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The Effects of Spouse-Based Cognitive-Behavior Therapy on the Treatment of Agoraphobia

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The Effects of Spouse-Based Cognitive-Behavior Therapy on the Treatment of Agoraphobia Western Michigan University ScholarWorks at WMU Dissertations Graduate College 6-1988 The Effects of Spouse-Based Cognitive-Behavior Therapy on the Treatment of Agoraphobia Joan Woods Western Michigan University Follow this and additional works at: https://scholarworks.wmich.edu/dissertations Part of the Experimental Analysis of Behavior Commons, and the Mental Disorders Commons Recommended Citation Woods, Joan, "The Effects of Spouse-Based Cognitive-Behavior Therapy on the Treatment of Agoraphobia" (1988). Dissertations. 2200. https://scholarworks.wmich.edu/dissertations/2200 This Dissertation-Open Access is brought to you for free and open access by the Graduate College at ScholarWorks at WMU. It has been accepted for inclusion in Dissertations by an authorized administrator of ScholarWorks at WMU. For more information, please contact [email protected]. THE EFFECTS OF SPOUSE-BASED COGNITIVE-BEHAVIOR THERAPY ON THE TREATMENT OF AGORAPHOBIA by Joan Woods A Dissertation Submitted to the Faculty of The Graduate College in partial fulfillment of the requirements for the Degree of Doctor of Philosophy Department of Psychology Western Michigan University Kalamazoo, Michigan June 1988 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. THE EFFECTS OF SPOUSE-BASED COGNITIVE-BEHAVIOR THERAPY ON THE TREATMENT OF AGORAPHOBIA Joan Woods, Ph.D. Western Michigan University, 1988 The purpose of this clinical research was to deter­ mine whether spouse-supported treatment of agoraphobia would result in greater improvement on measures of expo­ sure and avoidance than would individual treatment or no treatment. It was hypothesized that Couples Treatment subjects would demonstrate a significantly greater change from pretest to posttest than would Individual Treatment subjects or No-Treatment Control subjects. The study further predicted that significant improvements would be demonstrated for both treated groups on the same outcome measures, pretest to posttest and from pretest to follow- up. Total N was 10 subjects; all were agoraphobic, mar­ ried, and female, with 4 in Couples Treatment with spouses, 3 in Individual Treatment, and 3 in the No-Treat- ment control condition. Random assignment of subjects to conditions was precluded by preferences of some subjects to be accompanied by spouses, resulting in more severely agoraphobic subjects in Couples Treatment. Seven sessions of cognitive-behavior therapy were provided subjects in Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Couples and Individual Treatment, preceded by one assess­ ment session (pretest), followed by posttest (ninth ses­ sion), with follow-up assessment two weeks later, 10 sessions in all. Assessments of exposure were derived from subjects' reports of actual exposures; avoidance measures were based on self-report questionnaires. Since sample characteristics did not meet assumptions on which between-group statistical analyses are based, between-group hypotheses could not be tested statistical­ ly. However, large differences between group means were found at posttest; the Couples Treatment condition mani­ fested superior improvements on outcome measures over the Individual and No-Treatment control conditions. Within- group hypotheses were confirmed; both treated groups im­ proved significantly from pretest to posttest and from pretest to follow-up. The No-Treatment Control group did not improve. Generalizing of results must be limited to married female agoraphobics in treatment for agoraphobia similar in characteristics to the subjects in the samples. The present study confirmed that spouse-supported treatment of agoraphobia enhances cognitive-behavioral treatment of selected married agoraphobic clients which is in line with previous research and has heuristic value. IF Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. INFORMATION TO USERS The most advanced technology has been used to photo­ graph and reproduce this manuscript from the microfilm master. UMI films the original text directly from the copy submitted. Thus, some dissertation copies are in typewriter face, while others may be from a computer printer. In the unlikely event that the author did not send UMI a complete manuscript and there are missingpages, these will be noted. Also, if unauthorized copyrighted material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are re­ produced by sectioning the original, beginning at l i e upper left-hand comer and continuing from left to right in equal sections with small overlaps. Each oversize page is available as one exposure on a standard 35 mm slide or as a 17" x 23" black and white photographic print for an additional charge. Photographs included in the original manuscript have been reproduced xerographically in this copy. 35 mm slides or 6" x 9" black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. Accessing theIUM-I World's Information since 1938 300 North Zeeb Road, Ann Arbor, Ml 48106-1346 USA Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Order Number 8821042 The effects of spouse-based cognitive-behavior therapy on the treatment of agoraphobia Woods, Joan, Ph.D. Western Michigan University, 1988 Copyright ©1989by Woods, Joan. All rights reserved. UMI 300N.ZeebR<L Ann Aibor, MI 48106 F " ' Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. PLEASE NOTE: In all cases this material has been filmed in the best possible way from the available copy. Problems encountered with this document have been identified here with a check mark V 1. Glossy photographs or pages. 2. Colored illustrations, paper or print_____ 3. Photographs with dark background____ 4. Illustrations are poor copy______ 5. Pages with black marks, not original copy. 6. Print shows through as there is text on both sides of page. 7. Indistinct, broken or small print on several pages^ 8. Print exceeds margin requirements_____ 9. Tightly bound copy with print lost in spine______ 10. Computer printout pages with indistinct print. 11. Page(s)__________lacking when material received, and not available from school or author. 12. Page(s)__________seem to be missing in numbering only as text follows. 13. Two pages numbered . Text follows. 14. Curling and wrinkled pages_____ 15. Dissertation contains pages with print at a slant, filmed as received________ 16. Other ____ _______ UMI Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ©1989 JOAN WOODS All Rights Reserved Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ACKNOWLEDGEMENTS I wish to express my appreciation to Dr. Chris Koronakos, Dr. Mai Robertson, Dr. Frederick Gault, and Dr. Thelma Urbick for their scholarly influence and participa­ tion as members of the faculty committee that has guided me through the doctoral program in- Clinical Psychology. Their instruction and counsel have contributed to my development as a clinician. I especially thank my Chairperson, Dr. Chris Koronakos, for his supportive endeavors on my behalf over the years of graduate study; his contributions to my learning, along with his consideration, patience, and uncommon kindness are immeasurable and will long be remem­ bered. I would also like to express my heartfelt appreci­ ation to my husband, Don, for his love, understanding, patience and encouragement during the many hours of labor that have gone into the research for this dissertation and during my years of study. Joan Woods F ' Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS ACKNOWLEDGEMENTS................................... ii LIST OF TABLES...................................... v LIST OF FIGURES.................................... vi CHAPTER I. INTRODUCTION................................. 1 The Problem.............................. 2 Definitions........................... 2 Clinical Description.................. 5 Predisposing Factors................... 9 II. REVIEW OF SELECTED LITERATURE OF AGORAPHOBIA TREATMENT....................... 13 Studies of Treatment Outcome............. 14 Behavioral and Cognitive Treatments.... 14 Psychopharmacological Treatment....... 26 Factors Facilitating Treatment Effects................................ 32 Summary................................ 39 III. DESIGN AND METHODOLOGY....................... 44 Design.................................... 44 Method.................................... 46 Subjects............................... 46 Assessments........................... 59 Materials.............................. 62 Procedures............................. 64 S F " ... Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Table of Contents— Continued CHAPTER Assessment and Treatment Protocol..... 65 IV. RESULTS....................................
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