Advertisement

Current Psychological Reviews

, Volume 2, Issue 1, pp 19–45 | Cite as

Agoraphobia: a critical review of methodology in behavioural treatment research

  • Moira A. Gray
  • Ian G. McPherson
Article

Abstract

This review focuses on the methodological status of the literature on behavioural treatment of agoraphobia. Thirty-three studies published between 1963 and 1979 are analysed using a methodological rating scale by which each study is assessed on the extent to which it meets eight basic criteria for outcome research. It is concluded that methodological weaknesses in these reports make questionable any general conclusions about the value of the behavioural treatment of agoraphobia, and recommendations are made concerning possible changes in the future direction of research in this area.

Keywords

Imipramine Behavioural Treatment Successive Approximation Group Exposure Agoraphobia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Agras, S., Leitenberg, H. & Barlow, D. (1968). Social reinforcement in the modification of agoraphobia. Archives of General Psychiatry, 19, 423–437.PubMedGoogle Scholar
  2. Auerbach, A. & Johnson, M. (1977). Research on the therapist’s level of experience. In A.S. Gurman & A.M. Razin (eds.), Effective Psychotherapy. New York: Pergamon.Google Scholar
  3. Bergin, A.E. (1971). The evaluation of therapeutic outcomes. In A.E. Bergin & S. Garfield (eds.), Handbook of Psychotherapy and Behavior Change, 1st Edition. New York: John Wiley.Google Scholar
  4. Burglass, D., Clarke, J., Henderson, A.S., Kreckman, N. & Presley, A.S. (1977). A study of agoraphobic housewives. Psychological Medicine, 7, 73–86.Google Scholar
  5. Butler, P.E. (1975). The treatment of severe agoraphobia employing induced anger as an anxiety inhibitor. Journal of Behaviour Therapy and Experimental Psychiatry, 6, 327–329.CrossRefGoogle Scholar
  6. Chambless, D.L., Foa, E.B., Groves, G.A. & Goldstein, A.J. (1979). Flooding with brevital in the treatment of agoraphobia: counter-effective? Behaviour Research and Therapy, 17, 243–251.PubMedCrossRefGoogle Scholar
  7. Cochrane, R. & Sobol, M.P. (1976). Myth and methodology in behaviour therapy research. In M.P. Feldman & A. Broadhurst (eds.), Theoretical and Experimental Bases of Behaviour Therapy. London: John Wiley.Google Scholar
  8. Cooper, J.E. (1963). A study of behaviour therapy in 30 psychiatric patients. Lancet, i, 411–415.CrossRefGoogle Scholar
  9. Cooper, J.E. & Gelder, M.G. (1965). Results of behaviour therapy in 77 psychiatric patients. British Medical Journal, i, 1222–1225.CrossRefGoogle Scholar
  10. Crowe, J.J., Marks, I.M., Agras, W.S., & Leitenberg, H. (1972). Time limited desensitization, implosion and shaping for phobic patients: a cross over study. Behaviour Research and Therapy, 10, 319–328.PubMedCrossRefGoogle Scholar
  11. Ellis, A. (1979). A note on the treatment of agoraphobics with cognitive modification versus prolonged exposure in vivo. Behaviour Research and Therapy, 17, 162–164.PubMedCrossRefGoogle Scholar
  12. Emmelkamp, P. (1974). Self observation versus flooding in the treatment of agoraphobia. Behaviour Research and Therapy, 12, 229–237.PubMedCrossRefGoogle Scholar
  13. Emmelkamp, P. & Emmelkamp-Benner, A. (1975). Effects of historically portrayed modelling and group treatment on self observation: a comparison with agoraphobics. Behaviour Research and Therapy, 13, 135–139.PubMedCrossRefGoogle Scholar
  14. Emmelkamp, P. & Kupers, A. (1979). Agoraphobia: a follow-up study 4 years after treatment. British Journal of Psychiatry, 134, 352–355.PubMedCrossRefGoogle Scholar
  15. Emmelkamp, P. & Ultee, K.A. (1974). A comparison of successive approximation and self observation in the treatment of agoraphobia. Behaviour Research and Therapy, 5, 606–613.Google Scholar
  16. Emmelkamp, P. & Wessels, H. (1975). Flooding in imagination and flooding in vivo in comparison with agoraphobics. Behaviour Research and Therapy, 13, 7–15.PubMedCrossRefGoogle Scholar
