Exposure Treatment of Agoraphobia with Panic Attacks: Are Drugs Essential?

  • G. Andrews
  • C. Moran


There is a body of opinion that holds that panic disorder and agoraphobia are different to the other anxiety disorders. This opinion is based on three sets of observations:
  1. a)

    panic disorder and agoraphobia seem to be influenced by specific genetic factors;

  2. b)

    the attacks of panic can be precipitated by the administration of lactate and other substances; and

  3. c)

    treatment with antidepressants is “uniquely effective” (Sheehan 1982).



Anxiety Disorder Panic Disorder Panic Attack Exposure Treatment Phobic Anxiety 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Andrews G (1984) On the promotion of non-drug treatments. Br Med J 289: 994–995CrossRefGoogle Scholar
  2. Andrews G, Moran C (1986) The control of hyperventilation. Videotape. Audio Visual Unit, University of New South Wale, SydneyGoogle Scholar
  3. Andrews G, Guitar B, Howie P (1980) Meta-analysis of the effects of stuttering treatment. J Speech Hear Disord 45: 289–307Google Scholar
  4. Andrews G, MacMahon SW, Austin A et al (1982) Hypertension: a comparison of drug and non-drug treatments. Br Med J 284: 1523–1526CrossRefGoogle Scholar
  5. Andrews G, Allen R, Henderson AS (1987) The genetics of four anxiety disorders: a twin study. J Affective Disord (in press)Google Scholar
  6. Andrews G, Hadzi-Pavlovic D, Christensen H et al. (1988) The treatment of anxiety and somatoform disorders: views of practising psychiatrists. Am J Psychiatry (in press)Google Scholar
  7. Christensen H, Hadzi-Pavlovic D, Andrews G (1987) Behavior therapy and tricyclic medication in the treatment of obsessive compulsive disorder: a quantitative review. J Consult Clin Psycho] 55: 000–000Google Scholar
  8. Craig A, Franklin J, Andrews G (1984) A scale to measure locus of control of behaviour. Br J Med Psychol 57: 173–180PubMedCrossRefGoogle Scholar
  9. Craig A, Andrews G (1985) The prediction and prevention of relapse in stuttering: the value of self-control techniques and locus of control measures. Behav Modif 9: 427–442PubMedCrossRefGoogle Scholar
  10. Derogatis LR, Lipman RS, Rickels K et al (1974) The Hopkins Symptoms Check List (HSCL): a self-report symptom inventory. Behav Sci 19: 1–15PubMedCrossRefGoogle Scholar
  11. Emmelkamp PM, Emmelkamp-Benner A (1975) Effects of historically portrayed modeling and group treatment on self observation: a comparison with agoraphobics. Behav Res Ther 13: 135–139PubMedCrossRefGoogle Scholar
  12. Emmelkamp PM, Mersch PP (1982) Cognition and exposure in vivo in the treatment of agoraphobia: short-term and delayed effects. Cogn Ther Res 6: 77–89CrossRefGoogle Scholar
  13. Emmelkamp PM, Wessels H (1975) Flooding in imagination versus flooding in vivo: a comparison with agoraphobies. Behav Res Ther 13: 7–15PubMedCrossRefGoogle Scholar
  14. Emmelkamp PM, Kuipers AC, Eggeraat JB (1978) Cognitive modification versus prolonged exposure in vivo: a comparison with agoraphobies as subjects. Behav Res Ther 16: 33–41PubMedCrossRefGoogle Scholar
  15. Emmelkamp PM, van der Hout A, Devries K (1983) Assertive training for agoraphobia. Behav Res Ther 21: 63–68PubMedCrossRefGoogle Scholar
  16. Ellis A (1962) Reason and emotion in psychotherapy. Lyle-Stuart, New YorkGoogle Scholar
  17. Eysenck HJ, Eysenck SBG (1964) Manual of the Eysenck personality inventory. University of London Press, LondonGoogle Scholar
  18. Hafner J, Marks I (1976) Exposure in vivo of agoraphobics: contributions of diazepam, group exposure, and anxiety evocation. Psycho] Med 6: 71–88CrossRefGoogle Scholar
  19. Henderson AS (1981) Neurosis and the social environment. Academic, SydneyGoogle Scholar
  20. Holt PE, Andrews G (in press) Provocation of panic: a comparison on three elements of the panic reaction in four anxiety disorders. J Abnorm PsycholGoogle Scholar
  21. Jacobsen E (1938) Progressive relaxation. University of Chicago Press, ChicagoGoogle Scholar
  22. Jakubowski P, Lange AJ (1976) Responsible assertive behavior: assertive option. Research Press, ChampaignGoogle Scholar
