The question is addressed as to whether cognitive-behavior treatment delivered as a routine service in a specialist clinic is effective in the long term. Of 124 consecutive patients completing treatment for panic disorder or social phobia, 93 were assessed an average of 2 years following treatment. The treatment produced significant improvement in measures of symptoms, avoidance, and disablement during treatment and further significant improvement during the follow-up. A quarter of participants no longer met diagnostic criteria, had not sought further treatment, and their anxiety had not troubled them since treatment. These findings, although not showing the large treatment effects reported from controlled outcome research, support the effectiveness of cognitive-behavioral interventions in routine care.
There is a strong case for the effectiveness of cognitive-behavior treatments for reduction of panic, anxiety, and associated avoidance in panic disorder and agoraphobia, and for reduction of social anxiety and avoidance in social phobia (Andrews, 1996). Several controlled trials have shown cognitive-behavioral treatment to produce superior outcome compared to credible placebo conditions for patients with panic disorder with agoraphobia Chambless, Foa, Groves, & Goldstein 1982 and Marks et al. 1993, panic disorder without agoraphobia Beck, Sokol, Clark, Berchick, & Wright 1992, Craske, Maidenberg, & Bystritsky 1995 and Klosko, Barlow, Tassinari, & Cerny 1990, and social phobia (Heimberg, Dodge, Hope, Kennedy, & Zollo, 1990). Furthermore, meta-analytic treatment reviews consistently support efficacy of cognitive-behavioral therapy for these disorders Chambless & Gillis 1993, Feske & Chambless 1995, Gould, Otto, & Pollack 1995 and Taylor 1996. Studies have also shown patients continuing to improve across a number of years following cessation of treatment (e.g., Clark et al. 1994, Craske et al. 1991, Heimberg et al. 1993, Scholing and Emmelkamp 1996a and Scholing and Emmelkamp 1996b).
This article addresses the question of whether cognitive-behavior therapy for panic disorder and social phobia is effective in the long term when delivered as a routine service in a hospital-based specialist clinic. The treatment programs studied in this article have been evaluated, and their effectiveness has been supported Andrews & Moran 1988, Mattick & Peters 1988 and Mattick, Peters, & Clarke 1989. Furthermore, dropout rates of these programs are very low relative to figures reported in the literature, supporting their overall acceptability to patients (Hunt & Andrews, 1992). Long-term outcome is assessed in terms of symptoms, course of the disorder, functioning and disablement, and change in personality traits.
