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.     

Marital interaction of agoraphobic women: a controlled,behavioral observation study

Married couples with a female agoraphobic spouse (n = 22) were compared with demographically similar community control couples (n = 21) on self-report and observational measures of marital interaction. Consistent with hypotheses, husbands of agoraphobic women were more critical of their wives than were control husbands, and clinical couples were less likely to engage in positive problem solution than control couples. Contrary to hypothesis, clinical husbands were not less supportive than control husbands. Where general measures of marital distress were concerned, clinical couples, relative to control couples, evinced more distress by self-report, by their higher rate of negative nonverbal behavior, and by their longer sequences of negative exchanges.     

More information from fewer questions: the factor structure and item properties of the original and brief fear of negative evaluation scale

Statistical methods designed for categorical data were used to perform confirmatory factor analyses and item response theory (IRT) analyses of the Fear of Negative Evaluation scale (FNE; D. Watson & R. Friend, 1969) and the Brief FNE (BFNE; M. R. Leary, 1983). Results suggested that a 2-factor model fit the data better for both the FNE and the BFNE, although the evidence was less strong for the FNE. The IRT analyses indicated that although both measures had items with good discrimination, the FNE items discriminated only at lower levels of the underlying construct, whereas the BFNE items discriminated across a wider range. Convergent validity analyses indicated that the straightforwardly-worded items on each scale had significantly stronger relationships with theoretically related measures than did the reverse-worded items. On the basis of all analyses, usage of the straightforwardly-worded BFNE factor is recommended for the assessment of fear of negative evaluation.     

A Qualitative Investigation of Practicing Psychologists' Attitudes Toward Research-Informed Practice: Implications for Dissemination Strategies

This article presents the results of a qualitative analysis of interviews with 25 psychologists in independent practice, investigating everyday treatment decisions and attitudes about treatment outcome research and empirically supported treatments (ESTs). Clinicians noted positive aspects about treatment outcome research, such as being interested in what works. However, they had misgivings about the application of controlled research findings to their practices, were skeptical about using manualized protocols, and expressed concern that nonpsychologists would use EST lists to dictate practice. Clinicians reported practicing in an eclectic framework, and many reported including cognitive-behavioral elements in their practice. To improve their practice, they reported valuing clinical experience, peer networks, practitioner-oriented books, and continuing education when it was not too basic. Time and financial barriers concerned nearly all participants. Clinicians suggested they might be interested in ESTs if they could integrate them into their current frameworks, and if resources for learning ESTs were improved.     

Context effects as auditory contrast

Three experiments are reported that collectively show that listeners perceive speech sounds as contrasting auditorily with neighboring sounds. Experiment 1 replicates the well-established finding that listeners categorize more of a [d–g] continuum as [g] after [l] than after [r]. Experiments 2 and 3 show that listeners discriminate stimuli in which the energy concentrations differ in frequency between the spectra of neighboring sounds better than those in which they do not differ. In Experiment 2, [alga–arda] pairs, in which the energy concentrations in the liquid-stop sequences are H(igh) L(ow)–LH, were more discriminable than [alda–arga] pairs, in which they are HH–LL. In Experiment 3, [da] and [ga] syllables were more easily discriminated when they were preceded by lower and higher pure tones, respectively—that is, tones that differed from the stops’ higher and lower F3 onset frequencies—than when they were preceded by H and L pure tones with similar frequencies. These discrimination results show that contrast with the target’s context exaggerates its perceived value when energy concentrations differ in frequency between the target’s spectrum and its context’s spectrum. Because contrast with its context does more that merely shift the criterion for categorizing the target, it cannot be produced by neural adaptation. The finding that nonspeech contexts exaggerate the perceived values of speech targets also rules out compensation for coarticulation by showing that their values depend on the proximal auditory qualities evoked by the stimuli’s acoustic properties, rather than the distal articulatory gestures.     

Gender Differences in the Construct Validity of the Silencing the Self Scale

Gender differences in the construct validity of Jack's (1991) Silencing the Self Scale (STSS) were assessed using 187 female and 169 male undergraduates. Results of exploratory and confirmatory factor analyses revealed gender differences in the scale's latent structure and at best provided only limited support for the validity of the scale's four subscales for women. Among men, the studies exposed a weakness in the scale's construct validity and provided insights into possible alternative interpretations made by men when responding to the scale's items. Convergent and discriminant validity of the scale were assessed by correlating it with measures of neuroticism and attachment. Whereas the construct validity of the STSS for use with women was supported, evidence was weaker for men. For men, data suggest that the STSS, in part, taps a motive to avoid intimacy and relationship situations that limit one's sense of independence and autonomy, a construct incongruous with Jack's notion of self-silencing.     

Social Anxiety Disorder and Perceived Criticism in Intimate Relationships: Comparisons With Normal and Clinical Control Groups

Individuals with social anxiety disorder (SAD) have difficulties in their romantic relationships, including decreased satisfaction and intimacy, but the reasons for these difficulties are poorly understood. Because fear of negative evaluation is a cardinal feature of SAD, perceived criticism from a romantic partner may play a central role in socially anxious individuals’ relationships. In the present study, we compared levels of perceived, expressed, and observed criticism and reactions to criticism among individuals with SAD and their partners (n = 21), individuals with other anxiety disorders and their partners (n = 35), and couples free of psychopathology (n = 30). Participants rated both global criticism and criticism during a 10-minute problem-solving task, which was also coded for criticism by observers. Individuals with anxiety disorders showed elevated levels of interaction-specific perceived criticism, expressed criticism, and upset and stress due to criticism relative to normal controls; they also reported that the interaction was more stressful. However, there were no group differences on global measures of criticism, and the two anxious groups did not differ on any measures. Findings suggest that the high levels of criticism anxious individuals perceive and their corresponding negative reactions to criticism, though not specific to SAD, may account for some of the relationship difficulties that have been identified in SAD. Results also indicate that anxious individuals may contribute to their relationship difficulties by being highly critical themselves. Overall, our findings point to the need for a clinical focus on decreasing perceived criticism among individuals with anxiety disorders.