Assertion training and in vivo exposure as treatment for agoraphobia

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Virginia Polytechnic Institute and State University


Agoraphobia is the most pervasive and serious of all the phobic disorders. Marks (1969) reported that agoraphobics represent between 50%-60% of all phobic clients seen by practicing mental health professionals. The syndrome includes fears of leaving home, being in closed spaces, shopping, and traveling especially when alone. There is much fear generalization throughout the course of the disorder, and numerous other symptoms are commonly present, including panic attacks, tension, dizziness, frequent depression, depersonalization, and obsessions.

The present study included a large-scale media outreach campaign directed towards gathering demographic and normative data regarding agoraphobia. Seventy individuals agreed to complete an extensive questionnaire survey. Data derived from this sample confirmed the findings presented in the literature that the majority of agoraphobics are middle-aged female housewives. A number of other demographic characteristics and scores on self-report inventories were also reported.

Ten of the respondents to the questionnaire survey agreed to participate in a treatment outcome study that compared assertion training and in vivo exposure according to a multiple baseline across subjects experimental design. Dependent measures included (1) self-report; (2) self-monitoring of daily anxiety, stress-related physical symptoms, and psychotropic medication; and (3) an in vivo behavioral assessment that incorporated a behavioral duration measure, heart rate, and self-ratings of anxiety level.

Results indicated that all subjects improved from pretreatment to post-treatment assessment periods on a number of dependent measures (self-report and self-monitoring). These treatment gains appeared to be maintained at three-month follow-up. Results of the behavioral in vivo assessment procedure were equivocal. There were no significant differences between the assertion training and in vivo exposure procedures on any measures of treatment outcome.

Treatment subjects were compared to a no-treatment control group and showed significantly greater improvement on a number of self-report measures. Methodological problems precluded firm conclusions and competing hypotheses of demand characteristics and subject expectancies were discussed.

Results were discussed within the context of the empirically derived literature and clinical reports and a model for the development and maintenance of agoraphobic behavior was presented. Directions for future research in the assessment and treatment of agoraphobia were suggested.