Vous êtes sur la page 1sur 26

{\rtf\ansi\deff0\ansicpg1252

{\fonttbl
{\f0\froman times new roman;}{\f1\fswiss helvetica;}}
{\colortbl\red0\green0\blue0;\red153\green153\blue153;}
\jexpand\viewkind1\viewscale100
{\shp{\*\shpinst\shpleft4880\shptop720\shpright6320\shpbottom720\shpfhdr0\shpwr3
\shpwrk0\shpfblwtxt1\shplid2028\shpz0\shpbxpage\shpbypage
{\sp{\sn shapeType}{\sv 0}}
{\sp{\sn fFlipH}{\sv 0}}
{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn rotation}{\sv 0}}
{\sp{\sn geoRight}{\sv 1440}}
{\sp{\sn geoBottom}{\sv 0}}
{\sp{\sn shapePath}{\sv 4}}
{\sp{\sn pVerticies}{\sv 8;2;(0,0);(1440,0);}}
{\sp{\sn pSegmentInfo}{\sv 2;5;16384;45824;1;45824;32768}}
{\sp{\sn fFillOK}{\sv 1}}
{\sp{\sn fFilled}{\sv 0}}
{\sp{\sn lineWidth}{\sv 6350}}
{\sp{\sn lineColor}{\sv 0}}
{\sp{\sn lineDashing}{\sv 0}}
{\sp{\sn fLine}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
{\sp{\sn lineType}{\sv 0}}
{\sp{\sn fArrowheadsOK}{\sv 0}}
{\sp{\sn fBehindDocument}{\sv 1}}
{\sp{\sn fLayoutInCell}{\sv 1}}}}
{\shp{\*\shpinst\shpleft2000\shptop13026\shpright3440\shpbottom13026\shpfhdr0\sh
pwr3\shpwrk0\shpfblwtxt1\shplid2029\shpz1\shpbxpage\shpbypage
{\sp{\sn shapeType}{\sv 0}}
{\sp{\sn fFlipH}{\sv 0}}
{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn rotation}{\sv 0}}
{\sp{\sn geoRight}{\sv 1440}}
{\sp{\sn geoBottom}{\sv 0}}
{\sp{\sn shapePath}{\sv 4}}
{\sp{\sn pVerticies}{\sv 8;2;(0,0);(1440,0);}}
{\sp{\sn pSegmentInfo}{\sv 2;5;16384;45824;1;45824;32768}}
{\sp{\sn fFillOK}{\sv 1}}
{\sp{\sn fFilled}{\sv 0}}
{\sp{\sn lineWidth}{\sv 6350}}
{\sp{\sn lineColor}{\sv 0}}
{\sp{\sn lineDashing}{\sv 0}}
{\sp{\sn fLine}{\sv 1}}{\sp{\sn lineColor}{\sv 0}}
{\sp{\sn lineType}{\sv 0}}
{\sp{\sn fArrowheadsOK}{\sv 0}}
{\sp{\sn fBehindDocument}{\sv 1}}
{\sp{\sn fLayoutInCell}{\sv 1}}}}\paperw10080\paperh14400\margl666\margr133\marg
t666\margb120
\cols2\colno1\colw1333\colsr-0\colno2\colw7946\pard\li253\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li25
3\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\p

ar\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs


18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li25
3\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li25
3\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li253\ri0\sl-186\slmult0 \fs20\cf0\f0\charscalex100\b {24}\b0 \p
ar\column\pard\li2866\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2866\ri0\sl-240\sl
mult0 \fs18\cf1\f0\charscalex100\b {C H A P T E R 2}\b0 \par\pard\li2573\ri0\s
l-546\slmult0 \fs36\cf0\f0\charscalex100 {Agoraphobia}\par\pard\li2680\ri0\sl-21
3\slmult0 \fs18\cf0\par\pard\li2680\ri0\sl-213\slmult0 \fs20\cf0\f0\charscalex10
0 {Holly Hazlett-Stevens}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-280\slmult0 \fs14\cf0\f0\chars
calex100\b {W H AT I S A G O R A P H O B I A ?}\b0 \par\pard\li0\ri0\sl-213\
slmult0 \fs18\cf0\par\pard\li0\ri0\sl-280\slmult0 \fs20\cf0\f0\charscalex100 {Ag
oraphobia literally means \uc1\u8220Xfear of the marketplace,\uc1\u8221X based o
n}{ }\fs18\cf0\f0\charscalex100\i {agora}\i0 \fs20\cf0\f0\charscalex100 {, the w
ord for}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {the Greek m
arketplace (Durand & Barlow, 2003). The term \uc1\u8220Xagoraphobia\uc1\u8221X w
as first}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {introduced
by Westphal in 1871 to describe the fear and avoidance of public places,}\par\p
ard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {although this condition w
as not widely recognized until the late 1970s (Barlow, 2002).}\par\pard\li0\ri0\
sl-240\slmult0 \fs20\cf0\f0\charscalex100 {Diagnosis of Agoraphobia first appear
ed in the}{ }\fs18\cf0\f0\charscalex100\i {Diagnostic and Statistical Manual of}
\i0 \par\pard\li0\ri0\sl-240\slmult0 \fs16\cf0\f0\charscalex100\i {Mental Disord
ers}\i0 { }\fs18\cf0\f0\charscalex100 {in its third edition (DSM-III; American P
sychiatric Association [APA],}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\char
scalex100 {1980). Agoraphobia was then considered a primary diagnosis, which may
or may not}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {be acco
mpanied by recurrent panic attacks (Mennin, Heimberg, & Holt, 2000).}\par\pard\l
i0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {However, since publication of
the DSM-III-R (APA, 1987), a diagnosis of Panic}\par\pard\li0\ri0\sl-240\slmult0
\fs18\cf0\f0\charscalex100 {Disorder is considered primary and is diagnosed eit
her with or without Agoraphobia.}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\c
harscalex100 {Under the current DSM-IV (APA, 1994) diagnostic system, individual
s exhibiting}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {sympto
ms of Agoraphobia but never meeting full diagnostic criteria for Panic}\par\pard
\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Disorder are given a diagnos
is of Agoraphobia Without History of Panic Disorder}\par\pard\li0\ri0\sl-240\slm
ult0 \fs20\cf0\f0\charscalex100 {(AWHPD).}\par\pard\li360\ri0\sl-240\slmult0 \fs
18\cf0\f0\charscalex100 {The DSM-IV (APA, 1994) describes Agoraphobia as anxiety
about several dif-}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100

{ferent places or situations from which escape would be either difficult or emba
r-}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {rassing if some
sort of unexpected or unwanted bodily symptoms occurred}\par\pard\li0\ri0\sl-240
\slmult0 \fs18\cf0\f0\charscalex100 {(Criterion A). As a result, such situations
are either avoided, require the presence}\par\pard\li0\ri0\sl-240\slmult0 \fs18
\cf0\f0\charscalex100 {of a trusted person, or are endured with great distress (
Criterion B). This anxiety}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charsca
lex100 {and situational avoidance is not better explained by another anxiety dis
order, such}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {as Soci
al Phobia or Specific Phobia (Criterion C). Although panic attacks or \uc1\u8220
Xpanic-}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {like\uc1\u8
221X bodily sensations are often feared, other feared symptoms include loss of b
lad-}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {der or bowel c
ontrol, vomiting, or severe headache. Agoraphobia is not recognized}\par\pard\li
0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {by DSM-IV as a diagnosis on its
own. An individual meeting criteria for}\par\pard\li0\ri0\sl-240\slmult0 \fs18\
cf0\f0\charscalex100 {Agoraphobia is then diagnosed with either Panic Disorder W
ith Agoraphobia}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {(PD
A) (if diagnostic criteria for Panic Disorder are also met) or AWHPD. Both}\par\
pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {diagnoses require that t
he symptoms cannot be fully explained by a general med-}\par\pard\li0\ri0\sl-240
\slmult0 \fs20\cf0\f0\charscalex100 {ical condition and do not reflect the direc
t physiological effects of a substance.}\par\pard\li360\ri0\sl-240\slmult0 \fs18
\cf0\f0\charscalex100 {Common agoraphobic situations include shopping malls, pub
lic transportation,}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100
{supermarkets, restaurants, theaters, additional situations involving crowds or
waiting}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {in line, tr
avel far from home, and being alone (Barlow & Craske, 2000). Such ago-}\par\pard
\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {raphobic situations are avoi
ded because of feared bodily sensations or physical symp-}\par\pard\li0\ri0\sl-2
40\slmult0 \fs18\cf0\f0\charscalex100 {toms; therefore it is not surprising that
other daily activities causing such}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\
f0\charscalex100 {interoceptive sensations are also avoided. Activities involvin
g physical exertion, such}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscal
ex100 {as aerobic exercise, running up flights of stairs, heavy lifting, and dan
cing, may be}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {avoide
d because they induce sensations of physiological arousal. Similar interocep-}\p
ar\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {tive activities inclu
de hot and stuffy spaces, sexual relations, watching suspenseful}\par\pard\li0\r
i0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {movies or sporting events, express
ing anger or engaging in emotionally arousing dis-}\par\pard\li0\ri0\sl-240\slmu
lt0 \fs18\cf0\f0\charscalex100 {cussions, and ingesting caffeine or chocolate (B
arlow & Craske, 2000). Individuals}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0
\charscalex100 {with AWHPD who fear sensations other than \uc1\u8220Xpanic-like\
uc1\u8221X symptoms might avoid}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs16\cf0\f
0\charscalex100 {Hazlett-Stevens, H. (2006). Agoraphobia. In J. E. Fisher & W. T
. O\uc1\u8217XDonohue (Eds.),}{ }\fs14\cf0\f0\charscalex100\i {Practitioner\uc1\
u8217Xs guide to}\i0 \par\pard\li0\ri0\sl-186\slmult0 \fs12\cf0\f0\charscalex100
\i {evidence-based psychotherapy}\i0 \fs16\cf0\f0\charscalex100 {. New York: Spr
inger.}\par\pard\sect\sectd\sbkpage\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn
133\margtsxn666\margbsxn226\cols2\colno1\colw8306\colsr-0\colno2\colw973\pard\li
240\ri0\sl-226\slmult0 \fs16\cf0\f0\charscalex100 {A}{ }\fs12\cf0\f0\charscalex1
00 {G O R A P H O B I A}\par\column\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\cha
rscalex100\b {25}\b0 \par\pard\sect\sectd\sbknone\pgwsxn10080\pghsxn14400\margls
xn666\margrsxn133\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\s
l-320\slmult0 \fs20\cf0\f0\charscalex100 {additional activities causing other fe
ared sensations. For example, an individual with}\par\pard\li1320\ri0\sl-240\slm
ult0 \fs18\cf0\f0\charscalex100 {AWHPD stemming from gastrointestinal distress a
nd fear of losing control of his}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f

0\charscalex100 {bowels might avoid eating spicy foods or heavy meals to prevent
unwanted gastroin-}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex1
00 {testinal sensations. Nevertheless, the actual agoraphobic situations avoided
by indi-}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {vidual
s with AWHPD do not seem to differ from those avoided by individuals with}\par\p
ard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Panic Disorder With Ag
oraphobia (Pollard, Tait, Meldrum, Dubinsky, & Gall, 1996).}\par\pard\li1680\ri0
\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {DSM-IV conceptualizes Agoraphobia as
a condition most often secondary to}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\c
f0\f0\charscalex100 {Panic Disorder or sub-clinical panic symptoms. This view re
sts on the assumption}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscale
x100 {that avoidance of public places and other agoraphobic situations develops
as a}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {behavioral
reaction to the unexpected physiological arousal of panic (Barlow, 2002).}\par\p
ard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Indeed, re-assessment
of 26 AWHPD patients revealed that 57% appeared to suffer}\par\pard\li1320\ri0\s
l-240\slmult0 \fs18\cf0\f0\charscalex100 {from panic attacks containing too few
symptoms to meet criteria for Panic Disorder}\par\pard\li1320\ri0\sl-240\slmult0
\fs18\cf0\f0\charscalex100 {(Goisman et al., 1995). In a longitudinal naturalis
tic study of 562 participants suf-}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0
\f0\charscalex100 {fering from panic and agoraphobia symptoms, only 6% were assi
gned diagnoses of}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100
{AWHPD (Goisman et al., 1994). These researchers proposed that AWHPD might be}\
par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {best conceptualiz
ed as part of a panic syndrome, in which AWHPD lies on a single}\par\pard\li1320
\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {continuum with PDA and Panic Dis
order Without Agoraphobia (PD). Similarly,}\par\pard\li1320\ri0\sl-240\slmult0 \
fs18\cf0\f0\charscalex100 {Andrews and Slade (2002) concluded that these three d
iagnoses represent three}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charsc
alex100 {variations of a single disorder after finding strong similarities among
AWHPD, PDA,}\par\pard\li1320\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {and
PD clinical groups.}\par\pard\li1680\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex
100 {Although AWHPD is not often seen in mental health treatment settings}\par\p
ard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {(Pollard, Bronson, & K
enney, 1989), Agoraphobia can develop in response to}\par\pard\li1320\ri0\sl-240
\slmult0 \fs18\cf0\f0\charscalex100 {somatic conditions other than panic. For ex
ample, AWHPD has been associated}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f
0\charscalex100 {with Generalized Anxiety Disorder (Hoffart, Thornes, & Hedley,
1995), Irritable}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100
{Bowel Syndrome (IBS; Mennin et al., 2000), headache (Spierings, Reinders, &}\pa
r\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Hoogduin, 1989), an
d fear of vomiting (Pollard et al., 1996). Wittchen, Reed, and}\par\pard\li1320\
ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Kessler (1998) found that most ag
oraphobic individuals in their community sample}\par\pard\li1320\ri0\sl-240\slmu
lt0 \fs18\cf0\f0\charscalex100 {reported no history of uncued panic-related symp
toms, challenging the predomi-}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\
charscalex100 {nant view that panic-like experiences are usually responsible for
the development}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100
{of Agoraphobia. They argued that AWHPD is not often seen in mental health set-}
\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {tings because su
ch individuals seldom seek treatment, not because it is a rare con-}\par\pard\li
1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {dition. Regardless of whethe
r or not panic-related sensations are responsible for the}\par\pard\li1320\ri0\s
l-240\slmult0 \fs18\cf0\f0\charscalex100 {development of an individual\uc1\u8217
Xs Agoraphobia, the behavioral avoidance is driven by}\par\pard\li1320\ri0\sl-24
0\slmult0 \fs20\cf0\f0\charscalex100 {a fear of some sort of internal bodily sen
sation or event.}\par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\r
i0\sl-253\slmult0 \fs12\cf0\f0\charscalex100\b {B A S I C FA C T S A B O U T
A G O R A P H O B I A}\b0 \par\pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li1320\ri0\sl-280\slmult0 \fs18\cf0\f0\charscalex100 {The American Psychiatr

