Psychiatric Quarterly

, Volume 85, Issue 2, pp 121–132 | Cite as

Treatment Modality Preferences and Adherence to Group Treatment for Panic Disorder with Agoraphobia

  • Michel Perreault
  • Dominic Julien
  • Noé Djawn White
  • Claude Bélanger
  • André Marchand
  • Theodora Katerelos
  • Diana Milton
Original Paper


To examine the relationship between preference for group psychotherapy and adherence to group cognitive-behavioral therapy (CBT) for clients with panic disorder with agoraphobia (PDA), 109 participants experiencing PDA completed a questionnaire measuring preference for group treatment (PGTQ) before beginning CBT groups. A t test was used to compare preference scores for group treatment to investigate whether participants who completed treatment differed from those who abandoned treatment. Participants who completed group therapy expressed higher preference for group treatment than participants who dropped out of treatment (t[107] = 1.99; p < 0.05). The PGTQ-4 presented adequate psychometric properties. Reliability analyses of the items retained after factorization demonstrated an acceptable level of internal consistency (Cronbach’s alpha of 0.76). Preference for individual or group therapy appears to impact treatment retention for patients with PDA. Matching patients’ preferences to the type of treatment modality used appears to be pertinent, especially for the treatment of anxiety disorders. In terms of practical implications, the rationale and benefits of group therapy should be explained to participants reluctant to engage in group therapy. Individual intervention or a combination of group and individual treatment could be considered for clients who are likely to drop out of group therapy.


Panic disorder with agoraphobia Treatment adherence Group treatment preference 



The authors would like to thank the participants of this study and clinicians from the anxiety disorders clinic at the Douglas Institute and the Cognitive-Behavioral Therapy Clinic at the Louis-H. Lafontaine Hospital in Montreal. This study was funded in part by a Grant from the Fonds de la Recherche en Santé du Québec (FRSQ 9125-81).


