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Arch Hellen Med, 24(3), May-June 2007, 203-215


Behavioral and cognitive views on the etiology and treatment of agoraphobia

Department of Psychiatry, University of Athens, Medical School, "Eginition" Hospital, Athens, Greece

This is a brief review of the history and the current state of the behavioral and cognitive theories on the etiology and treatment of panic disorder with agoraphobia (PDA). Throughout the 1960s and 1970s, behavioral theories focused on agoraphobia and exposure therapies were developed. Exposure-based treatments proved to markedly reduce escape and avoidance behaviors and agoraphobic distress in up to 60% of PDA patients. Nevertheless, a proportion continued to suffer from residual anxiety and panic attacks, even after the termination of therapy. In the 1980s researchers from both the biological and the cognitive fields turned their focus of attention to the phenomenon of panic. Agoraphobia soon came to be regarded as a secondary phenomenon, due to the occurrence of panic attacks, which constitute the core feature of the disorder. In panic disorder (PD) without agoraphobia, cognitive-behavioral therapies have received strong empirical support from studies carried out in various countries. The next logical step was to wonder about the efficacy of cognitive therapy treating patients with PD with moderate/severe agoraphobia. The majority of studies indicate that cognitive therapy is equally effective as exposure in vivo therapy in the treatment of panic disorder with moderate/severe agoraphobia, and that their combination does not seem to yield better results than each therapy alone. However, only 60% of patients with panic disorder with agoraphobia, treated in randomized clinical trials, achieved a clinically significant improvement after various forms of cognitive, behavioral and cognitive-behavioral therapies. More extensive research of the cognitive and learning mechanisms underlying the onset and maintenance of panic and agoraphobic symptoms is needed, in order to develop more sophisticated cognitive/ behavioral treatment methods.

Key words: Agoraphobia, Behavioral therapy, Cognitive therapy, Panic disorder.

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