The Change Process in a Cognitive-Behavioral Therapy: Testing a Cognitive, a Behavioral, and an Integrated Model of Panic Disorder With Agoraphobia

The authors investigated the relationship among catastrophic cognitions, fear of bodily sensations, and avoidance in patients undergoing cognitive therapy fur panic disorder with agoraphohia to determine which of three theoretical models was most consistent,with their data, which were analyzed by structural modeling techniques. The final path model indicated a three-step change process. Beliefs about losing control predicted a fear of bodily sensations. A fear of bodily sensations, in turn, predicted both avoidance and a conviction of a looming physical catastrophe. The results, although preliminary, are consistent with an integrated behavioral and cognitive model for understanding the intratherapeutic relationship among these variables.