Concordance and discordance of cognitive, behavioural and somatic self-ratings as a function of exposure: a Discan analysis

In an attempt to evaluate changes in client perception of anxiety responses over the course of treatment, an analysis was conducted based on Discan, a psychometric methodology designed to measure and monitor changing experential states within the individual. An agoraphobic client participated in a self-paced therapist-assisted exposure programme over a period of 4 weeks and was followed-up after 6 months. A hierarchy for exposure was first established, followed by daily exposure sessions of approximately 2 hr duration. The Discan measures were constructed to include behavioural, cognitive and somatic expectations regarding a subset of items in the hierarchy. The results showed recurrent patterns of changes as a function of exposure. After successful completion of an item of the hierarchy, concordance was observed between the three components of anxiety on those items completed. Hierarchy items immediately following conquered situations showed the most scatter, reflecting a differential rate of change between the three components measured. This suggests that a degree of discordance between the measures may be related to emotional processing.