  17. Emmelkamp, P., Kupers, A. & Eggeraat, J.H. (1978). Cognitive modification versus prolonged exposure in vivo: a comparison with agoraphobics as subjects. Behaviour Research and Therapy, 16, 33–41.PubMedCrossRefGoogle Scholar
  18. Evans, P.D. (1973). Semi-automated desensitization: a controlled clinical trial. Behaviour Research and Therapy, 11, 641–646.PubMedCrossRefGoogle Scholar
  19. Everaerd, W., Hanneke, M. & Emmelkamp, P. (1973). A comparison of flooding and successive approximation in the treatment of agoraphobia. Behaviour Research and Therapy, 11, 105–117.PubMedCrossRefGoogle Scholar
  20. Feldman, M.P. (1976). Social psychology and the behaviour therapies. In M.P. Feldman & A. Broadhurst (eds.), Theoretical and Experimental Bases of the Behaviour Therapies. New York: John Wiley.Google Scholar
  21. Flannery, R.B. (1972). Covert conditioning in the behavioural treatment of an agoraphobic. Psychotherapy: Theory, Research and Practice, 9, 217–220.CrossRefGoogle Scholar
  22. Friedman, D.E. & Lipsedge, M.S. (1971). Treatment of phobic anxiety and psychogenic impotence by systematic desensitization employing methohexitone-induced relaxation. British Journal of Psychiatry, 118, 87–90.PubMedCrossRefGoogle Scholar
  23. Gelder, M.G. & Marks, I.M. (1966). Severe agoraphobia: a controlled prospective trial of behaviour therapy. British Journal of Psychiatry, 112, 309–319.PubMedCrossRefGoogle Scholar
  24. Gelder, M.G. & Marks, I.M. (1968). Desensitisation and phobia: a cross over study. British Journal of Psychiatry, 14, 323–328.CrossRefGoogle Scholar
  25. Gelder, M.G., Marks, I.M. & Wolf, H.M. (1967). Desensitization and psychotherapy in the treatment of phobic states: a controlled inquiry. British Journal of Psychiatry, 113, 53–73.PubMedCrossRefGoogle Scholar
  26. Gelder, M.G., Bancroft, J.J., Gath, D.M., Johnston, D.W., Mathews, A.M. & Shaw, P.M. (1973). Specific and non-specific factors in behaviour therapy. British Journal of Psychiatry, 123, 445–462.PubMedCrossRefGoogle Scholar
  27. Gillan, P. & Rachman, S. (1974). An experimental investigation of desensitisation in phobic patients. British Journal of Psychiatry, 124, 392–401.PubMedCrossRefGoogle Scholar
  28. Gleed, E.A. (1974). Some psychological mechanisms in agoraphobia. British Journal of Projective Psychology and Personality Study, 19, 27–33.Google Scholar
  29. Glick, B.S. (1970). Conditioning therapy with phobic patients: success and failure. American Journal of Psychotherapy, 24, 92–101.PubMedGoogle Scholar
  30. Goldfried, M.R. & Merbaum, M. (eds.) (1973). Behaviour Change through Self-Control. New York: Holt, Rinehart & Winston.Google Scholar
  31. Goldstein, A.J. (1978). Case conference. The treatment of a case of agoraphobia by a multifaceted treatment program. Journal of Behaviour Therapy and Experimental Psychiatry, 9, 45–51.CrossRefGoogle Scholar
  32. Goldstein, A.J. & Chambless, D.L. (1978). A reanalysis of agoraphobia. Behavior Therapy, 9, 47–59.CrossRefGoogle Scholar
  33. Gottman, J. & Markham, H.J. (1978). Experimental designs in psychotherapy research. In S.L. Garfield & A.E. Bergin (eds.), Handbook of Psychotherapy and Behavior Change. New York: John Wiley.Google Scholar
  34. Hafner, J. & Marks, I. (1976). Exposure in vivo of agoraphobics: contributions of diazepam, group exposure and anxiety evocation. Psychological Medicine, 6, 71–88.PubMedCrossRefGoogle Scholar
  35. Hafner, J. & Milton, F. (1977). The influence of propanolol on the exposure in vivo of agoraphobics. Psychological Medicine, 7, 419–425.PubMedGoogle Scholar
  36. Hallam, R.S. (1978). Agoraphobia: a critical review of the concept. British Journal of Psychiatry, 133, 314–319.PubMedCrossRefGoogle Scholar
  37. Hand, I., Lamontagne, Y. & Marks, I. (1974). Group exposure (flooding) in vivo for agoraphobics. British Journal of Psychiatry, 124, 588–602.PubMedCrossRefGoogle Scholar
