Alan J. Goldstein

A reanalysis of agoraphobia

The authors review the existing models for understanding agoraphobia and suggest a more complex behavioral model which includes a combination of necessary and sufficient factors for its formation. This model is presented as a framework allowing classification of agoraphobic-like symptoms with implications for treatment planning and research efforts.

Continuous exposure and complete response prevention in the treatment of obsessive-compulsive neurosis

Twenty-one obsessive-compulsive patients were treated by continuous exposure to discomfort-evoking stimuli and complete prevention of discomfort-reducing rituals. Inventories and evaluation scales were used by an independent assessor and by the patient to measure outcome. For most variables no change occurred during the pretreatment period; a marked improvement was observed after therapy and at follow-up. About two-thirds of the patients became asymptomatic after treatment. Differences between checkers and washers, as well as conditions influencing synchrony between obsession and compulsion, are briefly considered.

MCMI-diagnosed personality disorders among agoraphobic outpatients: prevalence and relationship to severity and treatment outcome

Abstract The prevalence of personality disorders among 165 agoraphobic outpatients was assessed with the Million Clinical Multiaxial Inventory, Versions I or II. Over 90% of clients met criteria for one or more Axis II diagnoses, the most common of which were avoidant and dependent. Scores on the personality scales were not significantly related to agoraphobic avoidance or panic frequency, but were often related to social phobia and dysphoria. Avoidant, dependent, and histrionic, but not severe personality disorders, were significantly associated with one or more indices of outcome for a sample of 64 clients in a naturalistic psychosocial treatment study, whereas paranoid PD was linked with early termination (

Intensive behavioral group treatment of avoidant personality disorder

An intensive group treatment approach for avoidant personality disorder (APD) was devised and evaluated. Seventeen patients with APD participated in a 4-day group treatment program. Treatment included group systematic desensitization, behavioral rehearsal, and self-image work. Outcome was assessed at posttest and 1-year follow-up on self-report measures of social anxiety, social functioning, depression, and self-image. In addition to a MANOVA, results of reliable and clinically significant change are presented. Significant change was observed on the measures as a group. The most notable change was on the Fear of Negative Evaluation scale, where 40% of the sample were recovered at posttest. The results of this program are promising, although the need for a more extended period of treatment is apparent.

Flooding with brevital in the treatment of agoraphobia: Countereffective?

Summary Twenty-seven agoraphobic outpatients received eight sessions of flooding in fantasy with anxiety, flooding in fantasy with intravenous Brevital, or an attention-control procedure. Results on subjective rating scales provide some support for the hypothesis that agoraphobic clients benefit more from experiencing anxiety during flooding. No significant differences were found on a behavioral task. These results differ from previous findings where diazepam (Valium) was found to have no effect on outcome or to enhance improvement in agoraphobics. The discrepancy may be due to differences in the procedure.

Eye movement desensitization and reprocessing for panic disorder: A case series☆

Abstract Eye Movement Desensitization and Reprocessing (EMDR), a new technique that has shown some promise in the treatment of traumatic memories, was evaluated in this pilot study. Subjects were seven clients suffering from panic disorder who received EMDR treatment for memories of past and anticipated panic attacks and other anxiety-evoking memories of personal relevance. Standardized self-report inventories and behavioral monitoring instruments were employed to measure change with treatment. After five sessions of EMDR, subjects reported a considerable decrease in the frequency of panic attacks, fear of experiencing a panic attack, general anxiety, thoughts concerning negative consequences of experiencing anxiety, fear of body sensations, depression, and other measures of pathology.

Induced anger as a reciprocal inhibitor of fear

The concept of ‘reciprocal inhibition’ underlies a growing number of clinical techniques used in removal of specific fears. This paper describes the successful treatment of fears using artificially induced anger as the counterconditioning agent. It has been found in a limited number of cases that once the artificial induction of anger has been taught it can become available for immediate use by the patient at any time and may be of sufficient strength to counteract a high degree of fear. Three illustrative cases are presented and problems encountered noted.

The pubococcygens and female orgasm: A correlational study with normal subjects

The relationship of pubococcygeal condition to orgasmic responsiveness in 102 women from a university community was examined in a controlled, prospective investigation. Pubococcygeal strength was measured with a perineometer while responsiveness was assessed by a standardized interview yielding reliable measures of self-reported orgasmic response. Subjects whose responsiveness might have been impaired by such factors as alcohol consumption, inadequate stimulation, and high sexual anxiety were excluded from analyses. Excellent within-session but poor across-session test-retest reliability of the perineometer measures was noted. Initial Strength Contracting proved to be the most reliable measure. Though the majority of the parous women had performed Kegel exercises after delivery, parity was negatively related to pubococcygeal strength on most measures. Contrary to experimental hypotheses, pubococcygeal strength was not found to be positively related to frequency or self-reported intensity of orgasm. Furthermore, women with higher pubococcygeal strength did not report that vaginal stimulation contributed more to attainment of orgasm, nor did they rate vaginal sensations during coitus as more pleasurable. Only in the case of pleasurability of orgasm through clitoral stimulation was a significant, though low, relationship obtained. Possible factors contributing to the discrepancy between these findings and previous uncontrolled investigations are discussed, as are the implications of these findings for the use of Kegel exercises in the treatment of orgasmic dysfunction.

Case conference: Some aspects of agoraphobia☆

Abstract Three cases of agoraphobia are presented, showing the variety of factors relevant to different cases. Therapeutic strategy is determined by the features of the case.

Separate effects of extinction, counterconditioning and progressive approach in overcoming fear☆

Abstract The assumptions that counterconditioning, rather than extinction, and that progressive approach are effective variables in reciprocal inhibition therapy, were experimentally tested. In order to allow for a separate evaluation of each of the factors of extinction, counterconditioning, and progressive approach the present study employed four treatment groups and a control group. Ten Cebus monkeys were trained to traverse a runway to obtain sugar. Each S was then allowed to approach the sugar while a toy “teddy bear” (fear stimulus) was also present. The minimum distance separating the S from the sugar and bear constituted the avoidance measurement. This method of avoidance measurement was used to determine change throughout treatment. Treatments (presentation of the bear under conditions appropriate to each of the treatment groups) were conducted in a separate apparatus. In terms of percentage of change effected and efficiency in time, counterconditioning was more effective than extinction only when progressive approach was also used. In terms of time efficiency, progressive approach added effectiveness only when counterconditioning was also present. In terms of maximum percentage change, progressive approach added to the effectiveness of both counterconditioning and extinction. Progressive approach appears to be an effective procedure in and of itself while counterconditioning is of little value without the addition of progressive approach. When progressive approach and counterconditioning were used in combination there was a marked reduction in avoidance behavior over and above that achieved with any other treatment method.