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PubMed1990

The Agoraphobia Scale: an evaluation of its reliability and validity.

This article presents the Agoraphobia Scale (AS), and evidence for its reliability, validity, and sensitivity to change after treatment. The scale consists of 20 items depicting various typical agoraphobic situations, which are rated for anxiety/discomfort (0-4) and avoidance (0-2). The results show that AS has high internal consistency. Regarding concurrent validity it correlated significantly with other self-reported measures of agoraphobia (Mobility Inventory and Fear Questionnaire). The scale's predictive validity was shown as it correlated with avoidance behavior and self-rated anxiety during both an individualized and a standardized behavioral test of agoraphobia. The AS also discriminated between an agoraphobic sample and a normal sample, and a sample of simple phobia patients. Finally, it was sensitive to changes after behavioral treatment. The AS is useful both as a state, and as an outcome self-report measure of agoraphobia.

Adult↗
PubMed1995

A comparison of cognitive and guided mastery therapy of agoraphobia.

The aim of this study was to compare the efficacy of cognitive and performance-based therapy of agoraphobia. Fifty-two patients suffering from panic disorder with moderate or severe agoraphobia and considering agoraphobia as their main problem were randomly assigned to receive either cognitive therapy or guided mastery therapy in a six-week inpatient group program. Significantly more of the cognitive therapy patients attained high endstate functioning, whereas the proportion of responders in the two groups did not differ. An overall test revealed no differences between the two treatment groups on the continuous outcome measures at posttreatment. As predicted from the cognitive model of panic with agoraphobia, self-efficacy scores increased with the reduction of catastrophic belief scores in the cognitive therapy group. Inconsistent with the self-efficacy model, catastrophic belief scores did not change with the increase of self-efficacy scores in the guided mastery group. Overall, the superiority of one of the treatment methods over the other was not clearly demonstrated.

Adult↗
PubMedDate not supplied

Correlates of DSM-III personality disorder in panic disorder and agoraphobia.

One hundred eighty-seven patients meeting DSM-III criteria for panic disorder (n = 26) or agoraphobia with panic (n = 161) were assessed with the Personality Diagnostic Questionnaire (PDQ), a self-rating scale designed to assess Axis II personality disorders and traits. Results replicated our earlier findings of a preponderance of dependent, avoidant, and histrionic features and the finding that patients exhibiting a greater number of personality traits were also significantly more symptomatic. Patients with the diagnosis of panic disorder did not differ on any personality disorder variables from patients with the diagnosis of agoraphobia with panic. Furthermore, none of the specific symptom dimensions, i.e., panic, anxiety, or agoraphobia, was selected as a unique predictor of any personality variables in the regression analyses. Rather, the most important correlates of personality disorder in these patients consisted of general factors such as dysphoric mood, social phobia, or interpersonal sensitivity, and Eysenck's neuroticism dimension. The results are discussed in light of recent findings suggesting a nonspecific link between panic disorder or agoraphobia and personality disorder.

Adult↗
PubMed1998

The use of the Panic and Agoraphobia Scale in a clinical trial.

A new scale for assessing severity in PDA (Panic Disorder with/without Agoraphobia) has recently been developed: the Panic and Agoraphobia Scale [P & A (Bandelow, 1995)]. The objective of this study was to test whether the scale is sensitive to changes during a treatment trial. Thirty-seven patients (mean age, 32.7; S.D., 6.3) with PDA were treated with imipramine (75-150 mg/day) for 8 weeks in an open prospective trial. Patients with concurrent agoraphobia were instructed in practising self-exposure to agoraphobic situations. The total scores on the P & A, the Hamilton Anxiety Scale (HAMA) and the Clinical Global Impression Scale (CGI) were used as the main efficacy criteria. Treatment results were excellent, as could be shown by a decrease in the average severity scores of the P & A observer-rated version from 28.9 (S.D., 8.1) to 13.3 (S.D., 11.8; rank statistic T(N) = 6.7; P < 0.0001). The largest effect size r(w) of all clinician-rated scales was seen with the observer-rated version of the P & A, although closely followed by the CGI and the HAMA. Among the self-rated scales, the P & A (self-rated version) also showed the largest effect size. All five subscores of the P & A showed significant improvements. The highest treatment effect sizes could be seen in the 'panic attacks' subscore, followed by the 'anticipatory anxiety' subscore. The new Panic and Agoraphobia Scale (P & A) is a useful tool for measuring treatment efficacy in panic disorder trials.

