad dimensions of psychopathology in cognitive-behavioral therapy for panic disorder.
The dropout rate in this study was 14.0%. The previous meta-analysis showed that the average dropout rate was 19.6% in cognitive-behavioral therapy for anxiety disorder [
The present study has several limitations. First, the study did not involve a control group. We could not be sure if the significant reduction in broad dimensions of psychopathology may be due to group cognitive-behavioral therapy treatment for panic disorder rather than to passage of time. A randomized controlled trial with a control group is needed to examine the efficacy of the treatment. Second, we did not have follow-up data and were not able to decide the long-term effect on broad dimensions of psychopathology. Third, we used standardized cognitive-behavioral therapy manual; however, we did not record the interviews and performance to ensure the accuracy of materials provided to patients in the course of cognitive-behavioral therapy.
In summary, we examined the relationship of personal traits and broad dimensions of psychopathology in patients affected by panic disorder after cognitive-behavioral therapy using multiple regression analysis. Conscientiousness at baseline may predict several dimensions of psychiatric symptoms after treatment. For the purpose of improving broad psychiatric symptoms with patients affected by panic disorder, we need to pay more attention to conscientiousness trait at baseline.
The authors have declared that no conflicts of interest exist.
This work was carried out in collaboration between all authors. Sei Ogawa was the primary investigator for this study. Tatsuo Akechi initiated and supervised the overall research project. All authors took part in the clinical investigation (diagnosis, treatment, and assessment). All authors read and approved the final manuscript.
This study was supported by the Grant-in-Aid from the Ministry of Education, Culture, Sports, Science, and Technology (23530910).