Accuracy of fear inventories and self-efficacy scales in predicting agoraphobic behavior

Is the Fear Questionnaire (FQ) a Useful Instrument for Patients with Anxiety Disorders?

The Fear Questionnaire (FQ) has been widely used both nationally and internationally in the anxiety disorder literature. Research from a variety of centres advocating its psychometric properties and clinical utility is now available; however a critical and integrated review has been lacking. This paper offers an integration of empirical research for cross-cultural comparison and as a testament of the FQ itself. A refined FQ is also proposed to enhance its utility.

The mediational role of panic self-efficacy in cognitive behavioral therapy for panic disorder: a systematic review and meta-analysis

Cognitive models of panic disorder (PD) with or without agoraphobia have stressed the role of catastrophic beliefs of bodily symptoms as a central mediating variable of the efficacy of cognitive behavioral therapy (CBT). Perceived ability to cope with or control panic attacks, panic self-efficacy, has also been proposed to play a key role in therapeutic change; however, this cognitive factor has received much less attention in research. The aim of the present review is to evaluate panic self-efficacy as a mediator of therapeutic outcome in CBT for PD using descriptive and meta-analytic procedures. We performed systematic literature searches, and included and evaluated 33 studies according to four criteria for establishing mediation. Twenty-eight studies, including nine randomized waitlist-controlled studies, showed strong support for CBT improving panic self-efficacy (criterion 1); ten showed an association between change in panic self-efficacy and change in outcome during therapy (criterion 2); three tested, and one established formal statistical mediation of panic self-efficacy (criterion 3); while four tested and three found change in panic self-efficacy occurring before the reduction of panic severity (criterion 4). Although none of the studies fulfilled all of the four criteria, results provide some support for panic self-efficacy as a mediator of outcome in CBT for PD, generally on par with catastrophic beliefs in the reviewed studies.

Psychometric properties of the mobility inventory for agoraphobia: convergent, discriminant, and criterion-related validity

Aims of this study were (a) to summarize the psychometric literature on the Mobility Inventory for Agoraphobia (MIA), (b) to examine the convergent and discriminant validity of the MIA's Avoidance Alone and Avoidance Accompanied rating scales relative to clinical severity ratings of anxiety disorders from the Anxiety Disorders Interview Schedule (ADIS), and (c) to establish a cutoff score indicative of interviewers' diagnosis of agoraphobia for the Avoidance Alone scale. A meta-analytic synthesis of 10 published studies yielded positive evidence for internal consistency and convergent and discriminant validity of the scales. Participants in the present study were 129 people with a diagnosis of panic disorder. Internal consistency was excellent for this sample, α=.95 for AAC and .96 for AAL. When the MIA scales were correlated with interviewer ratings, evidence for convergent and discriminant validity for AAL was strong (convergent r with agoraphobia severity ratings=.63 vs. discriminant rs of .10-.29 for other anxiety disorders) and more modest but still positive for AAC (.54 vs. .01-.37). Receiver operating curve analysis indicated that the optimal operating point for AAL as an indicator of ADIS agoraphobia diagnosis was 1.61, which yielded sensitivity of .87 and specificity of .73.

Cognitive and performance-based treatments for panic attacks in people with varying degrees of agoraphobic disability

Compared the effectiveness of cognitive therapy and performance-based exposure as treatments for panic attacks. Subjects were 48 panicky individuals selected without regard to agoraphobic disability, and who varied widely in that respect. Subjects were assigned randomly to either cognitive treatment, performance-based exposure treatment, a combined cognitive/performance treatment, or a no-treatment control condition. All three treatments led to marked and enduring improvements in panic, and did not differ from one another in effectiveness, whereas the control condition produced little benefit. However, on several measures of phobia and panic-related cognitions, performance exposure was significantly more effective than cognitive therapy. Degree of agoraphobic disability had a significant bearing on panic treatment effectiveness. Whereas 94% of the low agoraphobia Ss were free of panic after treatment, only 52% of the high agoraphobia Ss became panic-free. The findings suggest that when panic treatment research excludes people with serious phobias, as it has routinely done in recent years, an overly positive estimate of panic treatment effectiveness can result.

Biofeedback-aided hypnotherapy for intractable phobic anxiety

Phobically avoidant people need treatments that enable them to cope effectively with their task threats. Field-mastery techniques that emphasize the importance of cognitively and behaviorally active roles to be taken by both therapist and patient have been shown to be superior to the clinic-based exposure and encouragement approaches. This paper describes a treatment model used with patients who were refractory to any performance-based treatment because of various reasons, primarily intense fear of even the initial guided exposure. Biofeedback-aided hypnotherapy (BAH) was the integrated new treatment employed. It offered the simultaneous safety of the clinic, enhanced vivification of the feared situation, combined with continuous convincing feedback about the growing mastery. BAH may ease the fear associated with the binary leap from in-vitro treatment to actual exposure. This treatment offers an alternative to phobic patients who are too fearful to engage in any other effective treatment modality.

Further psychometric evaluation of the Fear Questionnaire: responses of college students

This study presents evidence for the factor structure and psychometric properties of the Fear Questionnaire for college undergraduates. Fit indices of the 4- and 5-factor models identified previously were inadequate. Exploratory principal components analysis identified three factors, using data from Sample 1 (n = 208). LISREL confirmatory factor analyses supported generalizability of the three-factor model to Sample 2 (n = 200). Satisfactory reliability coefficients were obtained for the factor-derived subscales. Significant gender differences were obtained on 4 of the 15 items but not on the factor subscales. Finally, we examined the correlations between scores on the scale and on other measures of social anxiety, social desirability, and general psychological distress of the Brief Symptom Inventory. Present results suggest that the Fear Questionnaire is a valuable research instrument for a nonclinical sample.

Value of the Fear Questionnaire in differentiating agoraphobia and social phobia

The present study examined responses on the Fear Questionnaire (FQ) of 68 patients suffering panic disorder with agoraphobia, 50 social phobics, 75 subjects with 'non-clinical' panic attacks, and 188 non-panicking controls. The FQ agoraphobia and social subscales had satisfactory internal consistency and were accurate (82%) in correctly differentiating the patients. In general, the patient and control groups differed as expected. The highest level of social fear was reported by social phobics and the highest level of agoraphobic fear was reported by patients with panic disorder and agoraphobia. Five items from these two subscales significantly differentiated social phobia from panic disorder with agoraphobia. The results support the reliability and validity of the FQ.

Guided mastery and stimulus exposure treatments for severe performance anxiety in agoraphobics

The present experiment compared two models of treatment for high performance-related anxiety in agoraphobics: the stimulus exposure model, which emphasizes extinguishing anxiety by promoting prolonged exposure to phobic stimuli, and the self-efficacy model, which emphasizes building a sense of mastery by promoting rapid proficient performance accomplishments. Subjects were 26 agoraphobics who could perform phobic activities when behaviorally tested, but who became highly anxious when doing so. Subjects were assigned at random to either (a) guided mastery treatment based on self-efficacy theory, (b) stimulus exposure treatment, or (c) delayed treatment. The results showed that guided mastery was significantly more effective than stimulus exposure in reducing performance anxiety, and this difference increased over the follow-up period. The findings indicate that therapists can implement performance-based treatment more effectively by assisting clients to achieve proficient performance than by simply encouraging them to expose themselves to phobic stimuli.