Supplementary Material for: Treating Treatment-Resistant Patients with Panic Disorder and Agoraphobia Using Psychotherapy: A Randomized Controlled Switching Trial

<b><i>Background:</i></b> Nonresponsiveness to therapy is generally acknowledged, but only a few studies have tested switching to psychotherapy. This study is one of the first to examine the malleability of treatment-resistant patients using acceptance and commitment therapy (ACT). <b><i>Methods:</i></b> This was a randomized controlled trial that included 43 patients diagnosed with primary panic disorder and/or agoraphobia (PD/A) with prior unsuccessful state-of-the-art treatment (mean number of previous sessions = 42.2). Patients were treated with an ACT manual administered by novice therapists and followed up for 6 months. They were randomized to immediate treatment (n = 33) or a 4-week waiting list (n = 10) with delayed treatment (n = 8). Treatment consisted of eight sessions, implemented twice weekly over 4 weeks. Primary outcomes were measured with the Panic and Agoraphobia Scale (PAS), the Clinical Global Impression (CGI), and the Mobility Inventory (MI). <b><i>Results:</i></b> At post-treatment, patients who received ACT reported significantly more improvements on the PAS and CGI (d = 0.72 and 0.89, respectively) than those who were on the waiting list, while improvement on the MI (d = 0.50) was nearly significant. Secondary outcomes were consistent with ACT theory. Follow-up assessments indicated a stable and continued improvement after treatment. The dropout rate was low (9%). <b><i>Conclusions:</i></b> Despite a clinically challenging sample and brief treatment administered by novice therapists, patients who received ACT reported significantly greater changes in functioning and symptomatology than those on the waiting list, with medium-to-large effect sizes that were maintained for at least 6 months. These proof-of-principle data suggest that ACT is a viable treatment option for treatment-resistant PD/A patients. Further work on switching to psychotherapy for nonresponders is clearly needed.**背景**：临床中普遍认可治疗无应答现象，但目前仅有少量研究探讨了转向心理治疗的可行性。本研究为首项采用接纳与承诺疗法（Acceptance and Commitment Therapy，ACT）探究难治性患者治疗可塑性的研究之一。 **方法**：本研究为随机对照试验，共纳入43例确诊为原发性惊恐障碍伴/或伴广场恐惧症（Panic Disorder and/or Agoraphobia，PD/A）且既往接受过当前最优标准治疗但未获疗效的患者（既往平均治疗疗程数为42.2）。所有患者由新手治疗师按照ACT操作手册进行治疗，并接受为期6个月的随访。受试者被随机分为即刻治疗组（n=33）、4周等待组（n=10）及延迟治疗组（n=8）。治疗方案共包含8个疗程，于4周内每周实施2次。主要结局指标采用惊恐与广场恐惧量表（Panic and Agoraphobia Scale，PAS）、临床总体印象量表（Clinical Global Impression，CGI）以及移动能力问卷（Mobility Inventory，MI）进行评估。 **结果**：治疗结束时，接受ACT治疗的患者在PAS和CGI量表上的改善程度显著优于等待组患者（效应量d分别为0.72和0.89）；MI量表的改善效应量d=0.50，接近统计学显著性。次要结局指标与ACT理论预期一致。随访评估显示，治疗后患者的症状改善状态稳定且持续。本研究脱落率较低（9%）。 **结论**：尽管本研究纳入的样本临床挑战性较强，且治疗由新手治疗师实施、疗程较短，但接受ACT治疗的患者在功能状态与症状学方面的改善程度显著优于等待组，其中中等至大效应量至少可维持6个月。本原理验证性研究数据表明，ACT可作为难治性PD/A患者的可行治疗选择。后续仍需针对治疗无应答患者转向心理治疗的相关研究开展更多工作。