ic Association estimates the 1-year prevalence of Panic}\par\pard\li1320\ri0\sl240\slmult0 \fs18\cf0\f0\charscalex100 {Disorder between 1% and 2%, with up to o
ne-half of these individuals also suffer-}\par\pard\li1320\ri0\sl-240\slmult0 \f
s18\cf0\f0\charscalex100 {ing from Agoraphobia (APA, 1994). The US National Como
rbidity Survey (NCS)}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex
100 {lifetime prevalence estimate for PD with or without Agoraphobia is 3.5% (Ke
ssler}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {et al., 19
94). Determining the prevalence of AWHPD has proven much more com-}\par\pard\li1
320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {plicated. Initial epidemiolog
ical results suggested that AWHPD was more common}\par\pard\li1320\ri0\sl-240\sl
mult0 \fs18\cf0\f0\charscalex100 {than PDA. The NCS found the lifetime prevalenc
e for AWHPD to be 5.3% (Kessler}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0
\charscalex100 {et al., 1994). Similarly, the Epidemiological Catchment Area (EC
A) survey based on}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex10
0 {DSM-III criteria reported a 4.2% lifetime prevalence of AWHPD compared to onl
y}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {0.9% for Panic
Disorder (Robins et al., 1984). However, the high rates of AWHPD}\par\pard\li13
20\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {found in large-scale epidemiol
ogical research might reflect overestimates due to}\par\pard\li1320\ri0\sl-240\s
lmult0 \fs18\cf0\f0\charscalex100 {methodological difficulties. Both the ECA and
NCS relied on structured diagnostic}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\c
f0\f0\charscalex100 {interviews conducted by lay interviewers rather than traine
d clinicians: the ECA}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscale
x100 {determined DSM-III diagnoses with the Diagnostic Interview Schedule (DIS;}
\par\pard\sect\sectd\sbknone\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn133\par
d\sect\sectd\sbkpage\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn133\margtsxn666
\margbsxn226\cols2\colno1\colw1333\colsr-0\colno2\colw7946\pard\li253\ri0\sl-266
\slmult0 \fs20\cf0\f0\charscalex100\b {26}\b0 \par\column\pard\li6013\ri0\sl-226
\slmult0 \*\tx6840\fs16\cf0\f0\charscalex100 {C}\fs12\cf0\f0\charscalex100 {H A
P T E R}\tab \fs16\cf0\f0\charscalex100 {T}{ }\fs12\cf0\f0\charscalex100 {W O}\p
ar\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-360\slmult0 \fs20\c
f0\f0\charscalex100 {Robins, Helzer, Croughan, & Ratcliff, 1981) and the NCS ass
igned DSM-III-R diag-}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex10
0 {noses after administering the Composite International Diagnostic Interview (C
IDI;}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {World Health O
rganization, 1990).}\par\pard\li360\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex10
0 {Researchers have since taken a closer look at AWHPD cases from epidemio-}\par
\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {logical studies. Horwat
h, Lish, Johnson, Hornig, and Weissman (1993) blindly re-}\par\pard\li0\ri0\sl-2
40\slmult0 \fs20\cf0\f0\charscalex100 {interviewed 22 A}\fs20\cf0\f0\charscalex1
00 {WHPD participants from the original ECA study. Only two received}\par\pard\l
i0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {a diagnosis of AWHPD, one of w
hich had sub-clinical panic attacks. The remaining}\par\pard\li0\ri0\sl-240\slmu
lt0 \fs20\cf0\f0\charscalex100 {participants were reclassified with simple (spec
ific) phobias or PDA. In a more recent}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf
0\f0\charscalex100 {study using DSM-IV criteria, Andrews and Slade (2002) report
ed a 1-year prevalence}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex1
00 {rate of 1.3% for PD, 1.6% for AWHPD, and 0.6% for PDA in their Australian co
m-}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {munity sample. A
lthough AWHPD and PD groups were mutually exclusive, 18% of}\par\pard\li0\ri0\sl
-240\slmult0 \fs20\cf0\f0\charscalex100 {those with AWHPD reported recurrent and
unexpected panic attacks that did not}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf
0\f0\charscalex100 {meet criteria for PD. Thus, the prevalence of AWHPD and its
relationship to panic}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex10
0 {attacks and Panic Disorder remains the subject of much debate.}\par\pard\li36
0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {The prevalence of PDA does not
seem to differ among ethnic groups (Eaton,}\par\pard\li0\ri0\sl-240\slmult0 \fs2
0\cf0\f0\charscalex100 {Dryman, & Weissman, 1991; Horwath, Johnson, & Hornig, 19
93). However, African}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex10
0 {Americans are rarely found in treatment outcome research studies (Paradis, Ha

tch,}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {& Friedman, 19


94). Early epidemiological research based on DSM-III criteria con-}\par\pard\li0
\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {sistently revealed that Agorapho
bia was more common for women than men (see}\par\pard\li0\ri0\sl-240\slmult0 \fs
20\cf0\f0\charscalex100 {Pollard & Henderson, 1987). In the later NCS study, wom
en were more than twice}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex
100 {as likely as men to meet diagnostic criteria for Agoraphobia (ratio of 2.2:
1.0; Magee,}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {Eaton,
Wittchen, McGonagle, & Kessler, 1996). According to the DSM-IV-TR (APA,}\par\par
d\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {2000), approximately 75% of
those suffering from PDA are women. One explana-}\par\pard\li0\ri0\sl-240\slmul
t0 \fs20\cf0\f0\charscalex100 {tion for this gender difference is that avoidance
behavior is more culturally accept-}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\
f0\charscalex100 {able for women than for men. Agoraphobic individuals\uc1\u8217
X tendency to avoid situations}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\cha
rscalex100 {correlated with \uc1\u8220Xmasculinity\uc1\u8221X scores, such that
the lower the score, the greater the}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\
f0\charscalex100 {avoidance behavior (Chambless & Mason, 1986). Consistent with
this view, men are}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {
more likely than women to cope with unwanted anxiety and panic symptoms by}\par\
pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {using alcohol and other
psychoactive substances (Kushner, Abrams, & Borchardt,}\par\pard\li0\ri0\sl-240\
slmult0 \fs20\cf0\f0\charscalex100 {2000). For a thorough review of gender diffe
rence research see Craske (1999, 2003).}\par\pard\li360\ri0\sl-240\slmult0 \fs18
\cf0\f0\charscalex100 {Although little is known about the course of AWHPD, the c
ourse of PDA is}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {oft
en quite chronic. One longitudinal investigation reported a 1-year remission rat
e}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {of only 17%, and
relapse among these individuals was common (Keller et al.,}\par\pard\li0\ri0\sl240\slmult0 \fs20\cf0\f0\charscalex100 {1994).The onset of Agoraphobia usually o
ccurs in the late-twenties, with a median}\par\pard\li0\ri0\sl-240\slmult0 \fs20
\cf0\f0\charscalex100 {age of onset of 29 years (Magee et al., 1996). Panic Diso
rder begins as early as the}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charsc
alex100 {mid-teens (Burke, Burke, Regier, & Rae, 1990), but PDA is rarely found
in younger}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {children
(Albano, Chorpita, & Barlow, 1996). More than half the time, individuals}\par\p
ard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {with PDA are diagnosed wi
th additional comorbid conditions. This most often}\par\pard\li0\ri0\sl-240\slmu
lt0 \fs20\cf0\f0\charscalex100 {involves another anxiety disorder such as Genera
lized Anxiety Disorder, Specific}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\c
harscalex100 {Phobia, or Social Phobia, or a mood disorder such as Major Depress
ive Disorder or}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {Dys
thymia. Substance use disorders and Axis II personality disorders are also com-}
\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {mon (see Barlow, 20
02; Craske, 1999 for reviews).}\par\pard\li360\ri0\sl-240\slmult0 \fs18\cf0\f0\c
harscalex100 {Agoraphobia can become quite disabling. Although the NCS study fou
nd that}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {only 26.5%
of those with Agoraphobia reported that their avoidance interfered}\par\pard\li0
\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {\uc1\u8220Xa lot\uc1\u8221X with
their life (Magee et al., 1996), severe functional impairment across many}\par\
pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {life domains is common a
mong clinical samples (Mennin et al., 2000). Interpersonal}\par\pard\li0\ri0\sl240\slmult0 \fs20\cf0\f0\charscalex100 {problems and marital difficulties have b
een documented with PDA (Hoffart, 1997;}\par\pard\li0\ri0\sl-240\slmult0 \fs20\c
f0\f0\charscalex100 {Marcaurelle, Blanger, & Marchand, 2003), although it is uncl
ear whether these}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {p
roblems were present before the onset of PDA. Other important costs include med}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {ical utilization a
nd work disability. PDA often leads to increased use of nonpsychi-}\par\pard\li0
\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {atric general medical services a

nd emergency room visits (Markowitz, Weissman,}\par\pard\sect\sectd\sbkpage\pgws


xn10080\pghsxn14400\marglsxn666\margrsxn133\margtsxn666\margbsxn226\cols2\colno1
\colw8306\colsr-0\colno2\colw973\pard\li240\ri0\sl-226\slmult0 \fs16\cf0\f0\char
scalex100 {A}{ }\fs12\cf0\f0\charscalex100 {G O R A P H O B I A}\par\column\pard
\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100\b {27}\b0 \par\pard\sect\sect
d\sbknone\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn133\pard\li1320\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-320\slmult0 \fs20\cf0\f0\charscalex100
{Ouellette, Lish, & Klerman, 1989). Unemployment and other forms of work}\par\p
ard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {impairment are also co
mmon. Studies of treatment-seeking clinical populations}\par\pard\li1320\ri0\sl240\slmult0 \fs18\cf0\f0\charscalex100 {have documented unemployment rates of 50
%, and 33% of individuals suffering}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf
0\f0\charscalex100 {from PDA may be financially dependent on public assistance p
rograms (Edlund &}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100
{Swann, 1987; Massion, Warshaw, & Keller, 1993). Although little information ab
out}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {the social c
osts of AWHPD is available, severe agoraphobic avoidance associated}\par\pard\li
1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {with sub-clinical panic or c
onditions other than panic can also lead to significant}\par\pard\li1320\ri0\sl240\slmult0 \fs20\cf0\f0\charscalex100 {impairment.}\par\pard\li1320\ri0\sl-213\
slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-253\slmult0 \fs14\cf0\f0\charscalex100\
b {W H AT C A U S E S A G O R A P H O B I A ?}\b0 \par\pard\li1320\ri0\sl-21
3\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-280\slmult0 \fs18\cf0\f0\charscalex10
0 {Early theories of agoraphobia viewed avoidance behavior as a conditioned fear
}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {response. One i
nfluential model was the two-factor theory of Mowrer (1960). He}\par\pard\li1320
\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {proposed that fear is first acqu
ired from a classical conditioning experience, then}\par\pard\li1320\ri0\sl-240\
slmult0 \fs18\cf0\f0\charscalex100 {escape from or avoidance of the conditioned
stimulus situation maintains the fear}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\
cf0\f0\charscalex100 {by preventing extinction of this fear response. According
to this view, the fear of}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\chars
calex100 {certain public places would originate when some sort of noxious or ave
rsive event}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {happ
ened to occur in that context and the person became motivated to avoid that}\par
\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {particular situation
due to their conditioned fear response. In support of this}\par\pard\li1320\ri0
\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {model, st and Hugdahl (1983) found th
at 81% of their agoraphobia sample could}\par\pard\li1320\ri0\sl-240\slmult0 \fs
18\cf0\f0\charscalex100 {identify a specific conditioning experience to account
for their fear. Later behav-}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\ch
arscalex100 {ioral theories focused on fears of what might happen in the feared
situation rather}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100
{than fears of the situation itself. For example, Goldstein and Chambless (1978)
pro-}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {posed that
agoraphobic avoidance resulted from a fear of impending panic or}\par\pard\li13
20\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {other feared bodily sensations
, a model labeled \uc1\u8220Xfear of fear.\uc1\u8221X From this perspective,}\pa
r\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {innocuous bodily se
nsations become classically conditioned to the aversive physio-}\par\pard\li1320
\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {logical arousal associated with
panic attacks. Because these classically conditioned}\par\pard\li1320\ri0\sl-240
\slmult0 \fs18\cf0\f0\charscalex100 {sensations could trigger an unwanted panic
attack across situations, individuals}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\
cf0\f0\charscalex100 {avoid various agoraphobic situations out of fear that they
would be unable to cope}\par\pard\li1320\ri0\sl-240\slmult0 \fs20\cf0\f0\charsc
alex100 {with their panic if it were to occur in that situation.}\par\pard\li168
0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Modern approaches view the deve
lopment of Agoraphobia and PDA as a com-}\par\pard\li1320\ri0\sl-240\slmult0 \fs
18\cf0\f0\charscalex100 {plex interaction between both biological and psychologi

cal influences. Agoraphobia}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\cha


