Predicting the effects on husbands of behaviour therapy for wives' agoraphobia

The husbands of 33 agoraphobic women were studied systematically before and for 1 yr after their wives received intensive exposure in vivo mainly in small, cohesive groups. Although most husbands reported improved personal adjustment 1 yr after their wives' therapy, many had experienced transitory negative reactions such as anxiety and depressive symptoms. These were most likely to occur after large, rapid improvements in the phobic and general symptoms of severely-disabled patients. Such improvements challenged the husbands' capacity to adapt to their wives' changed attitudes and behaviour, particularly regarding sex roles. These findings explain why reports of negative effects on husbands are found infrequently in behavioural studies of agoraphobia, which generally exclude patients with major additional symptoms, have relatively high drop-out rates and generate improvements comparatively slowly. In contrast, group exposure in the present study generated rapid improvements and inhibited dropping-out, even in patients with severe additional symptoms and problems, who were included in the study. Thus, the likelihood of repercussions on the husband was maximized. Negative effects were most likely in husbands who had adapted to their wives' disability as part of a sex-role stereotyped view of marriage, and in husbands who were persistently critical and unsupportive of their wives.