  1. 1.
    Campbell B, Staley D, Matas M: Who misses appointments? An empirical analysis. Canadian Journal of Psychiatry 36(3):223–225, 1991.Google Scholar
  2. 2.
    Centorrino F, Hernan MA, Drago-Ferrante G, Rendall M, Apicella A, Langar G et al.: Factors associated with noncompliance with psychiatric outpatient visits. Psychiatric Services (Washington, DC) 52(3):378–380, 2001.CrossRefGoogle Scholar
  3. 3.
    Coles ME, Turk CL, Jindra L, Heimberg RG: The path from initial inquiry to initiation of treatment for social anxiety disorder in an anxiety disorders specialty clinic. Journal of Anxiety Disorders 18(3):371–383, 2004.PubMedCrossRefGoogle Scholar
  4. 4.
    Grunebaum M, Luber P, Callahan M, Leon AC, Olfson M, Portera L: Predictors of missed appointments for psychiatric consultations in a primary care clinic. Psychiatric Services (Washington, DC) 47(8):848–852, 1996.Google Scholar
  5. 5.
    Hunt C, Andrews G: Drop-out rate as a performance indicator in psychotherapy. Acta Psychiatrica Scandinavica 85(4):275–278, 1992.PubMedCrossRefGoogle Scholar
  6. 6.
    Issakidis C, Andrews G: Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders. Acta Psychiatrica Scandinavica 109(6):426–433, 2004.PubMedCrossRefGoogle Scholar
  7. 7.
    Morlino M, Martucci G, Musella V, Bolzan M, de Girolamo G: Patients dropping out of treatment in Italy. Acta Psychiatrica Scandinavica 92(1):1–6, 1995.PubMedCrossRefGoogle Scholar
  8. 8.
    Oei TP, Kazmierczak T: Factors associated with dropout in a group cognitive behaviour therapy for mood disorders. Behaviour Research and Therapy 35(11):1025–1030, 1997.PubMedCrossRefGoogle Scholar
  9. 9.
    Keijsers GPJ, Kampman M, Hoogduin CAL: Dropout prediction in cognitive behavior therapy for panic disorder. Behavior Therapy 32(4):739–749, 2001.CrossRefGoogle Scholar
  10. 10.
    Vincent N, Lionberg C: Treatment preference and patient satisfaction in chronic insomnia. Sleep 24(4):411–417, 2001.PubMedGoogle Scholar
  11. 11.
    Bakker A, Spinhoven P, van Balkom AJ, Vleugel L, van Dyck R: Cognitive therapy by allocation versus cognitive therapy by preference in the treatment of panic disorder. Psychotherapy and Psychosomatics 69(5):240–243, 2000.PubMedCrossRefGoogle Scholar
  12. 12.
    Renjilian DA, Perri MG, Nezu AM, McKelvey WF, Shermer RL, Anton SD: Individual versus group therapy for obesity: Effects of matching participants to their treatment preferences. Journal of Consulting and Clinical Psychology 69(4):717–721, 2001.PubMedCrossRefGoogle Scholar
  13. 13.
    DiNardo P, Brown TA, Barlow DH: Anxiety Disorders Interview Schedule for DSM-I-IV: Life time version (ADIS-IV-L). Albany, NY, Graywind Publications, 1994.Google Scholar
  14. 14.
    Van Dyck R, Spinhoven P: Does preference for type of treatment matter? A study of exposure in vivo with or without hypnosis in the treatment of panic disorder with agoraphobia. Behavior Modification 21(2):172–186, 1997.PubMedCrossRefGoogle Scholar
  15. 15.
    Blouin J, Schnarre K, Carter J, Blouin A, Tener L, Zuro C et al.: Factors affecting dropout rate from cognitive-behavioral group treatment for bulimia nervosa. International Journal of Eating Disorders 17(4):323–329, 1995.PubMedCrossRefGoogle Scholar
  16. 16.
    MacNair RR, Corazzini JG: Client factors influencing group therapy dropout. Psychotherapy 31(2):352–362, 1994.CrossRefGoogle Scholar
  17. 17.
    Mueller M, Pekarik G: Treatment duration prediction: Client accuracy and its relationship to dropout, outcome, and satisfaction. Psychotherapy Theory/Research/Practice/Training 37(2):117–123, 2000.Google Scholar
  18. 18.
    Rabin AS, Kaslow NJ, Rehm LP: Factors influencing continuation in a behavioral therapy. Behaviour Research and Therapy 23(6):695–698, 1985.PubMedCrossRefGoogle Scholar
  19. 19.
    Sharp DM, Power KG, Swanson V: A comparison of the efficacy and acceptability of group versus individual cognitive behaviour therapy in the treatment of panic disorder and agoraphobia in primary care. Clinical Psychology & Psychotherapy 11(2):73–82, 2004.CrossRefGoogle Scholar
  20. 20.
    Wierzbicki M, Pekarik G: A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice 24(2):190–195, 1993.CrossRefGoogle Scholar
  21. 21.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders IV-R, 4th edn. Washington, DC, American Psychiatric Press, 2000.Google Scholar
  22. 22.
    Chambless DL, Caputo GC, Jasin SE, Gracely EJ, Williams C: The mobility inventory for agoraphobia. Behaviour Research and Therapy 23(1):35–44, 1985.PubMedCrossRefGoogle Scholar
  23. 23.
    Stephenson R, Marchand A, Lavallée MC: Validation de l’inventaire de mobilité pour l’agoraphobie auprès de la population québécoise francophone. Science et comportement 26:35–58, 1997.Google Scholar
  24. 24.
