Assessment and significance of behavioral avoidance in agoraphobia

Two behavioral avoidance tests were administered, before and after in vivo exposure treatment, to 39 female patients with chronic and severe agoraphobia. The first test consisted of walking alone along a standard course covering several city blocks, and the second of entering and remaining in five different, individually selected phobic situations. Although significant improvement on the tests was observed in the sample as a whole, neither test had a high nosographic sensitivity (nearly two-thirds of the patients completed them initially) and subgroups of avoiders and nonavoiders, classified simultaneously on both tests, did not differ significantly in their clinical characteristics or response to treatment. The difficulty for the behavioral test to account for the majority of variance in phobic avoidance, and the severity of agoraphobia in general, is discussed with particular reference to the differences between the going to and the being in types of phobic situations and the essentially anticipatory nature of anxiety and fear.This research was supported by Grants MH40141 and MH34177 from the National Institute of Mental Health.