rscalex100 {is believed to begin with a general predisposition or vulnerability
common to all the}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100
{anxiety disorders (Craske, 1999). This temperament risk factor is often referr
ed to}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {as \uc1\u8
220Xnegative affectivity\uc1\u8221X (Watson & Clark, 1984), and is quite similar
to constructs}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {s
uch as neuroticism (Eysenck, 1967) and behavioral inhibition (Kagan, 1997).}\par
\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Genetic influences f
or negative affectivity are well established, but genes only}\par\pard\li1320\ri
0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {explain half the picture (Craske, 2
003). Environmental influences can also make a}\par\pard\li1320\ri0\sl-240\slmul
t0 \fs18\cf0\f0\charscalex100 {person vulnerable to experience negative emotiona
l states across situations. Early}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\
f0\charscalex100 {experiences with stressful situations, particularly those in w
hich the individual per-}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charsc
alex100 {ceived the event(s) to be unpredictable and difficult to control, also
contribute to}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {th
e negative affectivity temperament (Craske, 1999). Other developmental experi-}\
par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {ences that can pr
edispose a person to anxiety disorders include parental modeling}\par\pard\li132
0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {of anxious behavior, overprotec
tive treatment, and parental encouragement of anx-}\par\pard\li1320\ri0\sl-240\s
lmult0 \fs20\cf0\f0\charscalex100 {ious behavior and avoidance (Vasey & Dadds, 2
001).}\par\pard\li1680\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {More speci
fic physiological and psychological factors could make an individual}\par\pard\l
i1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {prone to experience Panic D
isorder and Agoraphobia symptoms in particular.}\par\pard\li1320\ri0\sl-240\slmu
lt0 \fs18\cf0\f0\charscalex100 {Evidence for an overactive hypothalamic\uc1\u821
1Xpituitary\uc1\u8211Xadrenal (HPA) axis and auto-}\par\pard\li1320\ri0\sl-240\s
lmult0 \fs18\cf0\f0\charscalex100 {nomic hyperactivity in Panic Disorder exists,
although research results are mixed}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\c
f0\f0\charscalex100 {(Craske, 1999). Psychological factors center on a specific
fear of unwanted bodily}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charsca
lex100 {sensations. Cognitive components include attributions and beliefs that c
ertain}\par\pard\sect\sectd\sbknone\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn
133\pard\sect\sectd\sbkpage\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn133\marg
tsxn666\margbsxn280\cols2\colno1\colw1333\colsr-0\colno2\colw7946\pard\li253\ri0
\sl-266\slmult0 \fs20\cf0\f0\charscalex100\b {28}\b0 \par\column\pard\li6013\ri0
\sl-226\slmult0 \*\tx6840\fs16\cf0\f0\charscalex100 {C}\fs12\cf0\f0\charscalex10
0 {H A P T E R}\tab \fs16\cf0\f0\charscalex100 {T}{ }\fs12\cf0\f0\charscalex100
{W O}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-360\slmult0
\fs20\cf0\f0\charscalex100 {innocuous sensations are dangerous. For example, acc
elerated heart rate might be}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\chars
calex100 {interpreted as a sign of heart attack or stroke, shortness of breath c
ould be taken as}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {a
sign of suffocation, and dizziness could be perceived as evidence that the perso
n}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {will faint (Barlo
w, 2002). Other feared consequences of unwanted bodily sensations}\par\pard\li0\
ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {include losing control over one\u
c1\u8217Xs body and going crazy. Clark (1988) described these}\par\pard\li0\ri0\
sl-240\slmult0 \fs20\cf0\f0\charscalex100 {cognitions as \uc1\u8220Xcatastrophic
misinterpretations,\uc1\u8221X in which normal anxiety sensations}\par\pard\li0
\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {and sometimes other harmless phy
sical sensations are interpreted in a catastrophic}\par\pard\li0\ri0\sl-240\slmu
lt0 \fs20\cf0\f0\charscalex100 {way to signal immediate and impending physical a
nd/or mental disaster.}\par\pard\li360\ri0\sl-240\slmult0 \fs18\cf0\f0\charscale
x100 {Along similar lines, Reiss et al. (1986) defined \uc1\u8220Xanxiety sensit
ivity\uc1\u8221X as the ten-}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\chars
calex100 {dency to interpret anxiety sensations as harmful. They suggested that

anxiety sensi-}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {tivi


ty represents a specific vulnerability to Panic Disorder and agoraphobic avoidan
ce,}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {and longitudina
l research supports this idea (Ehlers, 1995). Anxiety sensitivity among}\par\par
d\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {treatment-seeking agoraphob
ic clients reflected fears of heart and breathing symp-}\par\pard\li0\ri0\sl-240
\slmult0 \fs20\cf0\f0\charscalex100 {toms, loss of mental control, gastrointesti
nal difficulties, and other people detecting}\par\pard\li0\ri0\sl-240\slmult0 \f
s20\cf0\f0\charscalex100 {anxiety symptoms (Wardle, Ahmad, & Hayward, 1990). Ind
ividuals with PDA appear}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscale
x100 {more likely to fear physical catastrophes than AWHPD individuals (Hoffart,
Friis,}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {Strand, & O
lsen, 1994).}\par\pard\li360\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Barl
ow (2002) proposed a comprehensive etiological model of PDA that inte-}\par\pard
\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {grates these various compone
nts. He suggested that an individual may be predis-}\par\pard\li0\ri0\sl-240\slm
ult0 \fs20\cf0\f0\charscalex100 {posed to experience anxiety through both biolog
ical and psychological}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex1
00 {generalized vulnerability factors. When a stressful event triggers an exagge
rated}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {physiological
fear response, the individual becomes fearful of the associated inte-}\par\pard
\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {roceptive cues due to a spec
ific tendency to interpret unexplained physical sensa-}\par\pard\li0\ri0\sl-240\
slmult0 \fs20\cf0\f0\charscalex100 {tions as dangerous. This fear leads to antic
ipation of future unwanted somatic}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0
\charscalex100 {sensations, or \uc1\u8220Xanxious apprehension.\uc1\u8221X Agora
phobia develops when the individual}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f
0\charscalex100 {responds to feared somatic sensations and anticipation of futur
e interoceptive}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {cue
s with behavioral avoidance of certain situations. This avoidance maintains the}
\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {fear of unwanted se
nsations, reinforcing beliefs that such sensations are indeed}\par\pard\li0\ri0\
sl-240\slmult0 \fs20\cf0\f0\charscalex100 {harmful and need to be avoided in cer
tain situations. This model might also be}\par\pard\li0\ri0\sl-240\slmult0 \fs20
\cf0\f0\charscalex100 {applied to cases of AWHPD. For individuals fearing paniclike sensations, the same}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscal
ex100 {physiological fear response might lead to interoceptive conditioning and
the}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {development of
avoidance behavior even though full-blown panic attacks are not}\par\pard\li0\ri
0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {experienced. Individuals with AWHPD
in the absence of subclinical panic may also}\par\pard\li0\ri0\sl-240\slmult0 \
fs20\cf0\f0\charscalex100 {possess a specific psychological vulnerability to int
erpret unexplained physical sen-}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\c
harscalex100 {sations as dangerous. In this case, unwanted bodily sensations oth
er than panic}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {could
lead to the same cycle of anxious apprehension and behavioral avoidance}\par\pa
rd\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {seen in PDA.}\par\pard\li0
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-253\slmult0 \fs14\cf0\f0\chars
calex100\b {A S S E S S M E N T}\b0 \par\pard\sect\sectd\sbknone\pgwsxn10080\pgh
sxn14400\marglsxn666\margrsxn133\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\par
d\li253\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100\b {What Should be Ruled Ou
t?}\b0 \par\pard\li1333\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {Before PD
A or AWHPD is diagnosed, the clinician should rule out any medical con-}\par\par
d\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {ditions that might accou
nt for the client\uc1\u8217Xs feared bodily sensations. For example,}\par\pard\l
i1333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {certain thyroid and vestibu
lar problems can cause panic-like sensations (see Panic}\par\pard\li1333\ri0\sl240\slmult0 \fs18\cf0\f0\charscalex100 {Disorder chapter, this volume). Similarl
y, the clinician should determine that the}\par\pard\li1333\ri0\sl-240\slmult0 \
fs18\cf0\f0\charscalex100 {somatic sensations associated with the client\uc1\u82

17Xs Agoraphobia are not merely due to}\par\pard\li1333\ri0\sl-240\slmult0 \fs18


\cf0\f0\charscalex100 {the effects of a substance. If the client uses psychoacti
ve substances, careful assess-}\par\pard\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\
charscalex100 {ment of when the physiological effects of these substances were e
xperienced is nec-}\par\pard\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex10
0 {essary. This allows the clinician to determine whether the direct effects of
the}\par\pard\li1333\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {substance ca
n account for the avoidance behavior.}\par\pard\sect\sectd\sbknone\pgwsxn10080\p
ghsxn14400\marglsxn666\margrsxn133\pard\sect\sectd\sbkpage\pgwsxn10080\pghsxn144
00\marglsxn666\margrsxn133\margtsxn666\margbsxn280\cols2\colno1\colw1680\colsr-0
\colno2\colw7600\pard\li240\ri0\sl-226\slmult0 \fs16\cf0\f0\charscalex100 {A}{ }
\fs12\cf0\f0\charscalex100 {G O R A P H O B I A}\par\column\pard\li6626\ri0\sl-2
66\slmult0 \fs20\cf0\f0\charscalex100\b {29}\b0 \par\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-320\slmult0 \fs20\cf0\f0\charscalex100 {Clinician
s must also determine that a client\uc1\u8217Xs avoidance behavior is not better
}\par\pard\sect\sectd\sbknone\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn133\pa
rd\li1320\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {accounted for by anothe
r DSM-IV diagnosis. As reviewed above, epidemiological}\par\pard\li1320\ri0\sl-2
40\slmult0 \fs18\cf0\f0\charscalex100 {survey results may have been confounded b
y misdiagnosed cases of Agoraphobia.}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\c
f0\f0\charscalex100 {Specific Phobia and Social Phobia are easily confused with
PDA and AWHPD}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {be
cause all involve behavioral avoidance of in vivo situations. However, the defin
ing}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {feature of A
goraphobia is that fear and avoidance of certain situations stems from a}\par\pa
rd\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {fear that escape would
be difficult or embarrassing or that help would be unavailable}\par\pard\li1320\
ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {in the event of a panic attack or
other unwanted bodily sensations. If an individual\uc1\u8217Xs}\par\pard\li1320
\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {avoidance is driven by a fear of
negative evaluation or fear that he or she might}\par\pard\li1320\ri0\sl-240\sl
mult0 \fs18\cf0\f0\charscalex100 {behave in a way that other people would scruti
nize, an alternative diagnosis of Social}\par\pard\li1320\ri0\sl-240\slmult0 \fs
18\cf0\f0\charscalex100 {Phobia (Social Anxiety Disorder) should be considered.
If the situational avoidance}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\ch
arscalex100 {is confined to specific types of situations or objects, a diagnosis
of Specific Phobia}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex1
00 {(formerly Simple Phobia) may be more appropriate. An individual might avoid
var-}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {ious public
places due to contamination fears or other intrusive obsessive thoughts,}\par\p
ard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {but this avoidance beh
avior would be best conceptualized as a symptom of Obsessive-}\par\pard\li1320\r
i0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Compulsive Disorder. Sometimes ind
ividuals suffering from Posttraumatic or Acute}\par\pard\li1320\ri0\sl-240\slmul
t0 \fs18\cf0\f0\charscalex100 {Stress Disorder will avoid certain places, people
, or activities because these stimuli}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\
cf0\f0\charscalex100 {remind them of the traumatic event or because they fear ad
ditional harm from the}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscal
ex100 {environment. From a diagnostic perspective, this form of behavioral avoid
ance is}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {usually
subsumed under the \uc1\u8220Xavoidance of stimuli\uc1\u8221X criterion required
for both stress}\par\pard\li1320\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100
{disorder diagnoses and does not warrant a separate AWHPD diagnosis.}\par\pard\l
i240\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li240\ri0\sl-253\slmult0 \fs18\cf0\f0
\charscalex100\b {What is Involved in Effective Assessment?}\b0 \par\pard\li1320
\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {In clinical settings, Agoraphobi
a is often detected at the initial diagnostic inter-}\par\pard\li1320\ri0\sl-240
\slmult0 \fs18\cf0\f0\charscalex100 {view. Structured diagnostic interviews such
as the DIS (Robins et al., 1981) and the}\par\pard\li1320\ri0\sl-240\slmult0 \f
s18\cf0\f0\charscalex100 {CIDI (World Health Organization, 1990) have been devel

oped for administration}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charsca


lex100 {by lay interviewers, but this practice may not always yield a valid diag
nosis. Ideally,}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {
diagnosis is obtained with a semi-structured clinician administered diagnostic}\
par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {interview so that
differential diagnosis issues can be explored fully. Empirically}\par\pard\li13
20\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {supported semi-structured inte
rviews such as the Anxiety Disorders Interview}\par\pard\li1320\ri0\sl-240\slmul
t0 \fs18\cf0\f0\charscalex100 {Schedule for DSM-IV (ADIS-IV; Brown, Di Nardo, &
Barlow, 1994) allow the clini-}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\
charscalex100 {cian to systematically assess the function of reported anxiety sy
mptoms and avoid-}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100
{ance behavior. This information prepares the clinician to conduct a functional
}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {analysis of the
individual\uc1\u8217Xs ideographic cognitions, interoceptive avoidance, situa-}
\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {tional avoidance
, and subtle avoidance and safety behaviors that maintain the}\par\pard\li1320\r
i0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {disorder (see Barlow, 2002).}\par\
pard\li1680\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Additional informatio
n regarding specific cognitive and behavioral features of}\par\pard\li1320\ri0\s
l-240\slmult0 \fs18\cf0\f0\charscalex100 {Agoraphobia can be obtained with selfreport questionnaires. Widely used self-}\par\pard\li1320\ri0\sl-240\slmult0 \fs
18\cf0\f0\charscalex100 {report measures include the Anxiety Sensitivity Index (
ASI; Reiss et al., 1986), the}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\c
harscalex100 {Anxiety Control Questionnaire (AnxCQ; Rapee, Craske, Brown, & Barl
ow, 1996),}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {the B
ody Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire}\par\p
ard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {(BSQ and ACQ; Chambles
s, Caputo, Bright, & Gallagher, 1984), and the Mobility}\par\pard\li1320\ri0\sl240\slmult0 \fs18\cf0\f0\charscalex100 {Inventory for Agoraphobia (MI; Chambless
, Caputo, Jasin, Gracely, & Williams,}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\
cf0\f0\charscalex100 {1985). Complete descriptions of these and many other measu
res, along with reviews}\par\pard\li1320\ri0\sl-240\slmult0 \fs20\cf0\f0\charsca
lex100 {of available psychometric data, are available from Antony (2001).}\par\p
ard\li240\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li240\ri0\sl-253\slmult0 \fs18\c
f0\f0\charscalex100\b {What Assessments are Not Helpful?}\b0 \par\pard\li1320\ri
0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {Personality inventories such as the
Minnesota Multiphasic Personality Inventory}\par\pard\li1320\ri0\sl-240\slmult0
\fs18\cf0\f0\charscalex100 {(MMPI) and its revision, the MMPI-2, are not partic
ularly useful in the assessment}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0
\charscalex100 {of Agoraphobia. Neither projective psychological tests, includin
g the Rorschach}\par\pard\sect\sectd\sbknone\pgwsxn10080\pghsxn14400\marglsxn666
\margrsxn133\pard\sect\sectd\sbkpage\pgwsxn10080\pghsxn14400\marglsxn666\margrsx
n133\margtsxn666\margbsxn226\cols2\colno1\colw1333\colsr-0\colno2\colw7946\pard\
li253\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100\b {30}\b0 \par\column\pard\l
i6013\ri0\sl-226\slmult0 \*\tx6840\fs16\cf0\f0\charscalex100 {C}\fs12\cf0\f0\cha
rscalex100 {H A P T E R}\tab \fs16\cf0\f0\charscalex100 {T}{ }\fs12\cf0\f0\chars
calex100 {W O}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-360
\slmult0 \fs20\cf0\f0\charscalex100 {inkblot test and the Thematic Apperception
Test (TAT), nor neuropsychological}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0
\charscalex100 {tests such as those found in the Luria-Nebraska and Halstead-Rei
tan batteries are}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {u
seful in the diagnosis of Agoraphobia. Medical markers or tests for this conditi
on}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {are not availabl
e.}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-253\slmult0 \f
s18\cf0\f0\charscalex100\b {T R E AT M E N T}\b0 \par\pard\sect\sectd\sbknone\pg
wsxn10080\pghsxn14400\marglsxn666\margrsxn133\pard\li253\ri0\sl-213\slmult0 \fs1
8\cf0\par\pard\li253\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100\b {What Treat
ments are Effective?}\b0 \par\pard\li1333\ri0\sl-253\slmult0 \fs20\cf0\f0\charsc
alex100 {Situational exposure has been central to the psychological treatment of

