Failures in Exposure Treatment of Agoraphobia: Evaluation and Prediction

Failures in behavior therapy of agoraphobics have been largely neglected during the 1970s and early 1980s when research interest was mainly focussed on proving the effectiveness of behavioral treatments (Marks 1969; Chambless and Goldstein 1982; Thorpe and Burns 1983; Strian 1983; Foa et al. 1984; Tearnan and Telch 1984; Marks 1987a). Several long-term follow-up studies have confirmed exposure in vivo to be the treatment of choice for some 70% of agoraphobic patients who participated in such a treatment (Marks 1971; Emmelkamp and Kuipers 1979; McPherson et al. 1980; Munby and Johnston 1980; Cohen et al. 1984; Fiegenbaum 1986; Hand et al. 1986). Most of these studies found a significant and stable reduction of agoraphobic and other symptomatology for up to 9 years after treatment. When assessed at all, an improved private and social adjustment was evident. This high effectiveness turns out to be even more important as: 1. Agoraphobia shows a chronic course without treatment (Agras et al. 1972; Wittchen and von Zerssen 1987). 2. Agoraphobic patients are highly restricted in their daily-life activities and have to depend on significant others as accompanying persons (Marks 1987). 3. Agoraphobic patients without behavioral treatment run a considerable risk for secondary alcohol or tranquilizer dependence (Smail et al. 1984; Fyer et al. 1987).