The experimental analysis of agoraphobia

A concerted move towards the use of experimental analyses is proposed. It is suggested that our understanding of agoraphobia can best be advanced by taking this step. The argument in support of such a move is illustrated and developed in respect of the role of safety signals in maintaining and influencing agoraphobic behaviour. A detailed analysis is given of the factors postulated to determine the strength of safety signals, and the complex inter-relations between fear and safety are examined.     

Emptiness in agoraphobia patients

In light of new research findings about the efficacy of psychodynamic treatment for panic disorder and agoraphobia, it seems a prudent time to carefully address psychoanalytic thinking about the treatment of agoraphobia. The literature has highlighted oedipal contributions to its genesis and clinical unraveling in psychoanalysis. While those contributions are indeed central to the disorder, structural deficits in the self-representation often become a central focus of treatment once symptomatic remission has been achieved in psychoanalytic treatment. This aspect of the clinical presentation of agoraphobia has not yet been specifically addressed in the psychiatric literature. Some aspects of the phenomenon have been described by psychoanalysts. It is more difficult to treat this "emptiness" than the overt symptoms of agoraphobia, as described in DSM-IV. Nonetheless, this phenomenon may be one of the contributors to the chronicity of the disorder. Two clinical cases illustrate these points.     

The social validity of treatments for agoraphobia

Two experiments evaluated the public's (Experiment 1) and agoraphobics' ratings of Acceptability and Perceived Effectiveness of five different procedures that have been used to treat agoraphobia. The results showed that both groups evaluated psychological treatment procedures as more acceptable and generally more effective, especially in the long run, than the drug treatments. An exposure treatment was highly rated by both groups, but the two groups differed in their evaluations of a cognitive or a relationship therapy. Recommendations were made for considering the opinions of different consumer groups when evaluating treatment validity.     

Structural conflict and object relations conflict.

A hierarchical model of the mind is required for a more integrated understanding of psychic conflict. At a higher developmental level, the hierarchical model includes the tripartite model, and at a lower level it includes an object-relations model. Psychic conflicts may be classified into object relations conflicts and structural conflicts. The object-relations class of psychic conflict covers the phase of psychic development prior to id-ego-superego differentiation. The earlier psychoanalytic writings tended to ascribe all kinds of symptoms, conflicts, and disorders to structural conflicts. Logical and empirical evidence against the universality of structural conflicts in various disorders and symptoms, even psychoneurotic symptoms, has been summarized and discussed.     

Physical symptoms and illness attributions in agoraphobia and panic.

The cognitive model of panic disorder proposes that panic patients interpret physical symptoms in a catastrophic way, thus precipitating panic attacks. This study describes the development of a questionnaire measure designed to assess beliefs about the health implications of various symptoms. Two groups, agoraphobics and normals, were compared on a variety of measures. Agoraphobics showed much higher panic frequency, fear of anxiety, and prevalence of frightening cognitions when anxious, but did not score higher than normals when assessing seriousness of symptoms. The implications of these results are considered.     

A follow-up study on short-term treatment of agoraphobia.

The differential effectiveness of three treatment packages for agoraphobia was tested. Patients received one of three short-term treatments: Breathing Retraining and Cognitive Restructuring, graded Self-Exposure in vivo, or a combination of both. No differential effects were found between the treatment conditions at posttest and at an 18 months follow-up. Improvement at follow-up assessment was associated with whether patients had further treatment during the follow-up period. No relationship was found between further improvement and demographic variables, pre- and posttest scores on psychological questionnaires or the use of medication at follow-up. Implications of these findings are examined.     

Virtual reality applications to agoraphobia: a protocol.

Recently, educators and instructional designers have focused on the development and implementation of virtual learning environments that effectively combine theoretical and applied knowledge to teach university students. One of the trusts of the Psychology Virtual Teaching Laboratory in collaboration with the IXTLI observatory is to develop dissemination programs to promote the insertion of virtual reality (VR) technologies applied to rehabilitation in their clinical practice. This paper describes the development of (1) agoraphobia VR learning objects to be use as a teaching support tools in class and (2) a multimedia teaching program that incorporate digital video and VR scenarios address to students in the field of mental health. Promotion among professors and students about the use of this technology will allow us to initiate research in our country as well as to validate contextualized applications for our culture, therefore contributing with new advances in this field.     

