Therapist adherence to a treatment manual influences outcome and dropout rates: Results from a multicenter randomized clinical CBT trial for panic disorder with agoraphobia

2013 IJRSP – Volume 2 Issue 4


Hauke, Christina*
Technical University of Dresden, Germany (

Gloster, Andrew T.
Technical University of Dresden, Germany (

Gerlach, Alexander
University of Cologne, Germany (

Hamm, Alfons
Ernst-Moritz-Arndt University Greifswald, Germany (

Deckert, Jürgen
University of Würzburg, Germany (

Fehm, Lydia
University of Berlin, Germany (

Alpers, Georg W.
University of Mannheim, Germany (

Kircher, Tilo
Philipps University Marburg, Germany (

Ströhle, Andreas
Universitätsmedizin Berlin, Germany (

Arolt, Volker
University of Münster, Germany (

Wittchen, Hans-Ulrich
Technical University of Dresden, Germany (


Therapist adherence has been shown to contribute to the effectiveness of treatment interventions. The role in a patient’s decision to drop out of treatment, however, is unknown. This study investigates whether therapist adherence affects clinical outcome and the risk for dropout. Patients diagnosed with panic disorder with agoraphobia (N = 265) were treated in one of two CBT variations: with (T+) and without (T-) explicit therapist-guided exposure. Significant associations between lower levels of adherence and symptomatic improvement were observed in treatment completers in the T- condition and dropouts in T+ condition suggesting that adherence-outcome relations are potentially contributed by patient and treatment characteristics. Moreover, our results propose that patient related difficulties with exposure procedures may lead to lower adherence and dropout.

Keywords: treatment integrity; cognitive behavior therapy; exposure; anxiety; therapist variables



*Corresponding Author