Adult↗
PubMed1998

The application of behavioral couples therapy to the assessment and treatment of agoraphobia: implications of empirical research.

The present review was undertaken to examine the literature regarding the role of the marital relationship in treatment of agoraphobia from a behavioral couples therapy (BCT) perspective. Both qualitative and quantitative analyses were conducted to evaluate (a) whether marital quality predicts treatment responsiveness and (b) how best to include the spouse in treatment of agoraphobia. Regarding the assessment of agoraphobics' relationship quality, it is recommended that subjectively experienced "satisfaction" with the relationship be distinguished from more descriptive measures of general and agoraphobia-specific relationship "adjustment." Treatment can include the partner as a "co-therapist" to assist with interventions directly targeted at the agoraphobia, or use BCT interventions to modify relationship interactions that might impede treatment gains. The application of BCT for these couples poses a number of challenges, including (a) the need to maintain a balanced treatment approach in an "unbalanced" system, (b) the need to target interventions at more than one treatment goal, and (c) the task of combining couple-focused interventions with those aimed at reducing phobic symptoms.

Agoraphobia↗
PubMed2004

Association of a functional 1019C>G 5-HT1A receptor gene polymorphism with panic disorder with agoraphobia.

Panic disorder is a common anxiety disorder which frequently co-occurs with agoraphobia. A functional promoter polymorphism in the serotonin receptor 1A (5-HT1A) gene has been found to be associated with major depression as well as anxiety- and depression-related personality traits. We investigated a possible association between this 5-HT1A gene promoter polymorphism and panic disorder by genotyping the 1019C>G single nucleotide polymorphism in 134 panic-disorder patients with and without agoraphobia and matched 134 controls. In our sample no significant evidence of allelic association in the combined panic-disorder group was found. However, our results show a significant association with the G allele in patients with panic disorder with agoraphobia (p=0.03, n=101). In conclusion, our findings do not support a major contribution of this polymorphism to the pathogenesis of panic disorder, but provide evidence for a possible role in the subgroup with agoraphobia.

Adult↗
PubMed2000

The use of the Panic and Agoraphobia Scale (P & A) in a controlled clinical trial.

BACKGROUND: A new 13-item scale has been developed for measuring severity of illness in patients with panic disorder and agoraphobia, the Panic and Agoraphobia Scale (P & A). The scale has five subscales covering the main factors that reduce quality of life in panic disorder patients (panic attacks, avoidance, anticipatory anxiety, disability and worries about health). The application of this scale in a double-blind placebo-controlled panic disorder trial is described. At the same time, the aim of the study was to compare the therapeutic effects of aerobic exercise with a treatment of well-documented efficacy. METHODS: Patients with Panic disorder (DSM-IV) were randomly assigned to three treatment modalities: running (n=45), clomipramine (n=15) or placebo (n=15). Treatment efficacy was measured with the Panic and Agoraphobia Scale (P & A) and other rating scales. RESULTS: According to the P & A and other scales, both exercise and clomipramine led to a significant decrease of symptoms in comparison to placebo treatment. Clomipramine was significantly more effective and improved anxiety symptoms significantly earlier than exercise. The evaluation of the P & A subscales revealed that exercise exerted its effect mainly reducing anticipatory anxiew and panic-related disability. CONCLUSIONS: The new Panic and Agoraphobia Scale was shown to be sensitive to differences between different panic treatments. Analysis of the scales five subscores may help to understand mechanisms of action of panic disorder treatments.

Agoraphobia↗
PubMed1985

Agoraphobia. Is fear the basis of symptoms?

All human beings are biologic, psychological, and sociologic creatures. The treatment program for agoraphobia at the University of Kansas Medical Center School of Medicine, Kansas City, is designed to deal effectively with problems in these three areas. The biologic area is dealt with by medication; tricyclic antidepressants are used to block panic attacks, and benzodiazepines are given, as needed, for anticipatory anxiety. Group therapy is particularly effective in the areas of individual psychopathology and social anxiety. We have not found agoraphobia difficult to treat and have demonstrated that it can be cured. The track record of primary care physicians and specialists in diagnosing and managing agoraphobia so far leaves much to be desired. If physicians obtain the appropriate history at initial contact with a patient and administer appropriate treatment, it may be possible to prevent full-blown agoraphobia from developing.

