Research Article

Cognitive mediation of clinical improvement after intensive exposure therapy of agoraphobia and social phobia†

  1. Claus Vögele Ph.D.1,*,
  2. Anke Ehlers Ph.D.2,
  3. Andrea H. Meyer Ph.D.3,
  4. Monika Frank Ph.D.4,
  5. Kurt Hahlweg Ph.D.5,
  6. Jürgen Margraf Ph.D.6

Article first published online: 27 DEC 2009

DOI: 10.1002/da.20651

Issue

Depression and Anxiety

Depression and Anxiety

Volume 27, Issue 3, pages 294–301, March 2010

Additional Information

How to Cite

Vögele, C., Ehlers, A., Meyer, A. H., Frank, M., Hahlweg, K. and Margraf, J. (2010), Cognitive mediation of clinical improvement after intensive exposure therapy of agoraphobia and social phobia. Depression and Anxiety, 27: 294–301. doi: 10.1002/da.20651

Author Information

  1. 1

    Clinical and Health Psychology Research Centre, School of Human and Life Sciences, Roehampton University, London, United Kingdom

  2. 2

    King's College, Institute of Psychiatry, Department of Psychology, London, United Kingdom

  3. 3

    Department of Psychology, University of Basel, Basel, Switzerland

  4. 4

    Christoph-Dornier Foundation for Clinical Psychology, Marburg, Germany

  5. 5

    Department of Psychology, University of Braunschweig, Braunschweig, Germany

  6. 6

    Faculty of Psychology, Ruhr-University of Bochum, Bochum, Germany

*Clinical and Health Psychology Research Centre, School of Human and Life Sciences, Roehampton University, Whitelands College, Holybourne Avenue, London SW15 4JD, United Kingdom

  1. †

    This paper is dedicated to the memory of our friend and colleague, Irmela Florin.

Publication History

  1. Issue published online: 1 MAR 2010
  2. Article first published online: 27 DEC 2009
  3. Manuscript Accepted: 18 NOV 2009
  4. Manuscript Revised: 17 NOV 2009
  5. Manuscript Received: 2 AUG 2009

Funded by

  • Alfried-Krupp Science Foundation
  • University of Greifswald, Germany
  • Wellcome Trust. Grant Number: 069777

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Keywords:

  • cognitive–behavior therapy;
  • cognitive mediation;
  • agoraphobia;
  • social phobia;
  • panic disorder

Abstract

Background: The present study investigated cognitive mediation of clinical improvement in patients with agoraphobia (N=427) or social phobia (N=98) receiving high-density exposure therapy in a naturalistic clinical treatment setting. Methods: Patients were assessed before therapy, 6 weeks after the end of therapy, and 1 year thereafter, using a self-report assessment battery. Lower level mediation analyses provided support for the notion that cognitive changes partially mediate clinical improvement after exposure therapy. Results: Changes in cognitions relating to physical catastrophes mediated treatment outcome only for patients with agoraphobia, whereas changes in cognitions about loss of control mediated outcome for both agoraphobia and social phobia patients. Changes in relationship satisfaction did not mediate symptomatic improvement. Conclusions: The results extend previous findings by demonstrating mediation in an unselected clinical sample and by providing evidence for the specificity of mediation effects. They further support the importance of cognitive changes in cognitive–behavior therapy. Depression and Anxiety, 2010. © 2009 Wiley-Liss, Inc.

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