The differential impact of prognostic and process expectations versus panic severity on depressive symptoms in panic disorder with agoraphobia

Background: Panic disorder with agoraphobia (PDA) co-occurs highly with depression. Greater panic symptoms, agoraphobic avoidance, comorbidity and anxiety sensitivity have all been linked to depressive symptoms in PDA. Psychotherapy research has historically linked prognostic and process expectationsto symptom severity. However, no study has explored the relationship of expectancies and depressive symptoms in PDA. The purpose of the present study was to determine the extent to which expectations and panic symptomatology have a differential impact on depressive symptoms in PDA above and beyond the influence of anxiety sensitivity and secondary Axis I comorbid disorders (e.g., generalized anxiety disorder, social anxiety disorder) just prior to entering therapy. Method: The relationship between depressive symptoms, panic symptomatology and expectancies (i.e., prognostic and process expectations) was Expectancies and panic disorder 242 investigated in 74 patients with a primary diagnosis of panic disorder with agoraphobia. It was hypothesized that expectancy measures rather that panic symptomatology would add to the prediction of depressive symptoms beyond the effects of secondary comorbid disorders and anxiety sensitivity. Results: The findings showed that prognostic and process expectations accounted for significant variance in depressive symptoms beyond that predicted by anxiety sensitivity and secondary Axis I comorbid disorders. In addition, PDA symptomatology failed to significantly enter into our prediction model. Conclusions: These results suggest that expectancies have a greater impact on depressive symptoms in PDA regardless of the secondary comorbid disorders and severity of symptoms in PDA. Implications of these findings on the treatment of PDA are discussed.