  38. Hodgson, R. & Rachman, S. (1970). An experimental investigation of the implosion technique. Behaviour Research and Therapy, 8, 21–27.PubMedCrossRefGoogle Scholar
  39. Hogan, R.A. & Kirchmer, J.H. (1967). Preliminary report of the extinction of learned fears via short-term implosive therapy. Journal of Abnormal Psychology, 72, 106–109.PubMedCrossRefGoogle Scholar
  40. Hussain, M.Z. (1971). Desensitization and flooding (implosion) in treatment of phobias. American Journal of Psychiatry, 127, 1509–1514.PubMedGoogle Scholar
  41. Jannoun, L., Munby, M., Catalan, J. & Gelder, M. (1979). A home based treatment programme for agoraphobia: replication and controlled evaluation. Paper presented at Annual Conference, British Psychological Society.Google Scholar
  42. Johnston, D. & Gath, D. (1973). Arousal levels and attribution effects in diazepam-assisted flooding. British Journal of Psychiatry, 123, 463–466.PubMedCrossRefGoogle Scholar
  43. Kazdin, A.E. (1978). Methodological and interpretative problems of single-case experimental designs. Journal of Consulting and Clinical Psychology, 46, 629–642.PubMedCrossRefGoogle Scholar
  44. Kazdin, A.E. (1980). Research Designs in Clinical Psychology. New York: Harper & Row.Google Scholar
  45. Kazdin, A.E. & Wilson, T. (1978). Criteria for evaluating psychotherapy. Archives of General Psychiatry, 35, 407–416.PubMedGoogle Scholar
  46. Leitenberg, H., Agras, W.S., Thomson, L.E. & Wright, D.E. (1968). Feedback in behaviour modification, an experimental analysis of two phobic cases. Journal of Applied Behavior Analysis, 1, 131–137.PubMedCrossRefGoogle Scholar
  47. Leitenberg, H., Agras, W.S., Allen, R., Buty, R. & Edwards, J. (1975). Feedback and therapist praise during treatment of phobia. Journal of Consulting and Clinical Psychology, 43, 396–404.PubMedCrossRefGoogle Scholar
  48. Levy, P. (1974). Generalizability studies in clinical settings. British Journal of Social and Clinical Psychology, 13, 161–172.PubMedGoogle Scholar
  49. Lipsedge, M.S., Hajioff, J., Higgins, P., Napier, L., Peace, J., Pike, D.J. & Rich, M. (1973). The management of severe agoraphobia: a comparison of iproniazid and systematic desensitization. Psychopharmacologia, 32, 67–80.PubMedCrossRefGoogle Scholar
  50. McDonald, R., Sartory, G., Grey, S.J., Cobb, J., Skern, R. & Marks, I. (1979). The effects of self exposure instructions on agoraphobic outpatients. Behavior Research and Therapy, 17, 83–85.CrossRefGoogle Scholar
  51. Mahoney, M.J. (1978). Experimental methods and outcome evaluation. Journal of Consulting Clinical Psychology, 46, 600–672.CrossRefGoogle Scholar
  52. Mahoney, M.J. & Arnkoff, D. (1978). Cognitive and self-control therapies. In S.L. Garfield & A.E. Bergin (eds.), Handbook of Psychotherapy and Behavior Change. 2nd Edition. New York: John Wiley.Google Scholar
  53. Marks, I.M. (1969). Fears and Phobias. London: Heinemann.Google Scholar
  54. Marks, I.M. (1978). Behavioral psychotherapy of adult neurosis. In S.L. Garfield & A.E. Bergin (eds.), Handbook of Psychotherapy and Behavior Change, 2nd Edition. New York: John Wiley.Google Scholar
  55. Marks, I.M. & Gelder, M.G. (1965). A controlled retrospective study of behaviour therapy in phobic patients. British Journal of Psychiatry, 111, 561–573.PubMedCrossRefGoogle Scholar
  56. Marks, I.M., Boulougouris, J. & Marset, P. (1971). Flooding versus desensitization in the treatment of phobic patients: a cross-over study. British Journal of Psychiatry, 119, 353–375.PubMedCrossRefGoogle Scholar
  57. Marks, I., Gelder, M. & Edwards, G. (1968). Hypnosis and desensitization for phobics: a controlled prospective trial. British Journal of Psychiatry, 114, 1263–1274.PubMedCrossRefGoogle Scholar
  58. Marks, I.M., Viswanathan, R. & Lipsedge, M.S. (1972). Enhanced extinction of fear by flooding during waning diazepam effect. British Journal of Psychiatry, 121, 493.PubMedCrossRefGoogle Scholar
