Treatment choice for agoraphobic women: exposure or cognitive-behaviour therapy?
The paper describes a treatment trial where exposure was compared with cognitive-behaviour therapy in the treatment of 39 female participants with a diagnosis of agoraphobia (DSM-111-R). The primary objective of the study was to see if cognitive therapy enhanced the effectiveness of exposure in the treatment of agoraphobia.



Participants were randomly assigned to either exposure or cognitive-behaviour therapy. The two treatment groups were balanced for severity and duration of agoraphobia, presence of panic disorder, and age.



The exposure and the cognitive-behaviour therapy groups received the same amount of therapist-assisted exposure to feared situations but the participants in the cognitive-behaviour therapy group were, additionally, taught to identify and challenge negative automatic thoughts and dysfunctional assumptions. In the cognitive-behaviour therapy condition exposure was presented as an opportunity to identify and challenge negative thoughts. In the exposure condition, participants were given a behavioural rationale for doing exposure. Participants were seen individually for 10 sessions. Assessments were carried out before and after the treatment programme and, also, six months later. Assessments included self-reports of fear and avoidance, a behavioural test and questionnaire measures of relevant cognitions. Thirteen participants dropped out of treatment leaving 14 in the exposure condition and 12 in the cognitive-behaviour condition. Therapy sessions were taped and a sample of tapes was given to a judge who rated the quality of the cognitive-behaviour therapy.



Substantial improvement was seen on virtually all measures irrespective of treatment condition both at the end of treatment and six months later. The cognitive-behaviour therapy group and the exposure group did not differ significantly at post-treatment or at six-month follow-up.
Burke
M
M
Department of Psychology, St George's Hospital Medical School, University of London, UK.
Drummond
L M
LM
Johnston
D W
DW
D000328:Adult; D000379:Agoraphobia / Q000628:therapy*; D000704:Analysis of Variance; D001521:Behavior Therapy / Q000379:methods / Q000592:standards*; D015928:Cognitive Behavioral Therapy / Q000592:standards; D003863:Depression / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010352:Patient Dropouts; D011446:Prospective Studies; D011787:Quality of Health Care; D016896:Treatment Outcome