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Does Expectancy and Homework Compliance Predict Change in CBT?

Objective: For treating panic disorder with agoraphobia, a high efficacy of cognitive behavioral therapy (CBT) has been demonstrated. However, the exact mechanisms leading to symptom change have been hardly explored. Previous evidence demonstrated that patients with positive expectations regarding treatment outcome before start of therapy and with high homework compliance experience an early response in the course of treatment. Furthermore the correlation between homework compliance and the treatment outcome of a patient was mediated by an early response. The aim of the present study was to conceptually replicate these findings.

Method: Twenty-three patients who met the diagnostic criteria for a panic disorder with agoraphobia according to the DSM-IV were treated in an exposure-based therapy with a total of 12 sessions. After each session, interim measurements were taken to measure symptom intensity. To test the research questions, multiple regression analyses were calculated.

Results: Patients who experienced an early response according to the definition (n=19) showed this change on average in session 5.11 (SD=2.94). Testing the mediation hypotheses replicated neither that the relationship between positive treatment expectations and early change was mediated by homework compliance, nor that the relationship between homework compliance and treatment outcome was mediated by early change.

Conclusions: The results show that previous findings on the relationship of positive treatment expectation, homework compliance and early symptom change cannot be generalized to a different setting. Given this conclusion, there should be an increased interest in replication studies.


Annette Schroder

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