  59. Marzillier, J. & Winter, K. (1978). Success and failure in social skills training: individual differences. Behaviour Research and Therapy, 16, 67–84.PubMedCrossRefGoogle Scholar
  60. Mathews, A. (1978). Fear reduction research and clinical phobias. Psychological Bulletin, 85, 390–394.PubMedCrossRefGoogle Scholar
  61. Mathews, A.M., Johnston, D.W., Lancashire, M., Munby, M., Shaw, P.M. & Gelder, M.G. (1976). Imaginal flooding and exposure to real situations: treatment outcome with agoraphobic patients. British Journal of Psychiatry, 129, 363–371.CrossRefGoogle Scholar
  62. Mathews, A., Teasdale, J., Munby, M. & Johnston, P. (1977). A home-based treatment programme for agoraphobia. Behavior Therapy, 8, 915–924.CrossRefGoogle Scholar
  63. Meichenbaum, D. (1977). Cognitive Behavior Modification. New York: Plenum.Google Scholar
  64. Parloff, M.B., Waslow, I.E. & Wolff, B.E. (1978). Research on therapist variables in relation to process and outcome. In S.L. Garfield & A.E. Bergin (eds.), Handbook of Psychotherapy and Behavior Change, 2nd Edition. New York: John Wiley.Google Scholar
  65. Pinto, R. (1972). A case of movement epilepsy with agoraphobia treatment successfully by flooding. British Journal of Psychiatry, 121, 287–288.PubMedCrossRefGoogle Scholar
  66. Popler, K. (1977). Agoraphobia: indications for the application of the multimodal behavioural conceptualisation. Journal of Nervous and Mental Disease, 164, 97–101.PubMedCrossRefGoogle Scholar
  67. Roys, R.G. & Noyes, R. (1978). Agoraphobia: newer treatment approaches. Journal of Nervous and Mental Disorders, 164, 97–101.Google Scholar
  68. Shapiro, A.K. & Morris, L.A. (1978). Placebo effects in medical and psychological therapies. In S.L. Garfield & A.E. Bergin (eds.), Handbook of Psychotherapy and Behavior Change, 2nd Edition. New York: John Wiley.Google Scholar
  69. Solyom, L., Heseltine, G., McClure, D., Ledwidge, B. & Kenny, F. (1971). A comparative study of aversion relief and systematic desensitization in the treatment of phobics. British Journal of Psychiatry, 119, 299–303.PubMedCrossRefGoogle Scholar
  70. Solyom, L., McClure, D., Heseltine, G., Ledwidge, B. & Solyom, C. (1972). Variables in the relief or aversion relief therapy of phobics. Behavior Therapy, 3, 21–29.CrossRefGoogle Scholar
  71. Stern, R. & Marks, I. (1973). Brief and prolonged flooding. Archives of General Psychiatry, 28, 270–276.PubMedGoogle Scholar
  72. Teasdale, J.D., Walsh, P.A., Lancashire, M. & Mathews, A.M. (1977). Group exposure for agoraphobics: a replication study. British Journal of Psychiatry, 130, 186–193.PubMedCrossRefGoogle Scholar
  73. Watson, S.P. & Marks, I.M. (1971). Relevant and irrelevant fear in flooding — a crossover study of phobic patients. Behavior Therapy, 2, 275–293.CrossRefGoogle Scholar
  74. Watson, J.P., Mullett, G.E. & Pillay, A. (1973). The effects of prolonged exposure to phobic situations upon agoraphobic patients treated in groups. Behaviour Research and Therapy, 11, 531–545.PubMedCrossRefGoogle Scholar
  75. Wilson, G.T. & Evans, I.M. (1977). The therapist-client relationship in behaviour therapy. In A.S. Gurman & A.M. Razin (eds.), Effective Psychotherapy. New York: Pergamon.Google Scholar
  76. Wolpe, J. (1958). Psychotherapy by Reciprocal Inhibition. Stanford: Stanford University Press.Google Scholar
  77. Yalom, I. (1975). The Theory and Practice of Group Psychotherapy. New York: Basic Books.Google Scholar
  78. Zitrin, C.M., Klein, D.F., Lindemann, C., Tobak, P., Rock, M., Kaplan, J. & Ganz, V.H. (1976). Comparison of short-term treatment regimens in phobic patients. In R.L. Spitzer & D.F. Klein (eds.), Evaluation of Psychological Therapies. Baltimore: Johns Hopkins.Google Scholar

Copyright information

© Praeger Publishers 1982

Authors and Affiliations

  • Moira A. Gray
    • 1
  • Ian G. McPherson
    • 1
  1. 1.Department of PsychologyUniversity of BirminghamBirmingham

Personalised recommendations