Agoraphobia

This chapter summarizes the literature on assessment, maintenance, treatment,
and mechanisms of change in treatment of patients with panic disorder with or without agoraphobia.
Relevant theoretical contributions which are discussed may help to understand the
genesis and maintenance factors of panic disorder and agoraphobia. Further, we provide an
overview of empirically supported treatment approaches for these disorders and discuss the
mechanisms of change involved in these treatments Knowledge of the burgeoning literature
in this area is relevant for the development of basic and expert clinical competencies in panic
disorder/agoraphobia. It is argued that the clinician should first be familiar with the diagnostic
criteria for panic disorder and for agoraphobia. Knowledge of structured clinical interviews
is needed to be able to formalize the diagnosis. In addition, knowledge of self-report
measures, behavioral assessment, and self-monitoring is needed to assess the quality and
severity of panic disorder and agoraphobia and to evaluate progress of treatment. Further,
basic competencies also require knowledge on which factors are involved in the maintenance
of these disorders. In addition, basic clinical competencies should entail knowledge about
psycho-education, and evidence-based protocols for conducting interoceptive exposure and
exposure in vivo outside the therapist office. Expert clinical competencies may entail advanced
understanding and skills of applying psychological and pharmacological procedures
to augment exposure therapy, skills in enactment of cognitive therapy and couple therapy,
knowledge and skills to deal with panic disorder and agoraphobia in cases with comorbid
disorders (e.g. substance abuse/dependence, and depression) as well sensitivity to anxiety
related cultural factors.