agoraphobic}\par\pard\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {ind


ividuals for decades. Although variations in procedures exist, effective exposur
e}\par\pard\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {involves repea
ted contact with the avoided situation while the client experiences}\par\pard\li
1333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {moderate levels of anxiety (
Gelder, 1991). See Hazlett-Stevens and Craske (2003) for}\par\pard\li1333\ri0\sl
-240\slmult0 \fs18\cf0\f0\charscalex100 {a description of in vivo exposure proce
dures. Teaching clients how to apply progres-}\par\pard\li1333\ri0\sl-240\slmult
0 \fs18\cf0\f0\charscalex100 {sive relaxation in agoraphobic situations may also
prove beneficial, and this Applied}\par\pard\li1333\ri0\sl-240\slmult0 \fs18\cf
0\f0\charscalex100 {Relaxation approach was about as effective as in vivo exposu
re alone (st, Westling,}\par\pard\li1333\ri0\sl-240\slmult0 \fs20\cf0\f0\charscal
ex100 {& Hellstrm, 1993).}\par\pard\li1693\ri0\sl-240\slmult0 \fs18\cf0\f0\charsc
alex100 {When Agoraphobia is present in the context of PDA, treatment typically
begins}\par\pard\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {with educ
ational information about the physiology of panic and the harmless}\par\pard\li1
333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {nature of the fight or flight
response. Cognitive restructuring addresses misap-}\par\pard\li1333\ri0\sl-240\
slmult0 \fs18\cf0\f0\charscalex100 {praisals of feared bodily sensations, and th
e client is encouraged to engage in activ-}\par\pard\li1333\ri0\sl-240\slmult0 \
fs18\cf0\f0\charscalex100 {ities within and between sessions that induce their f
eared interoceptive cues.}\par\pard\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\chars
calex100 {Finally, a hierarchy of agoraphobic situations is constructed, and tre
atment contin-}\par\pard\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {u
es with systematic live exposure to each of these feared situations for the rema
in-}\par\pard\li1333\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {der of treat
ment.}\par\pard\li253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li253\ri0\sl-253\slm
ult0 \fs18\cf0\f0\charscalex100\b {What are Effective Self-Help Treatments?}\b0
\par\pard\li1333\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {A number of self
-help books containing these cognitive-behavioral elements are}\par\pard\li1333\
ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {available to the public. Many of
these resources are designed for people suffering}\par\pard\li1333\ri0\sl-240\sl
mult0 \fs18\cf0\f0\charscalex100 {from PDA (see Panic Disorder chapter in this v
olume). However, a few books tar-}\par\pard\li1333\ri0\sl-240\slmult0 \fs20\cf0\
f0\charscalex100 {get Agoraphobia symptoms exclusively:}\par\pard\li1160\ri0\sl360\slmult0 \*\tx1333\fs10\cf0\f0\charscalex100 {\uc1\u9679X}\tab \fs20\cf0\f0\c
harscalex100 {Pollard, C.A., & Zuercher-White, E. (2003).}{ }\fs18\cf0\f0\charsc
alex100\i {The agoraphobia workbook: A compre-}\i0 \par\pard\li1333\ri0\sl-240\s
lmult0 \fs16\cf0\f0\charscalex100\i {hensive program to end your fear of symptom
attacks}\i0 \fs18\cf0\f0\charscalex100 {. Oakland, CA: New Harbinger}\par\pard\
li1333\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {Publications, Inc.}\par\pa
rd\li1160\ri0\sl-240\slmult0 \*\tx1333\*\tx3373\fs8\cf0\f0\charscalex100 {\uc1\u
9679X}\tab \fs18\cf0\f0\charscalex100 {Eisenstadt, M. (2003).}\tab \fs16\cf0\f0\
charscalex100\i {Freedom from agoraphobia}\i0 \fs18\cf0\f0\charscalex100 {. Anch
orage, AK: Mark Eisenstadt,}\par\pard\li1333\ri0\sl-240\slmult0 \fs20\cf0\f0\cha
rscalex100 {M.D.}\par\pard\li1160\ri0\sl-240\slmult0 \*\tx1346\*\tx3373\fs8\cf0\
f0\charscalex100 {\uc1\u9679X}\tab \fs18\cf0\f0\charscalex100 {Weekes, C. (1990)
.}\tab \fs18\cf0\f0\charscalex100\i {Agoraphobia: Simple effective treatment}\i0
\fs18\cf0\f0\charscalex100 {. New York, NY:}\par\pard\li1333\ri0\sl-240\slmult0
\fs20\cf0\f0\charscalex100 {HarperCollins Publishers.}\par\pard\li1693\ri0\sl-3
60\slmult0 \fs18\cf0\f0\charscalex100 {One additional self-help resource might b
e beneficial to friends and family}\par\pard\li1333\ri0\sl-240\slmult0 \fs20\cf0
\f0\charscalex100 {members of people suffering from Agoraphobia:}\par\pard\li116
0\ri0\sl-360\slmult0 \*\tx1333\fs8\cf0\f0\charscalex100 {\uc1\u9679X}\tab \fs18\
cf0\f0\charscalex100 {Chope, R.C. (2001).}{ }\fs16\cf0\f0\charscalex100\i {Heali
ng options for you and the agoraphobic in your life}\i0 \fs18\cf0\f0\charscalex1
00 {. Oakland,}\par\pard\li1333\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {C
A: New Harbinger Publications, Inc.}\par\pard\li1693\ri0\sl-360\slmult0 \fs18\cf
0\f0\charscalex100 {While much empirical research supports the practice of thera
pist-adminis-}\par\pard\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {te

red cognitive-behavioral treatment for Agoraphobia, bibliotherapy approaches}\pa


r\pard\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {have been studied m
uch less. Ghosh and Marks (1987) administered a self-help}\par\pard\li1333\ri0\s
l-240\slmult0 \fs18\cf0\f0\charscalex100 {book instruction coupled with only thr
ee therapist contacts to treat mild agora-}\par\pard\li1333\ri0\sl-240\slmult0 \
fs18\cf0\f0\charscalex100 {phobic avoidance. Results suggested that this treatme
nt approach was as effective}\par\pard\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\ch
arscalex100 {as therapist-guided treatment in less severe cases of Agoraphobia.
However, these}\par\pard\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {r
esults do not seem to generalize to more severe agoraphobic individuals, possibl
y}\par\pard\li1333\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {due to difficu
lties engaging in self-guided exposure exercises (Holden, O\uc1\u8217XBrien,}\pa
r\pard\sect\sectd\sbknone\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn133\pard\s
ect\sectd\sbkpage\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn133\margtsxn666\ma
rgbsxn226\cols2\colno1\colw8306\colsr-0\colno2\colw973\pard\li240\ri0\sl-226\slm
ult0 \fs16\cf0\f0\charscalex100 {A}{ }\fs12\cf0\f0\charscalex100 {G O R A P H O
B I A}\par\column\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100\b {31}\
b0 \par\pard\sect\sectd\sbknone\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn133\
pard\li1320\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1320\ri0\sl-320\slmult0 \fs2
0\cf0\f0\charscalex100 {Barlow, Stetson, & Infantino, 1983). Self-administered b
ibliotherapy appears to be}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\char
scalex100 {an effective treatment approach in some cases of PDA as well (Gould,
Clum, &}\par\pard\li1320\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {Shaprio,
1993).}\par\pard\li1680\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Further
information about Agoraphobia can be found on the following websites:}\par\pard\
li1146\ri0\sl-360\slmult0 \*\tx1320\fs10\cf0\f0\charscalex100 {\uc1\u9679X}\tab
\fs20\cf0\f0\charscalex100 {http://www.adaa.org/Anxiety DisorderInfor/PanicDisAg
or.cfm}\par\pard\li1146\ri0\sl-240\slmult0 \*\tx1320\fs10\cf0\f0\charscalex100 {
\uc1\u9679X}\tab \fs20\cf0\f0\charscalex100 {http://www.nimh.nih.gov/ HealthInfo
rmation/panicmenu.cfm}\par\pard\li1146\ri0\sl-240\slmult0 \*\tx1320\fs10\cf0\f0\
charscalex100 {\uc1\u9679X}\tab \fs20\cf0\f0\charscalex100 {http://www.anxiety n
etwork.com/pdhome.html}\par\pard\li1146\ri0\sl-240\slmult0 \*\tx1320\fs10\cf0\f0
\charscalex100 {\uc1\u9679X}\tab \fs20\cf0\f0\charscalex100 {http://pages. infin
it.net/drnayman/agorapho.htm}\par\pard\li240\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li240\ri0\sl-373\slmult0 \fs18\cf0\f0\charscalex100\b {What are Effective The
rapist-Based Treatments?}\b0 \par\pard\li1320\ri0\sl-253\slmult0 \fs18\cf0\f0\ch
arscalex100 {Barlow and colleagues (Craske & Barlow, 2001; Craske, Barlow, & Mea
dows, 2000)}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {have
developed a widely used cognitive-behavioral therapy for PDA known as Panic}\pa
r\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Control Treatment (
PCT). This therapist-based treatment has received much empir-}\par\pard\li1320\r
i0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {ical support (see Craske, 1999 and
Barlow, 2002 for reviews). However, recent}\par\pard\li1320\ri0\sl-240\slmult0
\fs18\cf0\f0\charscalex100 {research suggests that situational exposure targetin
g agoraphobic avoidance might}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\c
harscalex100 {not be necessary for effective treatment of PDA (Craske, DeCola, S
achs, & Pontillo,}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100
{2003). See Panic Disorder chapter (this volume) for more information about cog
-}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {nitive-behavio
ral treatment approaches for PDA. Therapist-guided exposure was}\par\pard\li1320
\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {moderately effective for severe
Agoraphobia when administered over 4\uc1\u8211X8 weeks}\par\pard\li1320\ri0\sl-2
40\slmult0 \fs18\cf0\f0\charscalex100 {(Holden et al., 1983). st and colleagues f
ound that their Applied Relaxation (AR)}\par\pard\li1320\ri0\sl-240\slmult0 \fs1
8\cf0\f0\charscalex100 {approach coupled with self-exposure instructions was als
o an effective treatment for}\par\pard\li1320\ri0\sl-240\slmult0 \fs20\cf0\f0\ch
arscalex100 {PDA agoraphobic avoidance (st et al., 1993).}\par\pard\li240\ri0\sl213\slmult0 \fs18\cf0\par\pard\li240\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex1
00\b {What is Effective Medical Treatment?}\b0 \par\pard\li1320\ri0\sl-253\slmul
t0 \fs18\cf0\f0\charscalex100 {Pharmacotherapy for Agoraphobia has been widely s

tudied in the context of PDA.}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\c


