Is agoraphobia harder to treat? A comparison of agoraphobics' and simple phobics' response to treatment

Agoraphobia is reputed to be more difficult to treat than simple phobia. In a test of this supposition, 38 agoraphobics and 19 simple phobics were each given 10 sessions of graduated in vivo exposure. They were assessed before and after therapy using a behavioral avoidance test, behavioral diaries, and self-report measures. Analysis of covariance revealed unequivocal posttest differences only on self-assessed disability level; agoraphobics had changed less in their report of global disability immediately following treatment but not at follow-up. Sixty-eight percent of the simple phobics showed clinically significant improvement on avoidance of the Main Phobia, compared with 34% of the agoraphobics. On three other outcome measures, including more precise behavioral measures of phobia, agoraphobics and simple phobics responded equivalently to treatment. Given clinicians' impression about the comparative difficulty in treating agoraphobic clients, fewer differences in treatment response were obtained than were expected. Several possible explanations for this discrepancy are discussed.     

The observer perspective: biased imagery in social phobia, agoraphobia, and blood/injury phobia.

Clark and Wells' (1995): 'A cognitive model of social phobia'. In Social phobia: Diagnosis, assessment, and treatment (pp. 69-93), R. G. Heimberg, M. R. Liebowitz, D. A. & F. R. Hope (eds.); cognitive model of social phobia proposes that social phobics generate a negative impression of how they appear to others. This impression often occurs in the form of an image from an "observer" perspective in which social phobics can see themselves as if from another person's vantage point. This study investigated the specificity of the observer perspective among patients with social phobia, agoraphobia, and blood/injury phobia. All participants were asked to recall and imagine a recent anxiety-provoking social situation and a non-social/non-anxiety-provoking situation, and rate their perspective for each. Consistent with predictions only patients with social-evaluative concerns (social phobics and agoraphobics) reported observer perspectives for anxiety-provoking social situations. Only social phobics showed a significant shift from an observer to a field perspective across the two conditions. The clinical implications of these findings are briefly discussed.     

The co-therapy relationship: Mutuality,agreement and client outcome

This project, utilizing a pretest and posttest design, studied interactions between co-therapists and the relationships of their interactions to client outcome. Six co-therapist pairs at a counseling center saw two clients in multiple treatments yielding twelve cases. The study investigated co-therapist relationships in regard to: (a) their level of mutuality or caring for their partners, (b) their ratings of the quality of their relationships, and (c) their agreement as to perceptions and behavior during sessions. Also investigated were: the relation of co-therapist interaction to client outcome and the personal growth of the therapists over the course of therapy. Results supported success claims of the literature concerning co-therapy.     

Relationships Among Emerging Adult Psychological Problems,Maltreatment, and Parental Psychopathology: Moderation by Parent–Child Relationship Quality

Current research supports clear relationships between parental psychopathology, parental maltreatment, and emerging adult child psychopathology. Less research has examined how the role of the parent–child relationship influences these existing associations. The current study tested two models that examined the moderating effect of parent–child relationship quality on parental psychopathology and emerging adult mental health as well as the effect on parental maltreatment and emerging adult mental health. It was expected that high parent–child relationship quality would buffer against the negative effects of parental psychopathology and maltreatment while enhancing the effects of functional parenting characteristics. Participants included 1,452 emerging adults, predominantly Caucasian (73.3%) college students who completed surveys on their mental health, recent experienced maltreatment, and their parents’ mental health problems. Results suggested lowest rates of mental health problems for emerging adults were associated with higher parent–child relationship quality and lower parental psychological problems, whereas negative outcomes were associated with higher parental psychopathology, regardless of parent–child relationship quality. Additionally, physical maltreatment was associated with lower rates of mental health concerns in the context of higher mother-daughter relationship quality. Results emphasize the continuing impact of the parent–child relationship, particularly the mother-daughter relationship, on emerging adults’ mental health. Moreover, the current study demonstrates the continuing influence of parents on their emerging adult children.     

Cross-Informant Agreement in the Assessment of Social Phobia in Youth

In the present study involving children and adolescents with a principal diagnosis of social phobia, we measured parent–child agreement regarding social anxiety symptoms. Additionally, we examined variables related to the severity of the children's social phobia symptoms as reported by children and as rated by clinicians. Examination of cross-informant agreement indicated little difference between mean parent and children ratings of the children's social fears. In contrast, there was a significant difference in parent and children ratings of the children's avoidance, with parents endorsing greater degrees of social avoidance. Children's report of social avoidance was negatively related to scores on a measure of self-presentational concerns (i.e., social desirability). Clinicians' determination of the severity of the children's social phobia was also influenced by the children's self-presentation as well as parent report of social avoidance and children's depression scores. Thus, this differential weighting by the clinician of parent versus child report may be related to the finding that children's self-reported social avoidance was negatively related to their concerns regarding positive self-presentation. Results suggest the need to consider the impact of social desirability when examining clinical characteristics of children and adolescents with social phobia.     