Adult↗
PubMed2003

Is childhood separation anxiety disorder a predictor of adult panic disorder and agoraphobia? A seven-year longitudinal study.

OBJECTIVE: To examine whether separation anxiety disorder (SAD) in childhood is a risk factor for panic disorder and agoraphobia in adulthood. METHOD: Patients (n = 85) who had completed treatment for SAD, generalized anxiety disorder, and/or social phobia 7.42 years earlier (on average) were reassessed using structured diagnostic interviews. RESULTS: Subjects with a childhood diagnosis of SAD did not display a greater risk for developing panic disorder and agoraphobia in young adulthood than those with other childhood anxiety diagnoses. Subjects with a childhood diagnosis of SAD did not more frequently meet full diagnostic criteria for panic disorder and agoraphobia, generalized anxiety disorder, social phobia, or major depressive disorder in adulthood than subjects with childhood diagnoses of generalized anxiety disorder or social phobia, but were more likely to meet criteria for other anxiety disorders (i.e., specific phobia, obsessive compulsive disorder, posttraumatic stress disorder, and acute stress disorder). CONCLUSIONS: These results argue against the hypothesis that childhood SAD is a specific risk factor for adult panic disorder and agoraphobia.

Adolescent↗
PubMed1995

Assessing the efficacy of treatments for panic disorder and agoraphobia. I. Methodological problems.

An assessment of the efficacy of treatments in panic disorder and agoraphobia (PDA) is complicated by methodological problems resulting from the complexity of these disorders. In this paper, commonly used anxiety scales are discussed with regard to their relevance in the assessment of PDA. Although there are already many scales for assessing anxiety and agoraphobia, a qualified instrument for measuring the severity of PDA is still lacking. A survey of the instruments used in recent treatment studies of PDA shows that rather inhomogeneous efficacy criteria were applied. Most often, panic attack frequency was taken as a severity criterion, although this measure showed little power to differentiate between treatments. To deal with the special features of PDA, a battery of different scales was usually employed and non-standardized scales were sometimes used additionally. A new rating scale designed to overcome the methodological problems associated with the assessment of severity in PDA was introduced. The use of the psychiatrist-rated Panic and Agoraphobia (P&A) scale in patients with DSM-III-R panic disorder and/or agoraphobia (n = 235) shows that this scale has the highest correlation with the psychiatrists' clinical global impression of PDA patients (r = 0.79, p < 0.0001), compared with other commonly used observer-rated anxiety scales. The self-rating version of the P&A again had the highest correlation with a patient-rated clinical global impression (r = 0.82, p < 0.0001), whereas the other patient-rated anxiety questionnaires correlated only moderately or poorly. By means of logistic regression, it was shown that the five subscores of the scale contribute independently and almost equally to the prediction of PDA severity.

Adult↗
PubMed1995

Psychoanalytical personality types and agoraphobia.

The aim of this study was to examine the relationship between psychoanalytical personality types and agoraphobia. Thirty-two panic disorder with agoraphobia patients and 18 agoraphobia without panic disorder patients attending an inpatient 11-week behavioral-psychodynamic treatment program were assessed repeatedly from pretreatment to 2 years after the end of treatment. On personality scales measuring oral, obsessive, hysterical, and reality-weak traits, there were no differences between agoraphobic patients with and without panic disorder. The examined traits correlated across the period from pretreatment to 2-year follow-up, although the potential influence of symptoms were controlled for. Higher scores on the oral scale predicted poorer course of symptoms in the year immediately after treatment. Scores on the oral scale decreased with the improvements of agoraphobic and general symptoms, but did not attain a normal level. The results supported a combined predisposition-state model for the relationship between oral traits and agoraphobia.

Adult↗
PubMed1998

Follow-up on the treatment of panic disorder with or without agoraphobia: a quantitative review.

