Hostname: page-component-848d4c4894-2xdlg Total loading time: 0 Render date: 2024-06-23T01:41:13.192Z Has data issue: false hasContentIssue false

Two-Year Follow-Up of Agoraphobics after Exposure and Imipramine

Published online by Cambridge University Press:  29 January 2018

S. D. Cohen
Affiliation:
Cassel Hospital, Ham Common, Richmond, Surrey; Institute of Psychiatry, 99 Denmark Hill, London SE5 SAF and Bethlem and Maudsley Hospitals, Denmark Hill, London SE5 8AZ
W. Monteiro
Affiliation:
Institute of Psychiatry; Bethlem and Maudsley Hospitals, London SE5 8AZ
I. M. Marks
Affiliation:
Institute of Psychiatry, De Crespigny Park, London SE5 8AF; Bethlem and Maudsley Hospitals, Denmark Hill, London SE5 8AZ

Summary

Forty-five agoraphobic out-patients were randomly assigned to treatment with imipramine or placebo, and also to brief therapist-aided exposure or relaxation. All patients did systematic self-exposure homework and recorded this in a diary. Forty of these patients were followed-up two years later with self-ratings and ratings by interviewers blind to their treatment conditions. About two-thirds of the patients remained improved or much improved in their phobias, with no significant difference between any of the four treatment conditions. Spontaneous panics also remained improved. The absence of an imipramine effect may reflect the lack of initial dysphoria (anxiety–depression) in this sample compared with other studies where drug-effects have been found. The post-treatment superiority (evident at week 28) of patients who had therapist-aided exposure was no longer present at the two-year follow-up; the others had caught up, presumably because of their self-exposure homework.

Type
Research Article
Copyright
Copyright © 1984 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bernstein, D. A. & Borkovec, T. (1973) Progressive Relaxation Training. A Manual for the Helping Professions. Champaign, Illinois: Public Research Press.Google Scholar
Emmelkamp, P. M. G. & Kuipers, A. C. M. (1979) Agoraphobia: a follow-up study four years after treatment. British Journal of Psychiatry, 134, 352–5.Google Scholar
Gelder, M. G. & Marks, I. M. (1966) Severe agoraphobia: a controlled prospective trial of behaviour therapy. British Journal of Psychiatry, 102, 309–19.Google Scholar
Ghosh, A., Marks, I. M. & Carr, A. C. (1984) Self exposure treatment for phobias: a controlled study. Journal of the Royal Society of Medicine (In press).Google Scholar
Greist, J., Marks, I. M. & Noshirvani, H. F. (1980) Avoidance versus confrontation of fear. Behaviour Therapy, 11, 114.Google Scholar
Hamilton, M. (1969) Standardized assessment and recording of depressive symptoms. Psychiatrica Neurologia Neurochirurgia, 72, 201–5.Google Scholar
Jannoun, L., Munby, M., Catalan, J. & Gelder, M. (1980) A home-based treatment program for agoraphobia, replication and controlled evaluation. Behaviour Therapy, 11, 294305.Google Scholar
McDonald, R., Sartory, G., Grey, S. J. et al, (1979) The effects of self-exposure instructions on agoraphobic outpatients. Behaviour Research and Therapy, 17, 8385.Google Scholar
McPherson, F. M., Brougham, L. & McLaren, (1980) Maintenance of improvement in agoraphobic patients treated by behavioural methods. Four year follow-up. Behaviour Research and Therapy, 18, 150–2.CrossRefGoogle Scholar
Marks, I. M. (1971) Phobic disorders four years after treatment. British Journal of Psychiatry, 118, 683–8.Google Scholar
Marks, I. M. (1975) Behavioural treatments of phobic and obsessive–compulsive disorders: a critical appraisal. In Progress in Behaviour Modification (ed. Herson, R. et al), Vol. 1. New York: Academic Press.Google Scholar
Marks, I. M. (1978) Living with Fear. New York: McGraw-Hill.Google Scholar
Marks, I. M. (1981) Cure and Care of Neuroses. New York: John Wiley & Sons.Google Scholar
Marks, I. M. (1983) Are there anti-compulsive or anti-phobic drugs? Review of the evidence. British Journal of Psychiatry, 143, 338–47.Google Scholar
Marks, I. M. & Mathews, A. M. (1979) Brief standard self-rating for phobic patients. Behaviour Research and Therapy, 17, 263–7.CrossRefGoogle ScholarPubMed
Marks, I. M., Hallam, R. S., Connolly, J. & Philpott, R. (1977) Nursing in Behavioural Psychotherapy. London: Research Series of Royal College of Nursing.Google Scholar
Marks, I. M., Grey, S., Cohen, S. D., Hill, R., Mawson, D., Ramm, E. M. & Stern, R. S. (1983) Imipramine and brief therapist-aided exposure in agoraphobics having self exposure homework: a controlled trial. Archives of General Psychiatry, 40, 153–62.Google Scholar
Mathews, A. M., Teasdale, J., Munby, M. et al (1977) A home-based treatment programme for agoraphobics. Behaviour Therapy, 3, 915–24.Google Scholar
Munby, M. & Johnston, D. W. (1981) Agoraphobia: the long-term follow-up of behavioural treatment. British Journal of Psychiatry, 137, 418427.Google Scholar
Snaith, R. P., Ahmed, S. N., Mehta, S. & Hamilton, M. (1971) Assessment of the severity of primary depressive illness. Wakefield Self-Assessment Depression Inventory. Psychological Medicine, 1, 143–9.Google Scholar
Zitrin, C. M., Klein, D. F. & Woerner, M. G. (1980) Treatment of agoraphobia with group exposure in vivo and imipramine. Archives of General Psychiatry, 37, 6372.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.