harscalex100 {Tricyclic antidepressants such as imipramine have effectively trea
ted agoraphobic}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {
avoidance symptoms (Lydiard, Brawman-Mintzer, & Ballenger, 1996). More}\par\pard
\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {recently, several selecti
ve serotonin reuptake inhibitors (SSRIs) have received}\par\pard\li1320\ri0\sl-2
40\slmult0 \fs18\cf0\f0\charscalex100 {empirical support in the treatment of PDA
(see White & Barlow, 2002 for a review).}\par\pard\li1320\ri0\sl-240\slmult0 \f
s18\cf0\f0\charscalex100 {Benzodiazepines were the first approved for PDA treatm
ent, but these medications}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\char
scalex100 {have the potential to undermine effective situational exposure when c
ombined}\par\pard\li1320\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {with cog
nitive-behavioral therapy.}\par\pard\li240\ri0\sl-213\slmult0 \fs18\cf0\par\pard
\li240\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100\b {Other Issues in Manageme
nt}\b0 \par\pard\li1320\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {Many theo
retical and practical issues remain unresolved. The role of panic attacks}\par\p
ard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {and feared anxiety sen
sations, while clear in cases of PDA, might not always explain}\par\pard\li1320\
ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {the development of AWHPD. Some re
searchers have suggested that the pathway}\par\pard\li1320\ri0\sl-240\slmult0 \f
s18\cf0\f0\charscalex100 {leading to Panic Disorder differs from the pathway lea
ding to Agoraphobia}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex1
00 {(Wittchen et al., 1998). Alternatively, comprehensive PDA models (e.g., Barl
ow,}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {2002) might
be extended to explain how fears of unexplained bodily sensations}\par\pard\li13
20\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {lead to AWHPD clinical present
ations involving sensations other than panic.}\par\pard\li1320\ri0\sl-240\slmult
0 \fs18\cf0\f0\charscalex100 {Nevertheless, careful assessment of any feared sen
sations associated with agora-}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\
charscalex100 {phobic avoidance is crucial. The clinical nature and treatment of
AWHPD needs to}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {
be further explored, particularly in medical settings where individuals experien
cing}\par\pard\li1320\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {IBS, headac
hes, and other physical conditions that might lead to Agoraphobia}\par\pard\li13
20\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {would likely present for treat
ment.}\par\pard\li240\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li240\ri0\sl-253\slm
ult0 \fs18\cf0\f0\charscalex100\b {How Does One Select Among Treatments?}\b0 \pa
r\pard\li1320\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {Exposure-based cogn
itive-behavioral therapy treatments are a good choice for}\par\pard\li1320\ri0\s
l-240\slmult0 \fs18\cf0\f0\charscalex100 {individuals willing to confront their
feared situations. This treatment can be quite}\par\pard\sect\sectd\sbknone\pgws
xn10080\pghsxn14400\marglsxn666\margrsxn133\pard\sect\sectd\sbkpage\pgwsxn10080\
pghsxn14400\marglsxn666\margrsxn133\margtsxn666\margbsxn213\cols2\colno1\colw133
3\colsr-0\colno2\colw7946\pard\li253\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex1
00\b {32}\b0 \par\column\pard\li6013\ri0\sl-226\slmult0 \*\tx6840\fs16\cf0\f0\ch
arscalex100 {C}\fs12\cf0\f0\charscalex100 {H A P T E R}\tab \fs16\cf0\f0\charsca
lex100 {T}{ }\fs12\cf0\f0\charscalex100 {W O}\par\pard\li0\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li0\ri0\sl-360\slmult0 \fs20\cf0\f0\charscalex100 {difficult fo
r severely agoraphobic individuals. Therefore, clinicians must assess}\par\pard\
li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {whether the individual can en
dure the distress involved in exposure. Individuals at}\par\pard\li0\ri0\sl-240\
slmult0 \fs20\cf0\f0\charscalex100 {a heightened risk for suicide may need addit
ional intervention before exposure is}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0
\f0\charscalex100 {attempted. In cases involving domestic violence, avoidance be
havior that appears to}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex1
00 {be Agoraphobia might be serving an adaptive self-protective purpose. Exposur
e}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {treatment may als
o be inappropriate for individuals suffering from comorbid psy-}\par\pard\li0\ri
0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {chosis, mania, or dementia. As with
all psychological disorders, the potential for}\par\pard\li0\ri0\sl-240\slmult0

\fs20\cf0\f0\charscalex100 {side-effects and medical contraindications should b


e addressed with individuals}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\chars
calex100 {considering medication treatment.}\par\pard\li0\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li0\ri0\sl-306\slmult0 \fs14\cf0\f0\charscalex100\b {R E F E R E
N C E S}\b0 \par\pard\li360\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li360\ri0\sl213\slmult0 \fs14\cf0\f0\charscalex100 {Albano, A. M., Chorpita, B. F., & Barlow
, D. H. (1996). Childhood anxiety disorders. In E. J.}\par\pard\li0\ri0\sl-186\s
lmult0 \fs16\cf0\f0\charscalex100 {Mash & R. A. Barkley (Eds.),}{ }\fs16\cf0\f0\
charscalex100\i {Child psychopathology}\i0 \fs16\cf0\f0\charscalex100 {. New Yor
k: Guilford Press.}\par\pard\li360\ri0\sl-173\slmult0 \*\tx3546\fs14\cf0\f0\char
scalex100 {American Psychiatric Association. (1980).}\tab \fs14\cf0\f0\charscale
x100\i {Diagnostic and statistical manual of mental disorders}\i0 \par\pard\li0\
ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {(3rd ed.). Washington, DC: Americ
an Psychiatric Association.}\par\pard\li360\ri0\sl-173\slmult0 \*\tx3546\fs14\cf
0\f0\charscalex100 {American Psychiatric Association. (1987).}\tab \fs14\cf0\f0\
charscalex100\i {Diagnostic and statistical manual of mental disorders}\i0 \par\
pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {(3rd ed., rev.). Washing
ton, DC: American Psychiatric Association.}\par\pard\li360\ri0\sl-173\slmult0 \*
\tx3546\fs14\cf0\f0\charscalex100 {American Psychiatric Association. (1994).}\ta
b \fs14\cf0\f0\charscalex100\i {Diagnostic and statistical manual of mental diso
rders}\i0 \par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {(4th ed.)
. Washington, DC: American Psychiatric Association.}\par\pard\li360\ri0\sl-173\s
lmult0 \*\tx3546\fs14\cf0\f0\charscalex100 {American Psychiatric Association. (2
000).}\tab \fs14\cf0\f0\charscalex100\i {Diagnostic and statistical manual of me
ntal disorders}\i0 \par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {
(4th ed., text revision). Washington, DC: American Psychiatric Association.}\par
\pard\li360\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Andrews, G., & Slade,
T. (2002). Agoraphobia without a history of panic disorder may be part}\par\par
d\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {of the panic disorder syndr
ome.}{ }\fs16\cf0\f0\charscalex100\i {Journal of Nervous and Mental Disease, 190
,}\i0 { }\fs16\cf0\f0\charscalex100 {624\uc1\u8211X630.}\par\pard\li360\ri0\sl-1
73\slmult0 \fs14\cf0\f0\charscalex100 {Antony, M. M. (2001). Measures for panic
disorder and agoraphobia. In M. M. Antony, S. M.}\par\pard\li0\ri0\sl-186\slmult
0 \fs16\cf0\f0\charscalex100 {Orsillo, & L. Roemer (Eds.),}{ }\fs16\cf0\f0\chars
calex100\i {Practitioner\uc1\u8217Xs guide to empirically based measures of anxi
ety}\i0 \fs16\cf0\f0\charscalex100 {. New York:}\par\pard\li0\ri0\sl-173\slmult0
\fs16\cf0\f0\charscalex100 {Kluwer Academic/Plenum Publishers.}\par\pard\li360\
ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {Barlow, D. H. (2002).}{ }\fs14\cf
0\f0\charscalex100\i {Anxiety and its disorders: The nature and treatment of anx
iety and panic}\i0 { }\fs14\cf0\f0\charscalex100 {(2nd}\par\pard\li0\ri0\sl-173\
slmult0 \fs16\cf0\f0\charscalex100 {ed.). New York: Guilford Press.}\par\pard\li
360\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {Barlow, D. H., & Craske, M. G
. (2000).}{ }\fs16\cf0\f0\charscalex100\i {Mastery of your anxiety and panic (MA
P-3): Client work-}\i0 \par\pard\li0\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex1
00\i {book for anxiety and panic}\i0 { }\fs16\cf0\f0\charscalex100 {(3rd ed.). S
an Antonio, TX: Graywind/Psychological Corporation.}\par\pard\li360\ri0\sl-186\s
lmult0 \fs16\cf0\f0\charscalex100 {Brown, T. A., Di Nardo, P. A., & Barlow, D. H
. (1994).}{ }\fs16\cf0\f0\charscalex100\i {Anxiety Disorders Interview Schedule
for}\i0 \par\pard\li0\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100\i {DSM-IV (A
DIS-IV)}\i0 \fs16\cf0\f0\charscalex100 {. San Antonio, TX: Graywind/Psychologica
l Corporation.}\par\pard\li360\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {Bu
rke, K. C., Burke, J. D., Regier, D. A., & Rae, D. S. (1990). Age at onset of se
lected mental}\par\pard\li0\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {disor
ders in five community populations.}{ }\fs16\cf0\f0\charscalex100\i {Archives of
General Psychiatry, 47,}\i0 { }\fs16\cf0\f0\charscalex100 {511\uc1\u8211X518.}\
par\pard\li360\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {Chambless, D. L.,
Caputo, G. C., Bright, P., & Gallagher, R. (1984). Assessment of `fear of}\par\p
ard\li0\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {fear\uc1\u8217X in agorap
hobics: The Body Sensations Questionnaire and the Agoraphobic Cognitions}\par\pa
rd\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {Questionnaire.}{ }\fs16\cf

0\f0\charscalex100\i {Journal of Consulting and Clinical Psychology, 52,}\i0 { }


\fs16\cf0\f0\charscalex100 {1090\uc1\u8211X1097.}\par\pard\li360\ri0\sl-173\slmu
lt0 \fs14\cf0\f0\charscalex100 {Chambless, D. L., Caputo, G. C., Jasin, S. E., G
racely, E. J., & Williams, C. (1985). The Mobility}\par\pard\li0\ri0\sl-186\slmu
lt0 \fs16\cf0\f0\charscalex100 {Inventory for Agoraphobia.}{ }\fs16\cf0\f0\chars
calex100\i {Behaviour Research and Therapy, 23,}\i0 { }\fs16\cf0\f0\charscalex10
0 {35\uc1\u8211X44.}\par\pard\li360\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex10
0 {Chambless, D. L., & Mason, J. (1986). Sex, sex-role stereotyping, and agoraph
obia.}{ }\fs16\cf0\f0\charscalex100\i {Behaviour}\i0 \par\pard\li0\ri0\sl-186\sl
mult0 \fs16\cf0\f0\charscalex100\i {Research and Therapy, 24,}\i0 { }\fs16\cf0\f
0\charscalex100 {231\uc1\u8211X235.}\par\pard\li360\ri0\sl-173\slmult0 \fs14\cf0
\f0\charscalex100 {Clark, D. M. (1988). A cognitive model of panic attacks. In S
. Rachman & J. D. Maser (Eds.),}\par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\ch
arscalex100\i {Panic: Psychological perspectives}\i0 \fs16\cf0\f0\charscalex100
{. Hillsdale, NJ: Erlbaum.}\par\pard\li360\ri0\sl-173\slmult0 \fs14\cf0\f0\chars
calex100 {Craske, M. G. (1999).}{ }\fs14\cf0\f0\charscalex100\i {Anxiety disorde
rs: Psychological approaches to theory and treatment}\i0 \fs14\cf0\f0\charscalex
100 {. Boulder,}\par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {CO:
Westview Press.}\par\pard\li360\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {
Craske, M. G. (2003).}{ }\fs14\cf0\f0\charscalex100\i {Origins of phobias and an
xiety disorders: Why more women than men?}\i0 { }\fs14\cf0\f0\charscalex100 {Oxf
ord:}\par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {Elsevier Ltd.}
\par\pard\li360\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Craske, M. G., &
Barlow, D. H. (2001). Panic disorder and agoraphobia. In D. H. Barlow}\par\pard\
li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {(Ed.),}{ }\fs16\cf0\f0\charsc
alex100\i {Clinical handbook of psychological disorders}\i0 { }\fs16\cf0\f0\char
scalex100 {(3rd ed.). New York: Guilford.}\par\pard\li360\ri0\sl-173\slmult0 \fs
14\cf0\f0\charscalex100 {Craske, M. G., Barlow, D. H., & Meadows, E. A. (2000).
Mastery of your anxiety and panic:}\par\pard\li0\ri0\sl-186\slmult0 \*\tx893\*\t
x1480\*\tx1866\*\tx2600\*\tx3226\*\tx3680\*\tx4786\*\tx5653\*\tx6093\*\tx6920\fs
16\cf0\f0\charscalex100 {Therapist}\tab \fs16\cf0\f0\charscalex100 {guide}\tab \
fs16\cf0\f0\charscalex100 {for}\tab \fs16\cf0\f0\charscalex100 {anxiety,}\tab \f
s16\cf0\f0\charscalex100 {panic,}\tab \fs16\cf0\f0\charscalex100 {and}\tab \fs16
\cf0\f0\charscalex100 {agoraphobia}\tab \fs16\cf0\f0\charscalex100 {(MAP-3).}\ta
b \fs16\cf0\f0\charscalex100 {San}\tab \fs16\cf0\f0\charscalex100 {Antonio,}\tab
\fs16\cf0\f0\charscalex100 {TX:}\par\pard\li0\ri0\sl-173\slmult0 \fs16\cf0\f0\c
harscalex100 {Graywind/Psychological Corporation.}\par\pard\li360\ri0\sl-186\slm
ult0 \fs14\cf0\f0\charscalex100 {Craske, M. G., DeCola, J. P., Sachs, A. D., & P
ontillo, D. C. (2003). Panic control treatment}\par\pard\li0\ri0\sl-173\slmult0
\fs16\cf0\f0\charscalex100 {for agoraphobia.}{ }\fs16\cf0\f0\charscalex100\i {Jo
urnal of Anxiety Disorders, 17,}\i0 { }\fs16\cf0\f0\charscalex100 {321\uc1\u8211
X333.}\par\pard\li360\ri0\sl-186\slmult0 \*\tx3520\*\tx5893\fs14\cf0\f0\charscal
ex100 {Durand, V. M., & Barlow, D. H. (2003).}\tab \fs14\cf0\f0\charscalex100\i
{Essentials of abnormal psychology}\i0 \tab \fs14\cf0\f0\charscalex100 {(3rd ed.
). Pacific}\par\pard\li0\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {Grove, C
A: Wadsworth.}\par\pard\li360\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {Eat
on, W. W., Dryman, A., & Weissman, M. M. (1991). Panic and phobia. In L. N. Robi
ns &}\par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {D. A. Regier (
Eds.),}{ }\fs16\cf0\f0\charscalex100\i {Psychiatric disorders in America: The Ep
idemiological Catchment Area study}\i0 \fs16\cf0\f0\charscalex100 {. New}\par\pa
rd\li0\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {York: Free Press.}\par\par
d\li360\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Edlund, M. J., & Swann, A
. C. (1987). The economic and social costs of panic disorder.}\par\pard\li0\ri0\
sl-186\slmult0 \fs16\cf0\f0\charscalex100\i {Hospital and Community Psychiatry,
38,}\i0 { }\fs16\cf0\f0\charscalex100 {1277\uc1\u8211X1279.}\par\pard\li360\ri0\
sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Ehlers, A. (1995). A 1-year prospecti
ve study of panic attacks: Clinical course and factors asso-}\par\pard\li0\ri0\s
l-186\slmult0 \fs16\cf0\f0\charscalex100 {ciated with maintenance.}{ }\fs16\cf0\
f0\charscalex100\i {Journal of Abnormal Psychology, 104,}\i0 { }\fs16\cf0\f0\cha
rscalex100 {164\uc1\u8211X172.}\par\pard\sect\sectd\sbkpage\pgwsxn10080\pghsxn14