We conducted a meta-analysis to update the knowledge of long-term efficacy of different treatments in panic disorder with or without agoraphobia. Included were 68 studies pertaining to 106 treatment conditions and 1346 patients. Effect sizes Cohen's d were calculated within the treatment conditions at posttest and at follow-up for panic and agoraphobia. A comparison was made between six treatments: high-potency benzodiazepines, antidepressants, psychological panic management, exposure in vivo, antidepressants combined with exposure, and psychological panic management combined with exposure in vivo. The mean (+/- SD) duration of the follow-up period was 62 +/- 89 weeks. In the majority of the studies (84%), follow-up had a naturalistic character. The lack of information about treatments received between posttest and follow-up limits the interpretation of the results. For all conditions, the treatment gains at posttest were maintained during the follow-up period. The mean (+/- SD) d for panic was 1.11 +/- 0.70 at posttest and 1.28 +/- 0.61 at follow-up; for agoraphobia, the mean d at posttest was 1.36 +/- 1.10 and at follow-up it was 1.41 +/- 0.82. Significant differences were found in efficacy on agoraphobic measures at follow-up between the combination of antidepressants and exposure in vivo versus psychological panic management, exposure in vivo, and the combination of psychological panic management and exposure. Overall, the data suggest that different treatment options for panic disorder with or without agoraphobia are effective at both posttest and follow-up. Research on long-term treatment, discontinuation of therapies, and interventions between posttest and follow-up need more attention, for pharmacotherapy as well as psychotherapy.

Agoraphobia↗
PubMedDate not supplied

Surface dependence: a balance control strategy in panic disorder with agoraphobia.

OBJECTIVE: Previous studies have reported vestibular dysfunction and impaired balance in patients with agoraphobia. Vestibular dysfunction may lead to an information processing strategy focusing on spatial stimuli from two nonvestibular sensory channels, vision and proprioception. This nonvestibular balance control strategy may in turn lead to discomfort in situations involving inadequate visual or proprioceptive spatial cues (space and motion discomfort). The objective of this study was to examine sensory integration of spatial information in agoraphobia. Because of previous findings that space and motion discomfort and vestibular dysfunction are common in agoraphobia, we hypothesized that agoraphobics would use a nonvestibular balance control strategy. METHOD: Using computerized dynamic posturography, we examined balance performance in patients with panic disorder with agoraphobia, uncomplicated panic disorder, nonpanic anxiety disorders, and depression without anxiety, as well as healthy subjects for comparison. The posturography procedure included six sensory conditions in which visual and proprioceptive balance information was manipulated experimentally by permutations of sway-referencing the support surface or the visual surround or by having patients close their eyes. RESULTS: The agoraphobics had impaired balance when proprioceptive balance information was minimized by sway-referencing the support surface (p < 0.02). This pattern, called surface dependence, tended to be more pronounced in agoraphobics who reported space and motion discomfort, including fear of heights or boats. CONCLUSION: Agoraphobics rely on proprioceptive cues for maintenance of upright balance. This strategy may lead to intolerance of situations characterized by unstable support.

Adult↗
PubMed2006

Personality traits in early phases of panic disorder: implications on the presence of agoraphobia, clinical severity and short-term outcome.

OBJECTIVE: To explore the relations between personality traits using the Big Five model and presence of agoraphobia, clinical severity and short-term outcome in an unbiased clinical sample of never-treated panic disorder patients. METHOD: Panic disorder (PD) patients (n = 103) in the first stages of their illness were evaluated using the Neuroticism-Extraversion-Openness Five Factor Inventory of Personality (NEO-FFI) and were compared with a sample of healthy subjects. Severity was assessed by the Panic Disorder Severity Scale and the Clinical Global Impression Scales. Patients were evaluated after 8 weeks of naturalistic pharmacologic treatment with Selective Serotonin Reuptake Inhibitors. RESULTS: Panic disorder patients show more neuroticism than healthy subjects. Patients suffering from agoraphobia are more introverted than controls. Extraversion, in addition to gender and distress, during panic attacks allows to correctly classifying 72% of the cases of agoraphobia. CONCLUSION: Low scores in extraversion contribute to explain the presence of agoraphobia in panic disorder. Personality traits are neither related to clinical severity nor to short-term response to pharmacological treatment.

Adult↗
PubMed1986

Depersonalization and agoraphobia associated with marijuana use.

