Cognitive and Exposure Treatment for Agoraphobia: Reexamination of the Outcome Research

Abstract

Researchers working within the behavioral framework have concluded that in vivo exposure is an effective, though incomplete, treatment for agoraphobia. Cognitive treatments (i.e., the modification of internal dialogue) have been found less effective and show little supplemental value to exposure. In this paper it is argued that the behavioral perspective has provided a limited vision of cognitive therapy as an effective supplement to exposure. Reexamination of the research literature engenders different conclusions and opens up some fresh possibilities for a combined exposure-cognitive treatment. From a cognitive perspective, the modification of self-statements and internal dialogue is not enough for producing enduring and generalizable therapeutic results. A complete treatment for agoraphobia requires a combination of in vivo exposure with a bona fide cognitive therapy which addresses core cognitive constructs about the world and the self specific to agoraphobic patients.