400\marglsxn666\margrsxn133\margtsxn666\margbsxn213\cols3\colno1\colw1680\colsr0\colno2\colw6626\colsr-0\colno3\colw973\pard\li240\ri0\sl-226\slmult0 \fs16\cf0
\f0\charscalex100 {A}{ }\fs12\cf0\f0\charscalex100 {G O R A P H O B I A}\par\col
umn\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li0\ri0\sl-346\slmult0 \fs16\cf0\f0\charscalex100 {Eysenck, H. J. (
1967).}{ }\fs16\cf0\f0\charscalex100\i {The biological basis of personality}\i0
\fs16\cf0\f0\charscalex100 {. Springfield, IL: Thomas.}\par\column\pard\li0\ri0\
sl-266\slmult0 \fs20\cf0\f0\charscalex100\b {33}\b0 \par\pard\sect\sectd\sbknone
\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn133\pard\li1680\ri0\sl-173\slmult0
\fs16\cf0\f0\charscalex100 {Gelder, M. G. (1991). Psychological treatment of ago
raphobia.}{ }\fs16\cf0\f0\charscalex100\i {Psychiatric Annals, 21,}\i0 { }\fs16\
cf0\f0\charscalex100 {354\uc1\u8211X357.}\par\pard\li1680\ri0\sl-186\slmult0 \fs
16\cf0\f0\charscalex100 {Ghosh, A., & Marks, I. M. (1987). Self-directed exposur
e for agoraphobia: A controlled trial.}\par\pard\li1320\ri0\sl-173\slmult0 \fs16
\cf0\f0\charscalex100\i {Behavior Therapy, 18}\i0 \fs16\cf0\f0\charscalex100 {,
3\uc1\u8211X16.}\par\pard\li1680\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {
Goisman, R. M., Warshaw, M. G., Peterson, L. G., Rogers, M. P., Cuneo, P., Hunt,
M. F., et al.}\par\pard\li1320\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {(
1994). Panic, agoraphobia, and panic disorder with agoraphobia: Data from a mult
icenter anxi-}\par\pard\li1320\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {et
y disorders study.}{ }\fs16\cf0\f0\charscalex100\i {Journal of Nervous and Menta
l Disease, 182,}\i0 { }\fs16\cf0\f0\charscalex100 {72\uc1\u8211X79.}\par\pard\li
1680\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Goisman, R. M., Warshaw, M.
G., Steketee, G. S., Fierman, E. J., Rogers, M. P., Goldenberg,}\par\pard\li1320
\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {I., et al. (1995). DSM-IV and th
e disappearance of agoraphobia without a history of panic disor-}\par\pard\li132
0\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {der: New data on a controversia
l diagnosis.}{ }\fs16\cf0\f0\charscalex100\i {American Journal of Psychiatry, 15
2,}\i0 { }\fs16\cf0\f0\charscalex100 {1438\uc1\u8211X1443.}\par\pard\li1680\ri0\
sl-186\slmult0 \fs14\cf0\f0\charscalex100 {Goldstein, A. J., & Chambless, D. L.
(1978). A re-analysis of agoraphobia.}{ }\fs14\cf0\f0\charscalex100\i {Behavior
Therapy, 9,}\i0 \par\pard\li1320\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {
47\uc1\u8211X59.}\par\pard\li1680\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100
{Gould, R. A., Clum, G. A., & Shaprio, D. (1993). The use of bibliotherapy in th
e treatment of}\par\pard\li1320\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {p
anic: A preliminary investigation.}{ }\fs16\cf0\f0\charscalex100\i {Behavior The
rapy, 24,}\i0 { }\fs16\cf0\f0\charscalex100 {241\uc1\u8211X252.}\par\pard\li1680
\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {Hazlett-Stevens, H., & Craske, M
. G. (2003). Live (In vivo) exposure. In W. O\uc1\u8217XDonohue, J. E.}\par\pard
\li1320\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {Fisher, & S. C. Hayes (Ed
s.),}{ }\fs16\cf0\f0\charscalex100\i {Cognitive behavior therapy: Applying empir
ically supported techniques in your}\i0 \par\pard\li1320\ri0\sl-186\slmult0 \fs1
6\cf0\f0\charscalex100\i {practice}\i0 \fs16\cf0\f0\charscalex100 {. Hoboken, NJ
: Wiley.}\par\pard\li1680\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Hoffart
, A. (1997). Interpersonal problems among patients suffering from panic disorder
}\par\pard\li1320\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {with agoraphobi
a before and after treatment.}{ }\fs16\cf0\f0\charscalex100\i {British Journal o
f Medical Psychology, 70,}\i0 { }\fs16\cf0\f0\charscalex100 {149\uc1\u8211X157.}
\par\pard\li1680\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Hoffart, A., Fri
is, S., Strand, J. & Olsen, B. (1994). Symptoms and cognitions during situa-}\pa
r\pard\li1320\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {tional and hyperven
tilatory exposure in agoraphobic patients with and without panic.}{ }\fs16\cf0\f
0\charscalex100\i {Journal of}\i0 \par\pard\li1320\ri0\sl-173\slmult0 \fs16\cf0\
f0\charscalex100\i {Psychopathology and Behavioral Assessment, 16,}\i0 { }\fs16\
cf0\f0\charscalex100 {15\uc1\u8211X32.}\par\pard\li1680\ri0\sl-186\slmult0 \fs14
\cf0\f0\charscalex100 {Hoffart, A., Thornes, K., & Hedley, L. M. (1995). DSM-III
-R Axis I and II disorders in agora-}\par\pard\li1320\ri0\sl-173\slmult0 \fs14\c
f0\f0\charscalex100 {phobic inpatients with and without panic disorder before an
d after psychosocial treatment.}\par\pard\li1320\ri0\sl-186\slmult0 \fs16\cf0\f0
\charscalex100\i {Psychiatry Research, 56,}\i0 { }\fs16\cf0\f0\charscalex100 {1\

uc1\u8211X9.}\par\pard\li1680\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Hol


den, A. E., O\uc1\u8217XBrien, G. T., Barlow, D. H., Stetson, D., & Infantino, A
. (1983). Self-help}\par\pard\li1320\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex1
00 {manual for agoraphobia: A preliminary report of effectiveness.}{ }\fs16\cf0\
f0\charscalex100\i {Behavior Therapy, 14,}\i0 { }\fs16\cf0\f0\charscalex100 {545
\uc1\u8211X556.}\par\pard\li1680\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {
Horwath, E., Johnson, J., & Hornig, C. D. (1993). Epidemiology of panic disorder
in African-}\par\pard\li1320\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {Ame
ricans.}{ }\fs16\cf0\f0\charscalex100\i {American Journal of Psychiatry, 150,}\i
0 { }\fs16\cf0\f0\charscalex100 {465\uc1\u8211X469.}\par\pard\li1680\ri0\sl-173\
slmult0 \fs14\cf0\f0\charscalex100 {Horwath, E., Lish, J. D., Johnson, J., Horni
g, C. D., & Weissman, M. M. (1993).}\par\pard\li1320\ri0\sl-186\slmult0 \fs16\cf
0\f0\charscalex100 {Agoraphobia without panic: Clinical reappraisal of an epidem
iologic finding.}{ }\fs16\cf0\f0\charscalex100\i {American Journal}\i0 \par\pard
\li1320\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100\i {of Psychiatry, 150,}\i0
{ }\fs16\cf0\f0\charscalex100 {1496\uc1\u8211X1501.}\par\pard\li1680\ri0\sl-186
\slmult0 \fs14\cf0\f0\charscalex100 {Kagan, J. (1997). Temperamental contributio
ns to the development of social behavior. In D.}\par\pard\li1320\ri0\sl-173\slmu
lt0 \fs16\cf0\f0\charscalex100 {Manusson (Ed.),}{ }\fs16\cf0\f0\charscalex100\i
{The lifespan development of individuals: Behavioral, neurological, and psychoso
cial per-}\i0 \par\pard\li1320\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100\i {
spectives, a synthesis}\i0 \fs16\cf0\f0\charscalex100 {. New York: Cambridge Uni
versity Press.}\par\pard\li1680\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {K
eller, M. B., Yonkers, K. A., Warshaw, M. G., Pratt, L. A., Golan, J., Mathews,
A. O., et al.,}\par\pard\li1320\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {(
1994). Remission and relapse in subjects with panic disorder and agoraphobia: A
prospective}\par\pard\li1320\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {shor
t interval naturalistic follow-up.}{ }\fs16\cf0\f0\charscalex100\i {Journal of N
ervous and Mental Disease, 182,}\i0 { }\fs16\cf0\f0\charscalex100 {290\uc1\u8211
X296.}\par\pard\li1680\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {Kessler, R
. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., et al
.,}\par\pard\li1320\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {(1994). Lifet
ime and 12-month prevalence of DSM-III-R psychiatric disorders in the United Sta
tes.}\par\pard\li1320\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100\i {Archives
of General Psychiatry, 51,}\i0 { }\fs16\cf0\f0\charscalex100 {8\uc1\u8211X19.}\p
ar\pard\li1680\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Kushner, M. G., Ab
rams, K., & Borchardt, C. (2000). The relationship between anxiety disor-}\par\p
ard\li1320\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {ders and alcohol use d
isorders: A review of major perspectives and findings.}{ }\fs14\cf0\f0\charscale
x100\i {Clinical Psychology Review,}\i0 \par\pard\li1320\ri0\sl-173\slmult0 \fs1
6\cf0\f0\charscalex100\i {20,}\i0 { }\fs16\cf0\f0\charscalex100 {149\uc1\u8211X1
71.}\par\pard\li1680\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {Lydiard, R.
B., Brawman-Mintzer, O., & Ballenger, J. C. (1996). Recent developments in the}\
par\pard\li1320\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {psychopharmacolog
y of anxiety disorders.}{ }\fs14\cf0\f0\charscalex100\i {Journal of Consulting a
nd Clinical Psychology, 64,}\i0 { }\fs14\cf0\f0\charscalex100 {660\uc1\u8211X668
.}\par\pard\li1680\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {Magee, W. J.,
Eaton, W. W., Wittchen, H.-U., McGonagle, K. A., & Kessler, R. C. (1996).}\par\p
ard\li1320\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {Agoraphobia, simple ph
obia, and social phobia in the National Comorbidity Survey.}{ }\fs16\cf0\f0\char
scalex100\i {Archives of}\i0 \par\pard\li1320\ri0\sl-186\slmult0 \fs16\cf0\f0\ch
arscalex100\i {General Psychiatry, 53,}\i0 { }\fs16\cf0\f0\charscalex100 {159\uc
1\u8211X168.}\par\pard\li1680\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Mar
caurelle, R., Blanger, C., & Marchand, A. (2003). Marital relationship and the tr
eatment}\par\pard\li1320\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {of panic
disorder with agoraphobia: A critical review.}{ }\fs16\cf0\f0\charscalex100\i {
Clinical Psychology Review, 23,}\i0 { }\fs16\cf0\f0\charscalex100 {247\uc1\u8211
X276.}\par\pard\li1680\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Markowitz,
J. S., Weissman, M. M., Ouellette, R., Lish, J. D., & Klerman, G. L. (1989). Qu
ality}\par\pard\li1320\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {of life in

