Cognitive, behavioral, and psychophysiological treatments of agoraphobia: A comparative outcome investigation

Abstract

Eighty-eight severe and chronic agoraphobics with panic attacks, diagnosed using Diagnostic and Statistical Manual of Mental Disorders (3rd ed.) criteria, were randomly assigned to one of three cognitive, behavioral or psychophysiological treatments: paradoxical intention, graduated in vivo exposure, or progressive deep muscle relaxation training. Experienced therapists, whose treatment integrity was objectively monitored, conducted 12 two-hour weekly sessions. Therapists were completely counterbalanced across treatments. All subjects received extensive programmed practice instruction and feedback, in addition to their primary treatment. A comprehensive assessment battery consisting of clinical ratings and self-report measures of severity, phobia, anxiety, panic, and depression, as well as direct measures of behavioral avoidance and in vivo phobic anxiety, was administered at pre-, mid- (6 weeks), post- (12 weeks), and at three-month follow-up. Analyses revealed statistically significant improvement across all domains and treatments, with few between-group differences. Composite measures of endstate functioning and improvement at posttreatment and three-month follow-up revealed that the treatments were equally effective, yet incomplete. The role of pretreatment clinical and historical measures was examined with regard to therapeutic outcome and maintenance. The phenomenon of tripartite concordance was investigated with regard to both treatment outcome and short-term follow-up. Theoretical and clinical issues raised by these findings are discussed with recommendations for future clinical research.