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.     

Long-term stability of cognitive behavioral therapy effects for panic disorder with agoraphobia: A two-year follow-up study

Objective

Cognitive-behavioral therapy (CBT) aims to help patients establish new behaviors that will be maintained and adapted to the demands of new situations. The long-term outcomes are therefore crucial in testing the durability of CBT.

Method

A two-year follow-up assessment was undertaken on a subsample of n = 146 PD/AG patients from a multicenter randomized controlled trial. Treatment consisted of two variations of CBT: exposure in situ in the presence of the therapist (T+) or on their own following therapist preparation (T−).

Results

Both variations of CBT had high response rates and, overall, maintained the level of symptomatology observed at post-treatment with high levels of clinical significance. Effect sizes 24 months following treatment were somewhat lower than at the 6-month follow up. Once patients reached responder status, they generally tended to remain responders at subsequent assessments. Differences were observed for patients that obtained additional treatment during the follow-up period. Expert opinion and subjective appraisal of treatment outcome differed. No robust baseline predictors of 2-year outcome were observed.

Conclusion

Most patients maintain clinically meaningful changes two years following treatment across multiple outcome measures. Approximately 1/3 of patients continued to experience meaningful residual problems.     

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.     

Behavioral treatment of obesity: a two-year follow-up

Data obtained from a two-year follow-up of 10 obese women treated via behavioral methods is presented. Failure to obtain lasting results was noted, and reasons for this failure suggested. Implications of these data for investigators in the area of obesity were discussed.A review of the recent literature indicates a number of studies with encouraging results obtained via the behavioral treatment of obesity (Hall and Hall, unpublished). However, long-term follow-up data are generally lacking. This lack of long-term data is especially troublesome in the area of obesity. With regard to traditional treatment methods, such as drugs, psychotherapy, and nutritional counseling, it has generally been noted that those overweight individuals who complete a course of treatment, and who lose weight, regain the weight lost (Stunkard and McClaren-Hume, 1958) Within the literature on the behavioral treatment of obesity, only one study (Stuart, 1967) has provided weight data for as long as 1 year after initiation of treatment Stuart's data indicated a gradual loss of weight over the year. However, these data did not reflect S's ability to control weight following termination of treatment, for during the year, follow-up sessions were scheduled monthly, and thus, therapist contact was available.The present paper, in an attempt to fill the need for long-term follow-up data, presents data obtained 2 years after the termination of a behavioral treatment program. None of the Ss had been in contact with the therapist since the termination of the study 2 years earlier.     

Behavioural treatment of trichotillomania: two-year follow-up results

Post-treatment evaluation studies of behaviour therapy (BT) for trichotillomania (TTM) have shown that BT is successful in reducing symptoms in this impulse-control disorder. The present study was aimed at investigating gain maintenance at long-term follow-up. TTM-related symptoms and other symptom characteristics were evaluated in 28 patients suffering from TTM before and after brief BT and at a 3-month and 2-year follow-up. The manual-based BT consisted of self-control procedures offered in six sessions. Pre-post effect sizes for TTM symptoms at post-treatment evaluation and at the two follow-ups were 2.91, 1.47, and .87. Compared to the post-treatment effects, the 3-month and 2-year follow-up effect sizes had decreased by 49% and 70%, respectively. Better 2-year follow-up results were associated with lower pre-treatment levels of depressive symptoms and with complete abstinence from hair pulling immediately after treatment.     

The effectiveness of sources of support in career decision-making: A two-year follow-up

Making career decisions is often difficult and challenging, and one way to advance in the process is to seek help. The present research focused on the various sources of support young adults tend to look for when making their career decision and the factors that affect their actual use of these sources. Study 1 elicited the self-reported help-seeking behavior and the Career Decision-Making Profile (CDMP) from 1071 young adults (ages 18–35) who had already chosen their major(s) at a university. The young adults used sources that were easily accessible, even when they were perceived as being less effective. Additionally, those with less career decision-making adaptability, as derived from the CDMP, tended to seek help more often. Study 2, a two-year follow-up of 296 young adults who participated in Study 1, revealed that getting help reduced the likelihood of changing one’s major.     