panic disorder. }\fs16\cf0\f0\charscalex100\i {Archives of General Psychiatry,


46,}\i0 { }\fs16\cf0\f0\charscalex100 {984\uc1\u8211X992.}\par\pard\li1680\ri0\s
l-173\slmult0 \fs14\cf0\f0\charscalex100 {Massion, A. O., Warshaw, M. G., & Kell
er, M. B. (1993). Quality of life and psychiatric morbid-}\par\pard\li1320\ri0\s
l-186\slmult0 \fs16\cf0\f0\charscalex100 {ity in panic disorder and generalized
anxiety disorder.}{ }\fs16\cf0\f0\charscalex100\i {American Journal of Psychiatr
y, 150,}\i0 { }\fs16\cf0\f0\charscalex100 {600\uc1\u8211X607.}\par\pard\li1680\r
i0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Mennin, D. S., Heimberg, R. G., &
Holt, C. S. (2000). Panic, agoraphobia, phobias, and gen-}\par\pard\li1320\ri0\s
l-186\slmult0 \*\tx6106\fs14\cf0\f0\charscalex100 {eralized anxiety disorder. In
M. Hersen & A. S. Bellack (Eds.),}\tab \fs14\cf0\f0\charscalex100\i {Psychopath
ology in adulthood}\i0 { }\fs14\cf0\f0\charscalex100 {(2nd}\par\pard\li1320\ri0\
sl-173\slmult0 \fs16\cf0\f0\charscalex100 {ed.). Needham Heights, MA: Allyn & Ba
con.}\par\pard\li1680\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {Mowrer, O.
H. (1960).}{ }\fs16\cf0\f0\charscalex100\i {Learning theory and behavior}\i0 \fs
16\cf0\f0\charscalex100 {. New York: Wiley.}\par\pard\li1680\ri0\sl-173\slmult0
\fs14\cf0\f0\charscalex100 {st, L.-G., & Hugdahl, K. (1983). Acquisition of agora
phobia, mode of onset, and anxiety}\par\pard\li1320\ri0\sl-186\slmult0 \fs16\cf0
\f0\charscalex100 {response patterns.}{ }\fs16\cf0\f0\charscalex100\i {Behaviour
Research and Therapy, 21,}\i0 { }\fs16\cf0\f0\charscalex100 {623\uc1\u8211X631.
}\par\pard\li1680\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {st, L.-G., Westl
ing, B. E., & Hellstrm, K. (1993). Applied relaxation, exposure in vivo and}\par\
pard\li1320\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {cognitive methods in
the treatment of panic disorder with agoraphobia.}{ }\fs16\cf0\f0\charscalex100\
i {Behaviour Research and}\i0 \par\pard\li1320\ri0\sl-173\slmult0 \fs16\cf0\f0\c
harscalex100\i {Therapy, 31,}\i0 { }\fs16\cf0\f0\charscalex100 {383\uc1\u8211X39
4.}\par\pard\li1680\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {Paradis, C. M
., Hatch, M., & Friedman, S. (1994). Anxiety disorders in African Americans: An}
\par\pard\li1320\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {update.}{ }\fs16
\cf0\f0\charscalex100\i {Journal of the National Medical Association, 86,}\i0 {
}\fs16\cf0\f0\charscalex100 {609\uc1\u8211X612.}\par\pard\li1680\ri0\sl-186\slmu
lt0 \fs14\cf0\f0\charscalex100 {Pollard, C. A., Bronson, S. S., & Kenney, M. R.
(1989). Prevalence of agoraphobia without}\par\pard\li1320\ri0\sl-173\slmult0 \f
s16\cf0\f0\charscalex100 {panic in clinical settings.}{ }\fs16\cf0\f0\charscalex
100\i {American Journal of Psychiatry, 146,}\i0 { }\fs16\cf0\f0\charscalex100 {5
59.}\par\pard\sect\sectd\sbknone\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn133
\pard\sect\sectd\sbkpage\pgwsxn10080\pghsxn14400\marglsxn666\margrsxn133\margtsx
n666\margbsxn666\cols2\colno1\colw1333\colsr-0\colno2\colw7946\pard\li253\ri0\sl
-266\slmult0 \fs20\cf0\f0\charscalex100\b {34}\b0 \par\column\pard\li6013\ri0\sl
-226\slmult0 \*\tx6840\fs16\cf0\f0\charscalex100 {C}\fs12\cf0\f0\charscalex100 {
H A P T E R}\tab \fs16\cf0\f0\charscalex100 {T}{ }\fs12\cf0\f0\charscalex100 {W
O}\par\pard\li360\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li360\ri0\sl-333\slmult0
\fs16\cf0\f0\charscalex100 {Pollard, C. A., & Henderson, J. G. (1987). Prevalen
ce of agoraphobia: Some confirmatory}\par\pard\li0\ri0\sl-173\slmult0 \fs16\cf0\
f0\charscalex100 {data.}{ }\fs16\cf0\f0\charscalex100\i {Psychological Reports,
60,}\i0 { }\fs16\cf0\f0\charscalex100 {1305.}\par\pard\li360\ri0\sl-186\slmult0
\fs14\cf0\f0\charscalex100 {Pollard, C. A., Tait, R. C., Meldrum, D., Dubinsky,
I. H., & Gall, J. S. (1996). Agoraphobia}\par\pard\li0\ri0\sl-173\slmult0 \fs16\
cf0\f0\charscalex100 {without panic: Case illustrations of an overlooked syndrom
e.}{ }\fs16\cf0\f0\charscalex100\i {Journal of Nervous and Mental Disease,}\i0 \
par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100\i {184,}\i0 { }\fs16\
cf0\f0\charscalex100 {61\uc1\u8211X62.}\par\pard\li360\ri0\sl-173\slmult0 \fs14\
cf0\f0\charscalex100 {Rapee, R. M., Craske, M. G., Brown, T. A., & Barlow, D. H.
(1996). Measurement of perceived}\par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\
charscalex100 {control over anxiety-related events.}{ }\fs16\cf0\f0\charscalex10
0\i {Behavior Therapy, 27,}\i0 { }\fs16\cf0\f0\charscalex100 {279\uc1\u8211X293.
}\par\pard\li360\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Reiss, S., Peter
son, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety
}\par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {frequency and the
prediction of fearfulness.}{ }\fs16\cf0\f0\charscalex100\i {Behaviour Research a

nd Therapy, 24,}\i0 { }\fs16\cf0\f0\charscalex100 {1\uc1\u8211X8.}\par\pard\li36


0\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Robins, L. N., Helzer, J. E., C
roughan, J., & Ratcliff, K. S. (1981). National Institute of Mental}\par\pard\li
0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {Health Diagnostic Interview Sch
edule: Its history, characteristics, and validity.}{ }\fs16\cf0\f0\charscalex100
\i {Archives of General}\i0 \par\pard\li0\ri0\sl-173\slmult0 \fs16\cf0\f0\charsc
alex100\i {Psychiatry, 38,}\i0 { }\fs16\cf0\f0\charscalex100 {381\uc1\u8211X389.
}\par\pard\li360\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {Robins, L. N., H
elzer, J. E., Weissman, M. M., Orvaschel, H., Gruenberg, E., Burke, J. D., et}\p
ar\pard\li0\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {al. (1984). Lifetime
prevalence of specific psychiatric disorders in three sites.}{ }\fs16\cf0\f0\cha
rscalex100\i {Archives of General}\i0 \par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0
\f0\charscalex100\i {Psychiatry, 41,}\i0 { }\fs16\cf0\f0\charscalex100 {949\uc1\
u8211X958.}\par\pard\li360\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Spieri
ngs, E. L. H., Reinders, M. J., & Hoogduin, C. A. L. (1989). The migraine aura a
s a}\par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {cause of avoida
nce behavior.}{ }\fs16\cf0\f0\charscalex100\i {Headache, 29,}\i0 { }\fs16\cf0\f0
\charscalex100 {254\uc1\u8211X255.}\par\pard\li360\ri0\sl-173\slmult0 \fs14\cf0\
f0\charscalex100 {Vasey, M. W., & Dadds, M. R. (2001). An introduction to the de
velopmental psychopathology}\par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charsc
alex100 {of anxiety. In M. W. Vasey & M. R. Dadds (Eds.),}{ }\fs16\cf0\f0\charsc
alex100\i {The developmental psychopathology of anxiety}\i0 \fs16\cf0\f0\charsca
lex100 {. Oxford:}\par\pard\li0\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100 {O
xford University Press.}\par\pard\li360\ri0\sl-186\slmult0 \fs16\cf0\f0\charscal
ex100 {Wardle, J., Ahmad, T., & Hayward, P. (1990). Anxiety sensitivity in agora
phobia.}{ }\fs16\cf0\f0\charscalex100\i {Journal of}\i0 \par\pard\li0\ri0\sl-173
\slmult0 \fs16\cf0\f0\charscalex100\i {Anxiety Disorders, 4,}\i0 { }\fs16\cf0\f0
\charscalex100 {325\uc1\u8211X333.}\par\pard\li360\ri0\sl-186\slmult0 \fs14\cf0\
f0\charscalex100 {Watson, D., & Clark, L. A. (1984). Negative affectivity: The d
isposition to experience aversive}\par\pard\li0\ri0\sl-173\slmult0 \fs16\cf0\f0\
charscalex100 {emotional states.}{ }\fs16\cf0\f0\charscalex100\i {Psychological
Bulletin, 96,}\i0 { }\fs16\cf0\f0\charscalex100 {465\uc1\u8211X490.}\par\pard\li
360\ri0\sl-186\slmult0 \fs14\cf0\f0\charscalex100 {White, K. S., & Barlow, D. H.
(2002). Panic disorder and agoraphobia. In D. H. Barlow (ed.),}\par\pard\li0\ri
0\sl-173\slmult0 \fs16\cf0\f0\charscalex100\i {Anxiety and its disorders: The na
ture and treatment of anxiety and panic}\i0 { }\fs16\cf0\f0\charscalex100 {(2nd
ed). New York: Guilford}\par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex
100 {Press.}\par\pard\li360\ri0\sl-173\slmult0 \fs14\cf0\f0\charscalex100 {Wittc
hen, H.-U., Reed, V., & Kessler, R. C. (1998). The relationship of agoraphobia a
nd panic}\par\pard\li0\ri0\sl-186\slmult0 \*\tx4680\fs16\cf0\f0\charscalex100 {i
n a community sample of adolescents and young adults.}\tab \fs16\cf0\f0\charscal
ex100\i {Archives of General Psychiatry, 55,}\i0 \par\pard\li0\ri0\sl-173\slmult
0 \fs16\cf0\f0\charscalex100 {1017\uc1\u8211X1024.}\par\pard\li360\ri0\sl-186\sl
mult0 \fs16\cf0\f0\charscalex100 {World Health Organization. (1990).}{ }\fs16\cf
0\f0\charscalex100\i {Composite International Diagnostic Interview (CIDI), Versi
on}\i0 \par\pard\li0\ri0\sl-173\slmult0 \fs16\cf0\f0\charscalex100\i {1.0}\i0 \f
s16\cf0\f0\charscalex100 {. Geneva: World Health Organization.}\par\pard\sect\se
ctd\sbkpage{\shp
{\*\shpinst
\shpleft720\shptop720\shpright3280\shpbottom1426
\shpfhdr0\shpwr3\shpwrk0\shpfblwtxt1\shplid2030\shpz0\shpbxpage\shpbypage
\absh16840\absw11893{\sp{\sn shapeType}{\sv 75}}
{\sp{\sn fFlipH}{\sv 0}}
{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn pibFlags}{\sv 2}}
{\sp{\sn fLine}{\sv 0}}{\sp{\sn fEditedWrap}{\sv 0}}
{\sp{\sn fBehindDocument}{\sv 1}}
{\sp{\sn pib}{\sv {\pict
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C

140D0C0B0B0C1912130F141D1A1F1E1D1A1C1C20242E2720222C231C1C2837292C30313434341F27
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
001108002C00A003012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
838485868788898A92939495969798999AA2A3A4A5A6A7A8A9AAB2B3B4B5B6B7B8B9BAC2C3C4C5C6
C7C8C9CAD2D3D4D5D6D7D8D9DAE1E2E3E4E5E6E7E8E9EAF1F2F3F4F5F6F7F8F9FAFFC4001F010003
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
A7A8A9AAB2B3B4B5B6B7B8B9BAC2C3C4C5C6C7C8C9CAD2D3D4D5D6D7D8D9DAE2E3E4E5E6E7E8E9EA
F2F3F4F5F6F7F8F9FAFFDA000C03010002110311003F00F7FAF1DD7B4FD77C6BE2CD5B4FB3D4A6BA
D0AD754B486E2052A15136E652AE7077211C8073F37B5763E3CD5277B583C31A53B7F6C6B19890A1
C7910FFCB4958F600640F53D3A55CF08786DFC330DF5AA4361059B4D9B68ED91B795191BA5762773
918E98031EFC6D07C8B9BAF43392E67CBD0E3FC35ABFC42B4D0ECEE0E996DAAE9D6CD240F16F68EF
5D518A863BF824633C7247BD771E17F15D878AECA7B8B249E17B794C335BDCA8496361FDE504E3FF
00AC7D2A58F5F493C61378796DD8BC364B76D3EEE06E72A171EBC6735CB78DADA2F0D78834BF1A40
F25BC22E12DB561131559616F955DC0FBDB491FA0ED4DDA6ECD59BD84AF157BDCF41A29B1C8B2C6B
221DC8C0329F506B1BC5BE25B7F09786EEB57B88CCA220163881C191C9C019EDEE7D01AC526DD91A
3692BB36E8AF3C327C47B9F0FA6B76D7BA42CEF089D34C168C41523217CC2D92D8FA0CF7AEA7C23A
D4BE21F09E9BAB4E91A4D75087758F3B43670719CF191552834AF71295DD8DAA28A2A0A0A28AE43C
77E21F12682BA6FF00C23DA1FF00699B898A4FF2336C1C607CBD3393F31E062AA317276426ECAE75
F4520C9032307D296A4614514500145145001451450078F68BAF9D0BE20DCB7889D975DBFB9FB1BC
022DC1A367410344E785840DE5B9C938C824559D63523AC5F5F78AA5D6AEF45D1AC37E9F66F64419
AFDF77CDB41C820B0C28033C1248C57A0F88349D0751B167D7ADACDED931BA4B921428CF19638C0C
9F5AE03C272F866F7579757BCD434DB6B1D3A792DB45B07B94548114FCD36D279666C904F41F863A
A32525CD63069AF76E743F0EFC3DA8E9D6777AC6B92CF2EADA9B2B3F9E4178A25188D1B000DD8393
8C75C76AB7F126159FE1CEBAAE385B62E3EAA430FD40AD4FF84ABC3BFF0041ED2FFF000323FF001A
E53E24789747B9F01EA56967AC69D35CDD79702225D231F99D412707A0193F85671E69544DAEA5BE
55068ED7499EE2E747B39EEE358AE24851E4457DC15881900F7AC7F1DF85FF00E130F0A5CE9492AC
5392B242EDF743A9E33EC4647E35AFA4183FB22D16DAF45EC2912C6B721D5BCDDA31BB2BC1391CE2
B9FF001E789E6F095A693A882059BEA31C37995DC7CA656C91EE300FE18A98DF9FDDDC72B72EA703
A17C43D6FC022DBC3FE36D22E16DE102282F23193B0703D9C01DC1CE3B135DC78A75DBBD37C0875B
F09BE986D228BCECC9192A633FDC0A400727A1FE752F8E2EFC3F7FF0FF00529AFAE6D26B292D99E0
9378399369D850FF007B38C62B87D234EBED33F676D492F91E369629268A37E0AC6CC31C76CF27F1
ADBDD95A56B3B99EB1BC6FD0D3D3750F893AFF0082ACF57B0BCD2A294C46408D1EE96E704F5E36A6
718000FA9F4D6F07F8D753F19782AEAEECA0B3875CB57F29E39F77925B83BB03E6008CF1EA2AB780
FC5BA0697F0BF4D96EF56B4436B015963F347981813F2EDEA49EC31CD37E16E8B3E81E14D4754D55
16CA4D4A66B9F2E53B7CA8F1F2EECF43C93F42294D2B4AEB67A046F7567D0E7741F1CFC43F17F87A
EE5D12CAD1AEE1B825E62AA88136AED8A30C796CEE2493C023D6B77C7BE2BF17785ED746913FB311
2F1A3867654669125C02FB7276EDEB8EB54FE01DC43FF0885F5BF9C9E77DBD9BCBDDF363CB4E71E9
C1FCA93E395D5BC761A0C4D346245BF1214DC32140E4E3D39156D2F6DC96D0577ECF9AE74BF12FC4
3AEF85BC3BFDABA38B03146C127FB4AB338DC405280103AF5CD73FAAEB5F1113C190F89E19F4BB58
22B68E77B5D9E6492A1032ECD8C02739DAB8C0EF9ABFF19AEED9BE1ADC85B8898CD2C5E580E0EFC3
83C7AF43526B1776C7E05B38B888AB68F1C6A438C16F2C0DA3DF3DAA20928C5DBA8E5F13D7A1AD69
E3781FE1BA78BEEA02882DBCD7850F57076ED07D0B700FBD72FF00DB9E39BAF033F8CE1D46C22511
B5CAE97F64DC9E4A93D642776EDA09FF000A5F0C0D1AFBE01C76DAB5F24163F679127981C985BCD6
DA703BE76E077AC8F08DB78A75AF870744B5BFD21347B8F32DE2BC99DBED0B06E208F2C6464F3805
8601FA53518ABF93EBD81C9BB7A1D3786FC6FA93F81AEFC63E219EC4D8F964C16F67132B060C54AB
162724B600EDDEB3353F1578B2CBC2A9E2DFED7D2501549BFB13CA07F74C460799BB717C302781FE
36BC75E0FF00ECFF00836FA2E8EB24A960126207DE9406DCEC71F52DF8565F8575BF85D37862DAEE
FEC745B5BD86155B98A7B652E5C0C12A0825B3D78CF5A6945AE74AFAFE026DDF95BE86DF8BBC73AC
5A7802C7C55A047642D678D1A65BA5669232F8036E08070720E69BA16B3F1035AD4B43D416CADA2D
027897CFF376891C6DE6523A8DC72540EC466A1F8AF75627E12916C8B6B14E60682DD93CA60BB81C
6CED81DBB5767E10B886E3C1FA318668E40B6302B14607044638E2A1D953BDBAB295DCED72F6AC34
F3A64C3558E192C8E3CC49A3DE87918C8C1CF38AE63CAF879FF40CD1BFF05EBFFC4575D776905F5B
3DBDCC62485F1B9492338391D3E9599FF08A687FF40F4FFBEDBFC6BCEAD2C5A97EE1C6DE77DFE477

