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Agoraphobia: a critical review of methodology in behavioural treatment research

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Current Psychological Reviews

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.

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References

  • Agras, S., Leitenberg, H. & Barlow, D. (1968). Social reinforcement in the modification of agoraphobia. Archives of General Psychiatry, 19, 423–437.

    PubMed  Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • Cooper, J.E. (1963). A study of behaviour therapy in 30 psychiatric patients. Lancet, i, 411–415.

    Article  Google Scholar 

  • Cooper, J.E. & Gelder, M.G. (1965). Results of behaviour therapy in 77 psychiatric patients. British Medical Journal, i, 1222–1225.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Emmelkamp, P. (1974). Self observation versus flooding in the treatment of agoraphobia. Behaviour Research and Therapy, 12, 229–237.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Emmelkamp, P. & Kupers, A. (1979). Agoraphobia: a follow-up study 4 years after treatment. British Journal of Psychiatry, 134, 352–355.

    Article  PubMed  Google Scholar 

  • 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 

  • Emmelkamp, P. & Wessels, H. (1975). Flooding in imagination and flooding in vivo in comparison with agoraphobics. Behaviour Research and Therapy, 13, 7–15.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Evans, P.D. (1973). Semi-automated desensitization: a controlled clinical trial. Behaviour Research and Therapy, 11, 641–646.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • Flannery, R.B. (1972). Covert conditioning in the behavioural treatment of an agoraphobic. Psychotherapy: Theory, Research and Practice, 9, 217–220.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Gelder, M.G. & Marks, I.M. (1966). Severe agoraphobia: a controlled prospective trial of behaviour therapy. British Journal of Psychiatry, 112, 309–319.

    Article  PubMed  Google Scholar 

  • Gelder, M.G. & Marks, I.M. (1968). Desensitisation and phobia: a cross over study. British Journal of Psychiatry, 14, 323–328.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Gillan, P. & Rachman, S. (1974). An experimental investigation of desensitisation in phobic patients. British Journal of Psychiatry, 124, 392–401.

    Article  PubMed  Google Scholar 

  • Gleed, E.A. (1974). Some psychological mechanisms in agoraphobia. British Journal of Projective Psychology and Personality Study, 19, 27–33.

    Google Scholar 

  • Glick, B.S. (1970). Conditioning therapy with phobic patients: success and failure. American Journal of Psychotherapy, 24, 92–101.

    PubMed  Google Scholar 

  • Goldfried, M.R. & Merbaum, M. (eds.) (1973). Behaviour Change through Self-Control. New York: Holt, Rinehart & Winston.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Goldstein, A.J. & Chambless, D.L. (1978). A reanalysis of agoraphobia. Behavior Therapy, 9, 47–59.

    Article  Google Scholar 

  • 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 

  • Hafner, J. & Marks, I. (1976). Exposure in vivo of agoraphobics: contributions of diazepam, group exposure and anxiety evocation. Psychological Medicine, 6, 71–88.

    Article  PubMed  Google Scholar 

  • Hafner, J. & Milton, F. (1977). The influence of propanolol on the exposure in vivo of agoraphobics. Psychological Medicine, 7, 419–425.

    PubMed  Google Scholar 

  • Hallam, R.S. (1978). Agoraphobia: a critical review of the concept. British Journal of Psychiatry, 133, 314–319.

    Article  PubMed  Google Scholar 

  • Hand, I., Lamontagne, Y. & Marks, I. (1974). Group exposure (flooding) in vivo for agoraphobics. British Journal of Psychiatry, 124, 588–602.

    Article  PubMed  Google Scholar 

  • Hodgson, R. & Rachman, S. (1970). An experimental investigation of the implosion technique. Behaviour Research and Therapy, 8, 21–27.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Hussain, M.Z. (1971). Desensitization and flooding (implosion) in treatment of phobias. American Journal of Psychiatry, 127, 1509–1514.

    PubMed  Google Scholar 

  • 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.

  • Johnston, D. & Gath, D. (1973). Arousal levels and attribution effects in diazepam-assisted flooding. British Journal of Psychiatry, 123, 463–466.

    Article  PubMed  Google Scholar 

  • Kazdin, A.E. (1978). Methodological and interpretative problems of single-case experimental designs. Journal of Consulting and Clinical Psychology, 46, 629–642.

    Article  PubMed  Google Scholar 

  • Kazdin, A.E. (1980). Research Designs in Clinical Psychology. New York: Harper & Row.

    Google Scholar 

  • Kazdin, A.E. & Wilson, T. (1978). Criteria for evaluating psychotherapy. Archives of General Psychiatry, 35, 407–416.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Levy, P. (1974). Generalizability studies in clinical settings. British Journal of Social and Clinical Psychology, 13, 161–172.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Mahoney, M.J. (1978). Experimental methods and outcome evaluation. Journal of Consulting Clinical Psychology, 46, 600–672.

    Article  Google Scholar 

  • 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 

  • Marks, I.M. (1969). Fears and Phobias. London: Heinemann.

    Google Scholar 

  • 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 

  • Marks, I.M. & Gelder, M.G. (1965). A controlled retrospective study of behaviour therapy in phobic patients. British Journal of Psychiatry, 111, 561–573.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Marks, I., Gelder, M. & Edwards, G. (1968). Hypnosis and desensitization for phobics: a controlled prospective trial. British Journal of Psychiatry, 114, 1263–1274.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Marzillier, J. & Winter, K. (1978). Success and failure in social skills training: individual differences. Behaviour Research and Therapy, 16, 67–84.

    Article  PubMed  Google Scholar 

  • Mathews, A. (1978). Fear reduction research and clinical phobias. Psychological Bulletin, 85, 390–394.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Mathews, A., Teasdale, J., Munby, M. & Johnston, P. (1977). A home-based treatment programme for agoraphobia. Behavior Therapy, 8, 915–924.

    Article  Google Scholar 

  • Meichenbaum, D. (1977). Cognitive Behavior Modification. New York: Plenum.

    Google Scholar 

  • 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 

  • Pinto, R. (1972). A case of movement epilepsy with agoraphobia treatment successfully by flooding. British Journal of Psychiatry, 121, 287–288.

    Article  PubMed  Google Scholar 

  • Popler, K. (1977). Agoraphobia: indications for the application of the multimodal behavioural conceptualisation. Journal of Nervous and Mental Disease, 164, 97–101.

    Article  PubMed  Google Scholar 

  • Roys, R.G. & Noyes, R. (1978). Agoraphobia: newer treatment approaches. Journal of Nervous and Mental Disorders, 164, 97–101.

    Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Stern, R. & Marks, I. (1973). Brief and prolonged flooding. Archives of General Psychiatry, 28, 270–276.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Watson, S.P. & Marks, I.M. (1971). Relevant and irrelevant fear in flooding — a crossover study of phobic patients. Behavior Therapy, 2, 275–293.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • Wolpe, J. (1958). Psychotherapy by Reciprocal Inhibition. Stanford: Stanford University Press.

    Google Scholar 

  • Yalom, I. (1975). The Theory and Practice of Group Psychotherapy. New York: Basic Books.

    Google Scholar 

  • 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 

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Gray, M.A., McPherson, I.G. Agoraphobia: a critical review of methodology in behavioural treatment research. Current Psychological Reviews 2, 19–45 (1982). https://doi.org/10.1007/BF02684453

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