Cognitive behavioral treatment of agoraphobia

Severe and chronic agoraphobics with panic attacks (DSM-III) were randomly assigned to one of three cognitive behavioral treatments: Cognitive Therapy plus Graduated Exposure, Progressive Deep Muscle Relaxation Training plus Graduated Exposure vs Graduated Exposure alone. Treatment consisted of 16 sessions conducted by experienced protocol therapists. All subjects received 90 min of graduated in vivo exposure each session and an extensive rationale, emphasizing self-directed exposure and programmed practice in addition to their primary treatment. Subjects also received cognitive therapy, relaxation training or programmed practice. An assessment battery consisting of clinical ratings of severity, phobia, anxiety, depression, panic and tripartite monitoring of behavioral, cognitive and psychophysiological response systems was administered at pre-, mid- and post-treatment. Analyses revealed statistically significant differences across treatments, tripartite response systems and assessment phases. The multi-modal treatments exhibited enhanced performance on self-report, phobic anxiety/avoidance, physiological, cognitive, and behavioral measures as compared to exposure alone. Conceptual and applied issues of these findings are discussed with regard to both future research and integration of cognitive behavioral strategies in the treatment of agoraphobia and related anxiety disorders.