For a full list of publications, please see my CV.
My current research program has two main foci: (a) the process and outcome of psychotherapy, especially cognitive-behavioral therapy, for anxiety disorders and (b) the intimate relationships of people with anxiety disorders, particularly the effects of relationships on patients’ response to treatment.
In recent research my colleagues and I have found CBT to be the most consistently effective treatment of panic disorder across two sites of a randomized controlled trial comparing CBT, panic-focused psychodynamic psychotherapy, and applied relaxation training (Milrod et al., 2016). My colleagues, students, and I are now engaged in studies of moderation and mediation of treatment outcome as well as prediction of which patients fare poorly regardless of treatment type. We believe that such findings will help us identify ways to increase the efficacy of treatment for those patients who currently fail in treatment. We are examining such factors as resistance to the therapists’ direction, expectancy of change, catastrophic thinking, and difficulty understanding the emotional context and underlying meaning of panic attacks. We also plan studies of therapists’ adherence to the treatment protocol in CBT and patients’ engagement in homework and in session exercises.
In our research on the family context of anxiety disorders and their treatment, we have found that expressed emotion (particularly in the form of hostility) in relatives of patients with anxiety disorders and the patients’ perceptions of their relatives as critical of them predict worse treatment response including premature termination of treatment and poorer response at either posttest or follow-up (Chambless & Steketee, 1999; Chambless et al., in press). In subsequent analyses of weekly ratings of anxiety and depression, we have obtained support for the stress-vulnerability hypothesis of the effects of expressed emotion and perceived criticism: When patients believe their relatives are being critical and are upset by that criticism, they respond with anxious and depressed mood, and are then more anxious when they confront challenges in exposure therapy (Steketee et al., 2007). We have pursued these findings by investigating what factors are related to relatives’ being more hostile toward the patient and to patients’ perceptions of the relatives as more critical – with a particular focus being the negative attributions relatives and patients make about one another’s behavior (Chambless, et al., 2010; Renshaw et al., 2006). These and other findings have shaped the development of a couple/family intervention used adjunctive to individual CBT for the patient’s anxiety disorder (Chambless, 2012). We are presently pilot testing this intervention. In addition, we are continuing to code and study videotaped interactions between patients and their closest relative to better understand patient-relative interactions, including the oft-overlooked contributions of patients’ behavior to their relatives’ critical reactions.
(students’ names marked *)
Chambless, D. L. (2012). Adjunctive couple and family intervention for patients with anxiety disorders. Journal of Clinical Psychology: In Session, 68, 548-560. doi: 10.1002/jclp.21851
Chambless, D. L., *Allred, K. M., Chen, F. F., McCarthy, K. S., Milrod, B., & Barber, J. P. (in press). Perceived criticism predicts outcome of psychotherapy for panic disorder: Replication and extension. Journal of Consulting and Clinical Psychology. doi: 10.1037/ccp0000161.
Chambless, D. L., *Blake, K. D., & *Simmons, R. A. (2010). Attributions for relatives’ behavior and perceived criticism: Studies with community participants and patients with anxiety disorders. Behavior Therapy, 41, 388-400. doi: 10.1016/j.beth.2009.11.001
Chambless, D. L., & Steketee, G. (1999). Expressed emotion and the prediction of outcome of behavior therapy: A prospective study with agoraphobic and obsessive-compulsive outpatients. Journal of Consulting and Clinical Psychology, 67, 658-665. doi: 10.1037/0022-006X.67.5.658
Milrod, B., Chambless, D. L., Gallop, R., Busch, F. N., Schwalberg, M., McCarthy, K. S., Gross, C., Sharpless, B. A., Leon, A. C., & Barber, J. P. (2016). Psychotherapies for panic disorder: A tale of two sites. Journal of Clinical Psychiatry, 77, 927-935. doi: 10.4088/JCP.14m09507.
*Renshaw, K. D., Chambless, D. L., & Steketee, G. (2006). The relationship of relatives’ attributions to their expressed emotion and to patients’ improvement in treatment for anxiety disorders. Behavior Therapy, 159-169. doi: 10.1016/j.beth.2005.11.001
Steketee, G., Lam, J. L., Chambless, D. L., *Rodebaugh, T. R., McCullough, C. E. (2007). Effects of perceived criticism on anxiety and depression during behavioral treatment for anxiety disorders. Behaviour Research and Therapy, 45, 11-19. doi: 10.1016/j.brat.2006.01.018