  23. Kelly D, Guirguis W, Frommer E et al (1970) Treatment of phobic states with anti-depressants: a retrospective study of 246 patients. Br J Psychiatry 116: 387–398PubMedCrossRefGoogle Scholar
  24. Lipsedge MJ, Hajioff J, Huggins P et al (1973) The management of severe agoraphobia: a comparison of iproniazid and systematic desensitisation. Psychopharmacologia 32: 67–80PubMedCrossRefGoogle Scholar
  25. Marks I (1975) Behavioral treatments of phobic and obsessive-compulsive disorders: a critical apparaisal. In: Herson M, Eisler R, Miller P (eds) Progress in behavior modification, vol 1. Academic, New YorkGoogle Scholar
  26. Marks IM, Gray S, Cohen D et al (1983) Imipramine and brief therapist-aided exposure in agoraphobics having self-exposure homework. Arch Gen Psychiatry 40: 153–162PubMedGoogle Scholar
  27. Mavissakalian M, Michelson L (1982) Agoraphobia: behavioral and pharmacological treatments, preliminary outcome, and process findings. Psychopharmacol Bull 18: 91–103PubMedGoogle Scholar
  28. Mavissakalian M, Penel J (1985) Imipramine in the treatment of agoraphobia: dose-response relationships. Am J Psychiatry 142: 1032–1036PubMedGoogle Scholar
  29. Mavissakalian M, Michelson L, Pealy RS (1983) Pharmacological treatment of agoraphobia: imipramine versus imipramine with programmed practice. Br J Psychiatry 143: 348–355PubMedCrossRefGoogle Scholar
  30. Mavissakalian M, Michelson L, Greenwald D et al (1983) Cognitive-behavioural treatment of agoraphobia: paradoxical intention versus self-statement training. Behav Res Ther 21: 75–86PubMedCrossRefGoogle Scholar
  31. Moran C, Andrews G (1985) The familial occurrence of agoraphobia. Br J Psychiatry 146: 262–267PubMedCrossRefGoogle Scholar
  32. Noyes R, Anderson D, Clancy J et al (1984) Diazepam and propranolol in panic disorder and agoraphobia. Arch Gen Psychiatry 41: 287–292PubMedGoogle Scholar
  33. Ost LG, Jerramalm A, Jansson L (1984) Individual response patterns and the effects of different behavioural methods in the treatment of agoraphobia. Behav Res Ther 22: 697–707PubMedCrossRefGoogle Scholar
  34. Robins LN, Helzer JG, Croughan J et al (1981) National Institutes of Mental Health Diagnostic Interview Schedule. Its history, characteristics and validity. Arch Gen Psychiatry 38: 381–389Google Scholar
  35. Robins LN, Helzer JE, Weissman MM et al (1984) Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry 41: 949–958PubMedGoogle Scholar
  36. Sheehan DV (1982) Panic attacks and phobias. N Engl J Med 307: 156–158PubMedCrossRefGoogle Scholar
  37. Sheehan DV, Ballinger J, Jacobsen G (1980) Treatment of endogenous anxiety with phobic, hysterical and hypochondrical symptoms. Arch Gen Psychiatry 37: 51–59PubMedGoogle Scholar
  38. Sheehan DV, Coleman JH, Greenblatt DJ et al (1984) Some biochemical correlates of panic attacks with agoraphobia and their response to a new treatment. J Clin Psychopharmacol 42: 66–75CrossRefGoogle Scholar
  39. Solyom L, Heseltine GFD, McClure DJ et al (1973) Behavior therapy versus drug therapy in the treatment of phobic neurosis. Can J Psychiatry 18: 25–32Google Scholar
  40. Teich MJ (1983) A comparison of behavioral and pharmacological approaches to the treatment of agoraphobia. Doctoral dissertation, Stanford University, University Microfilms InternationalGoogle Scholar
  41. The Quality Assurance Project (1985) Treatment outlines for the management of anxiety states. Aust NZ J Psychiatry 19: 138–151Google Scholar
  42. Tyrer P, Candy J, Kelly D (1973) A study of the clinical effects of phenelzine and placebo in the treatment of phobic anxiety. Psychopharmacologia 32: 237–254PubMedCrossRefGoogle Scholar
  43. Weissman MM, Prusoff BA, Klerman GL (1978) Personality as a predictor of long-term outcome of depression Am J Psychiatry 137: 797–800Google Scholar
  44. Williams SL, Rappoport A (1983) Cognitive treatment in the natural environment for agoraphobics. Behav Res Ther 14: 299–313CrossRefGoogle Scholar
  45. Zitrin CM, Klein DF, Woerner MG et al (1983) Treatment of phobias I: comparison of imipramine hydrochloride and placebo. Arch Gen Psychiatry 40: 125–138PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • G. Andrews
  • C. Moran

There are no affiliations available

Personalised recommendations