Gerald T. O'Brien

Couples treatment of agoraphobia

The results of 14 agoraphobic women treated in small groups and accompanied by their husbands were compared to the results of 14 agoraphobic women treated in an identical fashion without the presence of their husbands. Treatment consisted of cognitive restructuring and self-initiated exposure exercises. Results at posttest indcated a substantial advantage to the spouse group, when compared to the nonspouse group, on measures of agoraphobia. Ratings of social, work, and family functioning also improved more quickly in the spouse group, although this comparative advantage had disappeared at posttest. The overall results of this graduated, self-initiated, exposure-based treatment seem superior to more intensive therapist- or drug-assisted in vivo exposure when one considers attrition rates. However, the failure to confirm the role of between-session practice as a predictor of successful outcome suggested that variables in addition to exposure may play a major role in treatment.

Precipitants of Agoraphobia: Role of Stressful Life Events

Detailed clinical interviews were conducted with 58 agoraphobics to assess the precipitants of the disorder. Results supported the notion that stressful life events usually precede the development of agoraphobia. While interpersonal conflict was the most frequently cited stressor, other stressful life events also were often reported as precipitants.

The importance of assessing treatment integrity: An example in the anxiety disorders

One purpose of this investigation was to examine the importance of assessing treatment integrity in a study evaluating a treatment for specific anxiety disorders. Three subjects, two social phobics and one simple phobic, received self-instruction training (Phase I) followed by exposure and self-instruction training (Phase II) in a multiple baseline across subjects design. All subjects were assessed during a pretreatment baseline and throughout treatment using measures of treatment integrity and measures of change in phobic severity. Improvement took place at different times for different subjects. Measures of treatment integrity, which consisted of monitoring of self-statements as well as practice outside the session, indicated that treatment was not always received as intended and that improvement was correlated with practice. The usefulness of measures of treatment integrity in both clinical and research settings is highlighted.

Self-help manual for agoraphobia: A preliminary report of effectiveness*

The efficacy of a client-conducted treatment package for agoraphobia, using a self-treatment manual, was evaluated in a multiple baseline across subjects design. Six severe female agoraphobics were treated with a self-help manual for 4, 6, 8, or 10 weeks. During this period, they worked alone without any therapist direction. They then received 4, 6, or 8 weeks of therapist-directed home-based treatment. Cognitive restructuring and graduated in vivo exposure comparised the strategies in both conditions. Results indicated that the self-help manual was not effective. Subjects experienced motivational difficulties in that they did not perform the in vivo exposure practice required by the manual. The same treatment then conducted by the therapist proved moderately effective with most clients. These results suggest that many agoraphobics may not be treatable by self-help manuals.

A preliminary investigation of cognitive and relaxation treatment of panic disorder: effects on intense anxiety VS background anxiety

Abstract In this study, three adult males complaining of Panic Disorders were treated with cognitive therapy followed by relaxation training combined with cognitive therapy in a multiple-baseline across S s design. All S s demonstrated a decrease in the number and duration of episodes of heightened or intense anxiety, which was maintained at 3-month follow-up. Daily time-sampled ratings of ‘background’ anxiety, not necessarily associated with periods of intense anxiety, showed a substantial decrease for S 2, which was maintained at 3-month follow-up. However, S 1 and S 3 evidenced an increase in background anxiety during the combined treatment phase in contrast to the effects of treatment on periods of ‘intense’ anxiety. These results suggest that psychological treatments for patients classified as suffering from Panic Disorder are effective and lend some support to the differentiation of panic from ‘general’ anxiety. Recent observations of relaxation-induced anxiety were also replicated in this clinical setting. These data also illustrate the advantages and difficulties of self-monitoring anxiety over a period of time.

Cognitive Changes During In Vivo Exposure in an Agoraphobic

This case study assessed the relationship between cognitive changes and treatment outcome during in vivo exposure treatment of an agoraphobic, and at one year following the end of treatment. Results indicated that although the client was notably improved with respect to his phobic condition by the end of treatment (on all self-report, behavioral, and physiological measures), contrary to expectations, he had worsened on cognitive measures at this time. However, at one year following treatment, measures of fear and avoidance showed that relapse had occurred, while results from cognitive assessment revealed that the clients cognitions had improved. The relationship of cognitions and cognitive changes to short-term treatment outcome and the maintenance of phobic improvement over time is discussed.

The Relationship between Cognitions and Anxiety A Preliminary Report

Six agoraphobics were assessed repeatedly in regard to their cognitions and anxiety level while exposed to a shopping mall. Pearson product moment correlation coefficients were calculated for each subject for: (1) percentage of negative or maladaptive thoughts and self-reported anxiety level during exposure, and (2) percentage of positive or adaptive thoughts and anxiety. In the majority of cases, results showed a significant, positive relationship between negative thinking and anxiety, with larger percentages of maladaptive thoughts corresponding with higher ratings of anxiety. In addition, there was some evidence of an inverse relationship between positive thinking and anxiety, with larger percentages of these thoughts corresponding with lower ratings of anxiety.

Comparison of Two Cognitive Strategies in Treatment of a Patient with Generalized Anxiety Disorder

The relative efficacy of two cognitive strategies—coping self-statements and paradoxical intention—for reducing anxiety were compared using an alternating treatment design for a patient with generalized anxiety disorder. While cognitive restructuring appeared to be effective clinically in treating this patient, results did not suggest an advantage in effectiveness of one cognitive strategy over the other. However, although measures did not indicate a differential effectiveness between the two cognitive strategies, the patient reported that she found the coping self-statement strategy more helpful, a preference that continued at 1-yr. follow-up.

Imipramine with or without Cognitive-Behavior Therapy in the Treatment of an Agoraphobic

This single case experiment compared the relative efficacy of imipramine hydrochloride and imipramine in conjunction with in vivo exposure and cognitive therapy, in the treatment of an agoraphobic. Results indicated that imipramine alone was ineffective in improving the clients phobic condition. However, the addition of the cognitive-behavioral intervention to imipramine proved extremely effective in altering phobic fear and avoidance behavior.