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

Background: The present study investigated cognitive mediation of clinical
improvement in patients with agoraphobia (N5427) or social phobia (N598)
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 27:294–301, 2010.