Cognitive therapy versus interoceptive exposure as treatment of panic disorder without agoraphobia

Cognitive therapy (CT) and interoceptive exposure (IE) as treatments of panic disorder without agoraphobia were compared in a sample of 69 patients, randomly allocated to condition. There were no significant differences between treatments as to reductions in panic frequency, daily anxiety levels and a composite questionnaire score, at posttest after the 12-session treatment, and at both follow-ups (4 weeks, 6 months). In both conditions, high percentages of patients were panic free at post and follow-up tests (range 75-92%). Although the reduction in idiosyncratic beliefs about the catastrophic nature of bodily sensations was equally strong in both conditions, post-treatment beliefs correlated strongly with symptoms at post and follow-up tests in the CT condition, but not in the IE condition. Reduction of beliefs may be essential in CT, but not in IE. This suggests that the two treatments utilize different change mechanisms.     

Assessment and significance of behavioral avoidance in agoraphobia

Two behavioral avoidance tests were administered, before and after in vivo exposure treatment, to 39 female patients with chronic and severe agoraphobia. The first test consisted of walking alone along a standard course covering several city blocks, and the second of entering and remaining in five different, individually selected phobic situations. Although significant improvement on the tests was observed in the sample as a whole, neither test had a high nosographic sensitivity (nearly two-thirds of the patients completed them initially) and subgroups of avoiders and nonavoiders, classified simultaneously on both tests, did not differ significantly in their clinical characteristics or response to treatment. The difficulty for the behavioral test to account for the majority of variance in phobic avoidance, and the severity of agoraphobia in general, is discussed with particular reference to the differences between the going to and the being in types of phobic situations and the essentially anticipatory nature of anxiety and fear.This research was supported by Grants MH40141 and MH34177 from the National Institute of Mental Health.     

Individual response patterns and the effects of different behavioral methods in the treatment of agoraphobia

The importance of individual response patterns in agoraphobic patients was examined in the present study. Forty psychiatric outpatients with agoraphobia were assessed in individually relevant natural phobic situations. During this behavioral test their heart rates were measured continuously, and self-ratings of experienced anxiety were made at fixed intervals. On the basis of their reactions in the test situation, the patients were divided into two groups showing different response patterns—behavioral and physiological reactors. Within each group the patients were randomly assigned to one behaviorally-focused method (exposure in vivo, E) and one physiologically-focused method (applied relaxation, AR). The patients were treated individually for 12 sessions. Both treatments yielded significant improvements on most measures; 60% of the E group and 70% of the AR group patients were clinically improved after treatment. The between-group comparisons showed that both treatments did equally well both for behavioral and physiological reactors. Thus, the differential effects for these methods obtained in previous studies were not seen.     

Predicting treatment preferences for agoraphobia

Fifty-one university students completed two questionnaires: (1) The Millon Behavioral Health Inventory (MBHI) and (2) a questionnaire evaluating Ss' ratings of acceptability and effectiveness of five treatments for agoraphobia (Norton, Allen and Hilton, 1983a). The results showed that the Ss rated the three psychological treatments as more effective and acceptable than the two drug treatments. A discriminant function analysis, using the coping style measures of the MBHI and the Ss' ratings of acceptability and effectiveness of tranquilizers as predictor variables, correctly classified 78% of the Ss as to which psychological treatment they rated as more acceptable and effective for agoraphobia.     

Psychophysiological outcome of cognitive, behavioral and psychophysiologically-based treatments of agoraphobia

Psychophysiological process and outcome phenomena were analyzed to examine differential temporal patterns within and across cognitive, behavioral and physiologically-based treatments of agoraphobia. Eighty-eight severe and chronic agoraphobics with panic attacks (DSM-III) were randomly assigned to one of three treatments: Paradoxical Intention, Graduated Exposure or Progressive Deep Muscle Relaxation Training. Protocol therapists, whose treatment integrity was objectively monitored, conducted 12 two-hour weekly sessions. All subjects received programmed practice instructions concurrent with their primary treatment. Analyses revealed numerous significant reductions on in vivo psychophysiological measures for the relaxation condition, a few improvements for the exposure treatment and no effects for the paradoxical intention modality. The mediating role of pretreatment physiological reactivity in treatment outcome and follow-up status was examined and revealed no significant associations. Synchrony-desynchrony patterns were found to vary widely according to both treatment phase and the time interval between assessments. No between-group differences were observed on the proportion of synchronizers. However, synchronizers exhibited superior outcome and follow-up compared to desynchronizers on all domains except the physiological measures. Conceptual, methodological and clinical implications of these findings are discussed with recommendations for future research.