Personality in panic disorder with agoraphobia: a Rorschach study.

In this study, we tested several hypotheses derived from self psychology (Diamond, 1987) regarding personality features of patients suffering from panic disorder and agoraphobia (PDA). PDA patients are thought to suffer from a deficit in negative affect-regulating capacity, surrounded by defenses such as avoidance, repression, denial, and reaction formation against dependency needs. These defenses are thought to lead to a greatly impoverished affective life. The Rorschach Comprehensive System was used to assess the personality features of avoidance, restricted affective life, and reaction formation against dependency needs. We found evidence for the presence of a highly avoidant information-processing style (86% of protocols had lambda [L] greater than .99) and a constricted affective life (low weighted sum color [WSumC] and low affective ratio [Afr]). Our results were consistent with the hypothesis of reaction formation against dependency needs (low food content [Fd]). Findings are discussed in light of studies that found a high incidence of avoidant personality disorder in PDA patients.     

Preattentive bias for emotional information in panic disorder with agoraphobia.

A combined emotional Stroop and implicit memory (tachistoscopic identification) task with 3 types of words (panic-related, interpersonal threat, and neutral words) and 2 exposure conditions (subliminal, supraliminal) was administered to 35 patients with panic disorder and 35 age- and sex-matched controls. The patients showed Stroop interference for panic-related words both sub- and supraliminally and a similar but not equally robust effect on interpersonal threat words. On the tachistoscopic identification task, the patients identified more panic-related words than the controls did but showed no implicit memory bias effect. The patients' subliminal Stroop interference for panic-related words was found to correlate with trait anxiety and depression, although not with anxiety sensitivity.     

Massed vs. spaced exposure sessions in the treatment of agoraphobia

The differential effects of massed and spaced sessions of exposure in vivo were investigated with 11 agoraphobics in a crossover design. Clients were randomly assigned to one of the following two groups: (a) 10 daily sessions followed by 10 weekly sessions, or (b) 10 once-weekly sessions followed by 10 daily sessions. The results indicated that both massed and spaced sessions of exposure in vivo effected changes in avoidance behavior and subjective anxiety of agoraphobics, massed practice being superior especially with respect to avoidance. It was suggested that the superiority of massed practice is due to the lack of opportunity to engage in avoidance or escape during short inter-session intervals. The relationship between subjective anxiety and avoidance were considered and the differences between clinical and statistical significance were discussed.     

Behavioral assessment of avoidance in agoraphobia

Behavioral avoidance testing is a substantial addition to self-report questionnaires in the assessment of agoraphobia. However, the tests currently in use have drawbacks and limitations. A multitask behavioral avoidance test (M-BAT) is presented, designed to meet some of these problems. The test was administered to a group of 58 patients and proved to be reliable in terms of internal consistency. Concordance with self-report measures of agoraphobia indicated a high concurrent validity. In comparison with self-report questionnaires, the tests produced a slightly more conservative picture of gains achieved in treatment. Finally, the data revealed that the multitask test was more concordant with other measures of agoraphobia than a single-task test would have been.     

The intelligent brain in conflict

Can individual differences in general reasoning ability be reduced to an elementary cognitive process or isolated to a neural circuit? A breakthrough neuroimaging study finds that fluid intelligence and attention control are behaviorally linked via the neural activity in brain areas involved in resolving cognitive conflict.     

The elusive link between conflict and conflict adaptation

A core tenet of the original conflict-monitoring model is that regulation is triggered automatically when conflict is present and that the same regulation mechanism explains both trial-to-trial adaptation effects as well as effects of block-wise conflict manipulations. We present here results from two experiments using the Stroop task that show (a) that adaptation effects in the absence of response repetitions may occur only at the beginning of testing and that (b) robust block-wise effects can be found even in the absence of trial-by-trial effects. Furthermore, we show that the failure to eliminate target-to-distractor repetitions can produce artificial trial-to-trial adaptation effects. Based on the evidence of a weak link between conflict and conflict adaptation, we argue that a wider range of possible reasons for conflict adaptation effects needs to be taken into consideration.