    Bandelow B: Assessing the efficacy of treatments for panic disorder and agoraphobia. II. The Panic and Agoraphobia Scale. International Clinical Psychopharmacology 10(2):73–81, 1995.PubMedCrossRefGoogle Scholar
  25. 25.
    Roberge P, Marchand L, Grenier S, Marchand A: Validation canadienne-française de l’échelle d’évaluation de la panique et de l’agoraphobie. Canadian Journal of Behavioural Science 35(1):61–66, 2003.CrossRefGoogle Scholar
  26. 26.
    Reiss S, McNally RJ: The Expectancy Model of Fear. In: Reiss S, Bootzin RR (Eds) Theoretical Issues in Behaviour Therapy. New York, Academic Press, pp. 107–121, 1985.Google Scholar
  27. 27.
    Taylor S: The structure of fundamental fears. Journal of Behavior Therapy and Experimental Psychiatry 24(4):289–299, 1993.PubMedCrossRefGoogle Scholar
  28. 28.
    Cox BJ, Parker JD, Swinson RP: Anxiety sensitivity: Confirmatory evidence for a multidimensional construct. Behaviour Research and Therapy 34(7):591–598, 1996.PubMedCrossRefGoogle Scholar
  29. 29.
    Marchand L, Stephenson R, Feeney S, Marchand A: Validation factorielle de l’adaptation canadienne-française de l’Anxiety Sensitivity Scale. Poster session presented at the congrès de l’Association canadienne française pour l’avancement des sciences (ACFAS), 10–14 mai, Ottawa, ON, 1999.Google Scholar
  30. 30.
    Beck AT, Epstein N, Brown G, Steer RA: An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology 56(6):893–897, 1988.PubMedCrossRefGoogle Scholar
  31. 31.
    Freeston MH, Ladouceur R, Thibodeau N, Gagnon F, Rheaume J: The beck anxiety inventory. Psychometric properties of a French translation. Encephale 20(1):47–55, 1994.PubMedGoogle Scholar
  32. 32.
    Beck AT, Rush AJ, Shaw BF, Emery G: Cognitive Therapy of Depression. New York, Guilford Press, 1979.Google Scholar
  33. 33.
    Bourque P, Beaudette D: Étude psychométrique de questionnaire de dépression de Beck auprès d’un échantillon d’étudiants universitaires francophones. Canadian Journal of Behavioural Science 14:211–218, 1982.CrossRefGoogle Scholar
  34. 34.
    Craske MG, Barlow DH: Panic Disorder and Agoraphobia. In: Barlow DH (Ed) Clinical Handbook of Psychological Disorders. New York, The Guilford Press, pp. 1–47, 1993.Google Scholar
  35. 35.
    Marchand A, Letarte A: La peur d’avoir peur: Guide de traitement du trouble panique avec agoraphobie. Montréal, Stanké, 1993.Google Scholar
  36. 36.
    Marchand A, Roberge P, Dupuis G, Contrandriopoulus AP, Mainguy N, Savard P: Évaluation clinique, psychosociale et économique de trois modalités de traitement du trouble panique avec agoraphobie. Montréal, Conseil québécois de la recherche sociale (RS-3166), 2000.Google Scholar
  37. 37.
    Roberge P, Marchand A: Grille d’intégrité thérapeutique, 2000.Google Scholar
  38. 38.
    Raaijmakers QAW: Effectiveness of different missing data treatments in surveys with Likert-type data: Introducing the relative mean substitution approach. Educational and Psychological Measurement 59(5):725–748, 1999.CrossRefGoogle Scholar
  39. 39.
    SPPS: SPSS® Base 12.0 User’s Guide. Chicago, SPSS Inc., 2003.Google Scholar
  40. 40.
    Kaiser HF: The application of electronic computers to factor analysis. Educational and Psychological Measurement 20:141–151, 1960.CrossRefGoogle Scholar
  41. 41.
    Cicchetti DV: Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment 6(4):284–290, 1994.CrossRefGoogle Scholar
  42. 42.
    George D, Mallery P: SPSS for Windows Step by Step: A Simple Guide and Reference, 11.0 Update, 4th edn. Boston, Allyn & Bacon, 2003.Google Scholar
  43. 43.
    Dwight-Johnson M, Unutzer J, Sherbourne C, Tang L, Wells KB: Can quality improvement programs for depression in primary care address patient preferences for treatment? Medical Care 39(9):934–944, 2001.PubMedCrossRefGoogle Scholar
  44. 44.
    Corrigan PW, Salzer MS: The conflict between random assignment and treatment preference: Implications for internal validity. Evaluation and Program Planning 26(2):109–121, 2003.PubMedCrossRefGoogle Scholar
  45. 45.
    Moore A, Sellwood W, Stirling J: Compliance and psychological reactance in schizophrenia. British Journal of Clinical Psychology 39:287–295, 2000.Google Scholar
  46. 46.
    Cahill J: Patient participation: A concept analysis. Journal of Advanced Nursing 24(3):561–571, 1996.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Michel Perreault
    • 1
    • 2
  • Dominic Julien
    • 1
  • Noé Djawn White
    • 1
  • Claude Bélanger
    • 1
    • 3
  • André Marchand
    • 3
    • 4
  • Theodora Katerelos
    • 1
  • Diana Milton
    • 1
  1. 1.Douglas Mental Health University InstituteMontrealCanada
  2. 2.McGill UniversityMontrealCanada
  3. 3.University of Quebec at MontrealMontrealCanada
  4. 4.Louis-H. Lafontaine HospitalMontrealCanada

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