Cognitive bias in symptomatic and recovered agoraphobics

Symptomatic agoraphobics, recovered agoraphobics, and normal control subjects completed a series of sentence stems that had either ambiguous or unambiguous meanings, and had either a potentially threatening or a nonthreatening connotation. The written completions made by subjects to these stems were classified as indicating either a biased (i.e. threat-related) or unbiased interpretation of the meaning of the stem, and if a biased interpretation was made, whether the subject indicated efforts at adaptive coping with the perceived threat. Results indicated that symptomatic agoraphobics exhibited strong biases for interpreting information as threatening, relative to normal control subjects. Moreover, recovered agoraphobics resembled symptomatic agoraphobics more than normal control subjects, thus indicating that cognitive biases may persist following cessation of panic attacks and reductions in avoidance behavior. However, recovered agoraphobics also exhibited tendencies to cope adaptively with perceived threats whereas symptomatic agoraphobics did not.     

Thought suppression: specificity in agoraphobia versus broad impairment in social phobia?

The paradoxical effects of intended thought suppression have been linked to psychological disorders, specifically anxiety disorders. So far, the evidence for thought suppression playing a major role in the disorder is mixed. One important issue is whether thought suppression is impaired only for thoughts related to the disorder, or if the ability for mental control is generally impaired in anxiety patients. This study compared groups of agoraphobics and social phobics with a healthy control group. All subjects were asked to suppress two topics related to the respective central fear of the two disorders and one nonspecific topic. We found a rather specific deficit in thought suppression for the agoraphobics; that is, when compared with the control group, we found the biggest differences for the agoraphobic fear. The social phobics seem to be characterized by a general impairment of mental control, affecting specific and nonspecific stimuli. In addition, among several psychopathological variables, social anxiety proved to be the strongest predictor for problems with thought suppression. Taken together, there are several indicators that generally impaired thought suppression may be an important feature of social phobia.     

Couples treatment of agoraphobia: changes in marital satisfaction

Six agoraphobic women and their husbands participated in a group therapy program consisting of exposure and cognitive restructuring. The husbands acted as co-therapists. Ratings of marital satisfaction as well as severity of phobia were filled out independently by both clients and their husbands throughout the course of therapy and at follow-up. Two patterns of relationships among marital satisfaction and severity of phobia emerged. For four couples a parallel relationship was observed in that as phobia improved marital satisfaction increased. For two couples the inverse relationship was noted where improvements in phobia were correlated with decreases in marital satisfaction. The importance of the interpersonal context of agoraphobia and implications for treatment are suggested.     

Mobility,Cognitions, and panic

Responses to the Mobility Inventory for Agoraphobia and the Cognitions Questionnaire were compared from samples of agoraphobics, social phobics, senior citizens, students, and students' relatives. The data illustrate the occurrence of avoidant behavior and panic in groups other than agoraphobics. The Mobility Inventory was shown to have good discriminative power, but the Cognitions Questionnaire failed to discriminate between agoraphobics and social phobics. The relationship of panic to mobility and cognitions is considered.     

Discrepancy Analysis of Emerging Adult and Parental Report of Psychological Problems and Relationship Quality

Cross-informant discrepancies on reports of psychopathology can have detrimental consequences on the relationship between emerging adults and their parents. The current study utilized emerging adult reports of their own psychopathology and their perspective on their parent’s psychopathology as well as their parents’ reports of parental psychopathology and their perspective on the emerging adult’s psychopathology (measured using the Adult Self Report and Adult Behavior Checklist). Analyses were performed to further examine the associated between the discrepancies between emerging adult and parent reports of psychopathology on dyadic relationship qualities (i.e., affection, conflict, and satisfaction within the emerging adult-parent relationship). Emerging adults and their parents demonstrated significant differences in their reports of parental depression as well as emerging adult depression, anxiety, and antisocial personality problems. Furthermore, discrepancies on parental depression and antisocial problems and emerging adult depression were associated with differences on relationship qualities. Additional results and implications are discussed.

     

Modification of Cognitive-Behavioral Techniques in the Treatment of a Five Year-Old Girl with Social Phobia

Social phobia is a debilitating anxiety disorder that often goes undetected in young children, but can be effectively treated with cognitive-behavioral interventions. For children and adolescents, treatment usually includes education, social skills training, cognitive restructuring, relaxation training, and exposure. However, for very young children who present with social phobia, it is necessary to adapt treatment to the developmental level of the child. A case illustration demonstrates the way in which cognitive behavioral treatment (CBT) was modified for the treatment of a five year-old girl with social phobia. Several modifications were made, including utilizing novel exposure techniques and emphasizing parent management training in order to promote generalization of treatment gains outside of session.     