This paper examines the role of uncontrolled depersonalization associated with marijuana use in the development of agoraphobia. Cases of six people are described, all of whom reported first experiencing depersonalization while using marijuana, and subsequently experiencing depersonalization while not using the drug. A fear of this 'uncontrolled' depersonalization resulted in considerable anticipatory anxiety and panic attacks. Patients ultimately presented for treatment of agoraphobia. A temporal relationship between marijuana use, uncontrolled depersonalization, panic attacks and agoraphobia does not imply causality. Comparison of these cases with other agoraphobia clinic patients provides tentative evidence for a difference between the two types of patients. There were no systematic patterns of stressors in the cases prior to the onset of symptoms. Data obtained before and after treatment indicated the cases were slightly more severe than clinic patients. Males and females were represented equally in the cases, whereas there was a higher incidence of females in the clinic patients. The cases' age of onset was younger than that of the clinic patients. Our standard cognitive-behavioural treatment programme required modification to account for the intensity of the fear of depersonalization in the cases.

Adult↗
PubMed1997

The benefit of an insight-oriented and experiential approach on panic and agoraphobia symptoms. Results of a controlled comparison of client-centered therapy alone and in combination with behavioral exposure.

BACKGROUND: It is a common view that psychodynamic treatment does not help much to ameliorate the symptoms of panic and agoraphobia. The effects of an insight-oriented treatment on central anxiety symptoms are the subject of the present controlled study. METHODS: Forty patients with severe panic and agoraphobia were admitted to an inpatient anxiety treatment program. Most of the patients had been treated by pharmacological means unsuccessfully. The patients were randomly assigned to pure client-centered therapy or to additional behavioral exposure treatment. Client-centered and behavioral agoraphobia manuals were used. The patients were examined on admission, at discharge and at 3, 6, and 12 months follow-up for panic (Structured Clinical Interview for DSM III-R--SCID), anxiety (Hamilton Anxiety Scale), agoraphobia (SCID, Fear Survey Schedule), and depressive (Hamilton Depression Scale) symptoms. RESULTS: Both client-centered treatment and a combination with exposure treatment reduced panic, avoidance and depressive symptoms significantly. For a short period the combined treatment was superior in patients' coping actively with anxiety and improving agoraphobic symptoms. However, at 1-year follow-up there was no further difference in the reduction of anxiety and depressive symptoms. CONCLUSIONS: The results are discussed with regard to the combination of these forms of therapy and to widespread skepticism about the efficacy of insight-oriented treatment.

Adult↗
PubMed1985

Panic attacks, hypochondriasis, and agoraphobia: a self-psychology formulation.

The clinical and theoretical material presented points to the value of looking at the syndrome of panic attacks, hypochondriasis, and agoraphobia from a self-psychology perspective. From this vantage, the nature of the constellation of symptoms and its relationship to premorbid personality characteristics can be understood and a coherent view of the syndrome can be constructed. Phenomenologically and pathogenetically, panic attacks, hypochondriasis, and agoraphobia are related to states of self-fragmentation. Despite longstanding faulty anxiety-regulatory mechanisms, from which arises the vulnerability to self-fragmentation, a cohesive self may be formed in childhood through compensatory and defensive structures. If these structures are undermined, cohesion is lost and as the self experiences fragmentation, panic ensues. The panic state has far-reaching consequences by setting in motion a regression to a precohesive state and evoking powerful feelings as well as the need for selfobjects appropriate to that early troubled developmental period. Hypochondriasis and agoraphobia arise out of this regressed matrix: hypochondriasis as a somatic representation and elaboration on the state of self-fragmentation, and agoraphobia as a defense against and an attempt to repair self-fragmentation. Transference phenomena during the treatment of patients with the syndrome can best be understood in the light of this formulation.

Adult↗
PubMed1990

Major depression and agoraphobia in patients with angiographically normal coronary arteries and panic disorder.

Patients with panic disorder and/or agoraphobia appearing in psychiatric settings report rates for lifetime major depression between 24% and 91%. Between 40% and 90% of patients with panic disorder in psychiatric populations report concomitant agoraphobia. A recent study of panic disorder subjects appearing in an outpatient cardiology clinic confirmed the strong link between panic and depression but found only a weak association between panic disorder and agoraphobia. In order to test the reliability of these outpatient cardiology findings, the authors studied major depression and agoraphobia in patients with angiographically normal coronary arteries and panic disorder. Twelve of the 32 (37.5%) panic disorder subjects reported a lifetime history of major depression (nine current, three past only). Only two of the 32 (six percent) reported any phobic avoidance. This study confirms the previous findings which suggest that major depression is common in cardiology populations with panic disorder and that phobic avoidance is uncommon in this group.

Adult↗