Antidepressant medication in the treatment of agoraphobia: A critical review

The present article critically examines research on the use of antidepressants in treating agoraphobia. A number of studies have shown certain classes of antidepressant medication, namely tricyclic antidepressants and MAO inhibitors, to have beneficial effects on certain aspects of the agoraphobic syndrome. However, these studies must be interpreted with caution in light of two major methodological shortcomings, i.e. sole reliance on paper and pencil outcome indices and the confounding of the pharmacological effects of the drug with exposure to feared situations. Recent research, aimed at correcting for these methodological problems, seriously question the efficacy of antidepressant pharmacotherapy by itself as a treatment for agoraphobia. Moreover, it is argued that the disadvantages of drug treatments namely agoraphobics' reluctance to take medication, physical side effects and relapse upon withdrawal of the medication, caution against their routine use in clinical practice.     

Social inhibition and overfriendliness: two-year follow-up and observational validation

Studied socioemotional functioning in 3 groups (n = 15) of high-inhibited, low-inhibited-overfriendly, and low-inhibited-low-overfriendly children at age 9, who were identified by parental ratings in a sample (N = 392) at age 7. Ratings of social inhibition and overfriendliness were stable over the 2-year period from age 7 to age 9. Validity of rated social inhibition and overfriendliness is established with behavioral observations, both predictively and concurrently. The groups are contrasted along the dimensions of social inhibition and overfriendliness with respect to socioemotional distress, social problem solving, empathic ability, and the disinhibitory phenomena of thrill seeking and hyperactivity. The high-inhibited group shows heightened socioemotional distress. The overfriendly group shows heightened levels of thrill seeking and hyperactivity. Social problem solving and empathy are less well developed in the inhibited and in the overfriendly group as contrasted to the low-inhibited-low-overfriendly group. The results are interpreted in terms of risks for socioemotional problems at both ends of the dimension of social inhibition.     

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.     

A two-year follow-up study of a preventive mental health program for preschoolers

The long-term effects of a preschool intervention program for high-risk experimental children were assessed and compared to a high-risk placebo control group and low-risk normal controls. Seventy first-grade children were involved in this 2-year follow-up. The experimental treatment group was superior to that of the placebo control group at follow-up on the criteria measures of behavioral adjustment and achievement. The low-risk normal control group was significantly different from that of the placebo control groups, but generally not significantly different from that of the experimental groups, suggesting that the intervention had boosted the high-risk experimental treatment children to the point where their performance was comparable to that of children who had not experienced behavioral or learning difficulties.The study was supported by grants from the McGregor Fund and the Eloise and Richard Webber Foundation, and by the Detroit Public Schools, for which the authors express grateful appreciation. A version of this paper was presented at the Annual Meeting of the American Psychological Association, New York, September 1979.     

Cognitive-behavioral treatment of agoraphobia: paradoxical intention vs self-statement training

Twenty-six agoraphobics were randomly assigned to either Paradoxical Intention (PI) or Self-Statement Training (SST) which consisted of 12 weekly 90-min group sessions with 4–5 patients per group. Major assessments were carried out at pre-treatment, 6th week and 12th week of treatment, and at 1- and 6-month follow-ups. Measures included clinical ratings of severity of condition, phobia, anxiety and depression. Furthermore, a behavioral test was administered during which changes in subjective units of discomfort and cognitions were assessed. The results indicated statistically-significant improvement over time with both treatments. ANCOVAs performed revealed superior effects on several agoraphobia measures for the PI condition at post-treatment. However, by the 6-month follow-up assessment, the groups were equivalent due to marked improvement during the follow-up phase in the SST condition. Cognitive changes were marked by a decrease in self-defeating statements without concomitant increase in coping statements. These results and recommendations for future research are discussed.