Social phobia in youth: the diagnostic utility of feared social situations

The present study evaluated the utility of parent- and child-reported social fears for reaching a diagnosis of social phobia in youth. The diagnostic utility of (a) the number of fears and (b) specific feared social situations was examined. The sample included 140 youth and their parents: youth diagnosed with social phobia (n=50), youth diagnosed with generalized anxiety disorder or separation anxiety disorder but not social phobia (n=49), and youth without an anxiety disorder (n=41). Youth and their parents were interviewed separately using the Anxiety Disorders Interview Schedule for Children and Parents. Analyses indicate that a cut score of 4 parent-endorsed social fears optimally distinguished youth with and without social phobia. Analyses of child-reported fears did not identify a meaningful cut score. Conditional probability and odds ratio analyses indicated that several specific social fears have high diagnostic efficiency, and others were found to have limited diagnostic efficiency. Results are discussed with regard to informing diagnostic interviews and diagnostic systems for social phobia in youth.     

Relationship tensions and mood: Adult children's daily experience of aging parents' stubbornness

This study examined middle‐aged individuals' reports of parents' behaviors commonly attributed to stubbornness. Middle‐aged adults (N = 192) completed a 7‐day diary reporting their mood and how often they felt their parents (N = 254) engaged in behaviors often described as “stubbornness” (insistent or risky). Thirty‐one percent of middle‐aged children reported insistent behaviors, and 17% reported risky behaviors by their parent(s). Daily reports of parent behaviors attributed to stubbornness were positively associated with parent–child relationship quality, parent functional limitations, and child neuroticism. Reports of perceived parent insistent behaviors were also associated with greater daily negative mood among adult children. Findings highlight the impact of adult children's daily perceptions of parent behaviors commonly attributed to stubbornness on the individual and relationship.     

Exploring Child and Parent Factors in the Diagnostic Agreement on the Anxiety Disorders Interview Schedule

Worryingly low levels of parent–child agreement on child psychiatric diagnosis are reported. This study examined parent–child agreement on diagnostic categories and severity ratings with the Anxiety Disorders Interview Schedule, Child and Parents versions (ADIS-C/P). Children’s age, gender, motivation and self-concept and parent’s general psychopathology and diagnoses were examined. Participants were 110 children (aged 8–14 years) with a principal specific phobia diagnosis, and their parents. Findings revealed excellent parent–child agreement on principal specific phobia diagnosis (97.3%), and fair levels of concordance on most co-occurring secondary diagnoses. As expected, children with high motivation had generally stronger parent–child agreement on diagnoses and severity ratings (for ADHD p?p?p?相似文献   

Personality differences within a diagnostic entity: Types of phobia in men and women

Often, psychodiagnostic entities, like phobias, have been assumed implicitly to be homogeneous with respect to important personality variables. Three types of phobic women, agoraphobics, social phobics and simple phobics (n = 15 per type) were compared among themselves and with non-phobics on a variety of personality characteristics. The same was done with phobic men (respectively, n = 12, n = 11, n = 8). The results showed that types of phobia differ with regard to several personality characteristics; for women differently than for men. Implications for theory building, diagnosis, and therapy are discussed. On the whole, a personality-oriented approach to psychopathology is advocated.     

Enhancing Family Communication: Examining the Impact of a Therapeutic Wilderness Program for Struggling Teens and Parents

Every year approximately 130 families participate in Intercept, a program for struggling teens and their families at the Voyageur Outward Bound School, because they are concerned about the loss of trust, poor communication, and/or other high-risk behaviors they are experiencing with their children. Though families hope for improvements in family functioning, little research has been done on the impact of this type of program on the parent/child relationship or how families function once they leave the program. This phenomenological study collected qualitative data from nine families to determine what positive relationship outcomes emerged between parent(s) and their adolescent child post-program, as well as what aspects of the program curriculum were helpful in improving the parent/child relationship. Results showed that communication among family members improved as a result of participation in the Outward Bound program, and families reported utilizing new skills they had learned, including the use of time-outs, improved listening, and other assertive communication tools. Families reported that the parent/child conference at the end of the program was the most helpful aspect of the Intercept curriculum for improving the parent/child relationship. Implications for family therapy include support for therapeutic wilderness programs as a viable intervention for families of high-risk teens struggling with communication.     

Post-event rumination and negative self-appraisal in social phobia before and after treatment

This study investigated the relationship between self-appraisals of performance, symptom severity and post-event rumination in social phobia, and evaluated the effect of treatment on these variables. A socially phobic group and a nonanxious control group performed an impromptu speech and were told that their performance would be evaluated. Participants appraised their performance immediately after the speech and 1 week later, and the frequency of post-event rumination during the week following the speech was assessed. The socially phobic group maintained the negative appraisals of their speech over the week, whereas the nonclinical group showed increased positivity about their performance The socially phobic group also engaged in more negative rumination than controls. Treatment improved perceptions of performance and reduced negative rumination. These results are discussed in the light of cognitive models of social phobia.     

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.