The thesis addresses three main questions about the long-term outcome in panic disorder and social phobia: (i) whether cognitive behaviour treatment delivered as a routine service in a specialist clinic is effective in the long-term as measured by traditional outcome methods; (ii) whether this treatment is sufficiently effective, that is, whether patients show clinical improvement as well as statistical improvement; and (iii) whether long-term outcome can be predicted either by pre-treatment

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... ient characteristics or from their short-term treatment response. A consecutive sample of patients with panic disorder or social phobia were assessed an average of 2 years following treatment. The treatment produced significant improvement in measures of symptoms, avoidance, and disablement during treatment and further improvement during the follow-up period. A quarter of subjects no longer met diagnostic criteria, had not sought further treatment, and their anxiety had not interfered with their lives or activities since treatment ended. The majority of the remaining subjects reported a reduction in the disability due to panic attacks or avoidance. These findings support the clinical significance of the outcome, that is, the treatment was sufficiently effective for a sizeable proportion of the patients. However few patients met conventional criteria for a clinically significant outcome. Conceptual and practical difficulties in the criteria for assessing clinical significance are discussed and an alternative approach is proposed. Patients who dropped out from, or who refused the offer of treatment, showed a poor long-term outcome whether or not they sought further care. It is concluded that effective treatment can be delivered in routine care but that these findings may be the exception. Success is related to the use of treatment XI protocols in specialist treatment settings, and attention should be paid to improving the efficacy of the non-specialist treatment of anxiety disorders. Severity, as measured by symptoms and disablement at the time of treatment, were the only variables found to predict symptoms and disablement at long-term follow-up. Our understanding of why not all patients response similarly to cognitive behaviour treatment is still lacking. Chapter 1: An introduction to panic disorder and social phobia.