5258671FDF5EFE56FD4C4F2BE1E7FD03346FFC17AFFF00114795F0F3FE819A37FE0BD7FF0088ADBF
F845343FFA07A7FDF6DFE347FC229A1FFD03D3FEFB6FF1ACB9F31EF0FF00C98D39701DA5F81774B1
6034D846991C51D9007CA4863D8A064E703031CE6A5BBB2B5D42D9ADEF2DA1B881BEF47320753F81
A5B5B586CAD92DEDD364499DAB9271CE7BD4D5DB072B272DFAFA9C92E5BBE5D8E76D7C05E13B2BB1
756FE1FB04981C86F281DA7D81E0557F893FF24E75DFFAF63FCC5755591AF78674AF13411C1AB412
4F0C64911ACEF1A9CE3A85233D075E95A467EF2726438FBAD2396F865E1BD08F83344D53FB26C4DF
98326E4C2A5F76E3CEEC673EF5DC5F69F67A9DAB5ADFDA41756EC4168A78C3A92391C1E2B3341F09
E8DE19DE348B796DD1C60A1B991D0739E1598807DC0ADBA272BC9B4C231B46CCCBB2F0D685A75DAD
D58E8DA7DB5C28216586D911803D4640CD17BE1BD0B52BA3757DA369F757040532CD6C8EC40E8324
66B528A9E67BDC7646449E14F0ECB0C10C9A169AF1C0A56146B5422304E48518E32493C7AD38F863
416B15B16D174F368B279AB01B64D81F18DDB718CE3BD6AD14733EE16470BE379343F04F82351B8B
6F0FD8B25D6D81ADE3815124639C17DB8E073EFE98EB583A0FC18F0ADE787ACAE6E9EE6E27B88565
69A29B6AE5867E51E833C6735E99AAE9563ADE9B369DA8DBA5C5ACC30F1B77EE0FB107906BCCF47F
04DADB6B971A2C3AC6B69A52B11F634BE648C83C91F2E0F3EC6BA29C9B8BB3B3329A4A4AEB42E7C2
2B7BBB03E24D33ED725DE93657DE4594AED9071BB7007A74D9C0E324FAD7671F847C3916A43518F4
3D3D2F036E12ADBA821BD7A75F7EB5A1A7E9F67A5584363616F1DBDAC2BB638E318007F9EF566B29
CDCA4DA2E31B24999FA8683A3EAD2A4BA9697657924636A3DC40B2151E8091C53F4ED1F4CD21244D
374FB5B3590EE716F0AC618FA9C0E6AED151776B1565B9FFD9}
}}}}{\shp
{\*\shpinst
\shpleft720\shptop1960\shpright7720\shpbottom10960
\shpfhdr0\shpwr3\shpwrk0\shpfblwtxt1\shplid2031\shpz1\shpbxpage\shpbypage
\absh16840\absw11893{\sp{\sn shapeType}{\sv 75}}
{\sp{\sn fFlipH}{\sv 0}}
{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn pibFlags}{\sv 2}}
{\sp{\sn fLine}{\sv 0}}{\sp{\sn fEditedWrap}{\sv 0}}
{\sp{\sn fBehindDocument}{\sv 1}}
{\sp{\sn pib}{\sv {\pict
\jpegblip
FFD8FFE000104A46494600010100000100010000FFDB004300080606070605080707070909080A0C
140D0C0B0B0C1912130F141D1A1F1E1D1A1C1C20242E2720222C231C1C2837292C30313434341F27
393D38323C2E333432FFDB0043010909090C0B0C180D0D1832211C21323232323232323232323232
3232323232323232323232323232323232323232323232323232323232323232323232323232FFC0
00110801C2015E03012200021101031101FFC4001F00000105010101010101000000000000000001
02030405060708090A0BFFC400B5100002010303020403050504040000017D010203000411051221
31410613516107227114328191A1082342B1C11552D1F02433627282090A161718191A2526272829
2A3435363738393A434445464748494A535455565758595A636465666768696A737475767778797A
838485868788898A92939495969798999AA2A3A4A5A6A7A8A9AAB2B3B4B5B6B7B8B9BAC2C3C4C5C6
C7C8C9CAD2D3D4D5D6D7D8D9DAE1E2E3E4E5E6E7E8E9EAF1F2F3F4F5F6F7F8F9FAFFC4001F010003
0101010101010101010000000000000102030405060708090A0BFFC400B511000201020404030407
05040400010277000102031104052131061241510761711322328108144291A1B1C109233352F015
6272D10A162434E125F11718191A262728292A35363738393A434445464748494A53545556575859
5A636465666768696A737475767778797A82838485868788898A92939495969798999AA2A3A4A5A6
A7A8A9AAB2B3B4B5B6B7B8B9BAC2C3C4C5C6C7C8C9CAD2D3D4D5D6D7D8D9DAE2E3E4E5E6E7E8E9EA
F2F3F4F5F6F7F8F9FAFFDA000C03010002110311003F00F7FA2B9EB1F16C17BA8A5A9D36FE08A6BB
9ECA0BA97CAF2A69613207002B971FEAA420B28CEDFA55DFF849B40FB3CB71FDB7A6F910AA3CB27D
AE3DA8AE32849CE00600919EBDA803528ACFB8D7B47B4D3A3D46E755B186C65C7977325C22C4F9E9
862706ABA78A347B896F61B4BE82E66B1BB8ACEEA38E6406292465500EE20756C70492559402C36D
006C5158F61E28D1F578ADE6D2EFA0BD866BB92CC490CC9859115D88E482784246D04904301B72C2
D26B5A5482F0A6A764C2C4137656753F67C649F339F97183D71D0D005EA2A9C1ABE99751DCC96FA8
DA4A96AC56E1A39D584247243907E523DEA31AEE906C22BE1AAD89B398911DC7DA13CB7203120367
0701589F653E9401A145642789B486B5BBBC96F60B7B2B6952337734A8B0C9BE3491591F382A448A
33EA0FD4E82DEDAB580BF4B989ACCC5E709D5C1431E33B830E08C739A009E8AC5D375F9B539E1F2B
41D523B298164BD9BC948CAE320943279A33D06533C8CE07356AE75AB0B7D39AF56EA09A3368F791
849E31E6C4A012EACCC176FCCBF312146E19201A00D0A2B235CF12E93E1EB4B89AFEF215961B692E
45B09504D2A22963B1491B8F06AEC9A9D843A845A7CB7D6C97B32968ADDA5512381D4AAE724707A5
005AA2B3F50D734BD2AF2C2D2FEFE0B6B8D42530DAC723E0CAF8CE07E83EACA3AB00668F53B09751
934F8EFAD9EFA25DF25B2CAA6445F52B9C81C8FCE802D5158FAB6BC74CD46D2C20D2AFB51BABA8A5
9952D0C236A46630C4996441D655E99EF56EC3515BDB6692485ED268C9135B4D246D2427A80FE5B3

28CAE1BAF422802ED15971F88B496D257549B50B4B7B1695E24B896E63F2D8ABB270E18AF3B49033
9EC402080C83C4DA4C9A51D4E7BD86CED3ED32DA896EA548D59E395E33824E0825091CF231F4A00D
7A2A8DDEB5A5584CB0DE6A7656F2B6CDA934EA8C779213009EE5580F5DA7D29F26A9A7C3A943A6CB
7F6A97F3A968AD5A6512C80024955CE48C03D07634016E8AAB6DA9D85EDC5C5BDADF5B4F3DB36D9E
38A556688FA30072A783D6A1D6B564D134C37B25B4F73FBD8A14860DBBDDE49163503732AFDE71D4
8A00D0A2B16D3C51A7CB6177777C4E942CE7FB3DCA6A0E91989F6AB005831539575208620E6AC5CF
88745B3B086FEEB58D3E0B39FF00D55C4B728B1C9FEEB1383F850069515564D4EC21D422D3E5BEB6
4BD994B456ED2A891C0EA557392383D2A96A5E25D274C9D6DA6BC85EF0CD045F658E54330F36548D
58A120EDCB824FA67AF4A00D7A2B2F5AD6868C2C956C2EEFA7BDB8FB3C305A98C316F2DE424991D5
400B1B77F4A893C55A32E9316A57D7D069B0BCB2438BF99222B223B23A124E090CAC382471C64500
6CD1501BDB41692DD1BA845B45BFCC9BCC1B136121F27A0DA4107D307359D75E28D1EDE39D92FA0B
96B7B982DAE23B7991DE079A5589778CFCA37364E7B03D718A00D8A2B3D75DD1DF4C6D4D755B16D3
D4E1AE85C21881CE305F38EBC75A67FC245A31D5ACF4B1A9DAB5F5EC0D716D0AC8099631FC4B8EA3
A91EA1588C853800D3A2B2743F12695E21B3827B0BB89A496DA2B96B632299A1491432EF504ED383
53C3AE6937368F7506A9652DB24A217992E11916424284241C062580C75C91EB4017E8ACB3E26D00
476D21D6F4D0974C56DDBED71E2620ED210E7E6208238EE2A5975CD22DEF56CA6D56C63BB693CA58
1EE10485F01B6852739C329C7A30F5A00BF45406F6D05A4B746EA116D16FF326F306C4D8487C9E83
69041F4C1CD4F4005145140051451401CD7863C38BA72DCDD5DC530BC9350BD9D564B9791115EE25
64644DC51094619DA01F98E7926B32DF48D5F49F87BE1BD3EC6C365EDA456EB7696EB034D1111112
344643E599379C124E3058F27AF416DE27D36F25BC8EDC5F49F63F344AEBA7DC6C262628EA8FB36C
8C1811B509270700E2B62803CFF44D2F5BD162D3EEA7D26EEF64B39B50468525B7F3241713ACC930
F9923C800A11F2F2CD818C66FDF68BA94936B491DA975BAD6F4DD4229048A018E36B5120E4E41516
EEDD39057193903A9B0BEB7D4F4EB6BFB393CCB5BA892685F691B91802A7079190475AB1401C759E
8BA94336928F6A42D9F886FAF1E4F317061992E991C739EB3A2118CE41E31CD62B78635B9BC3373A
77F6718A7B4F0E5D692AE658FF00D3E69026D7186E06509CBED3994FB9AF4BAAEF7D6F1EA30D8349
8BA9A29268D369F9910A0639E9C1913F3F63401C9EB7E17BCBCBAD623D3D3ECB6F2D969C96ED0EC5
CB4171348E8AA4103E5283E652BF377008A86C7C3D752CDA5CD3D9EA526CD71EFAEBFB54DA9703EC
7246AEAB01D98DE63C00376ECB11DEBA2D43C4FA6E99A89B09C5F4974B12CCC969A7DC5CED462C14
9312301928DD7D0D6A4132DCDBC53A09024881D4491B230046795600A9F62011DE80317C59672DDE
9D6ED6D6BA84D7905C096DDEC1E159207DACBBCF9CC10AE18A91CFDEE9DC4D75A6DDEB3E0C9B4BD4
A48E3BDBDD3DADEE5E1195591E3DAC57DB24E2B4AEAEA0B1B496EAEA6486DE142F248E7015472493
5990F8AB479ACEFAE85C4B1C763099EE167B69629123009DFB1D4315C29C100E70719A00AB1DFF00
886EB52D2E06D1A7B1863998DFCE6581E1923F2A40163C3193FD618CF2AA700E7D0F2527873C4337
8762D24E9250D8F852F348490DC4644F70C902AED1BB856F28E0B60F5C85E33D9DE78C745B0BDBAB
5B99AE51AD1825C4A2CA768612555C07942796BF2BA9E5B8C8CD6E2B0650CA41046411DE80385F13
E95ABCDA7F8B6C2D7466D45B59858DB4DE6C48917FA3AC611B7B06C8752C3008CBF257934FD43C3B
7EDE2E9AE9DB579ECAEAFAD6E956CDAD045118846079865025C65093E59390C46324E7B8A28031B5
CB2B9B8BFD06EADE132AD96A3E74CA1803B1A09622C324038328623AE01C64E01C5B0D1B528B5DB4
8E4B2290DA6A7797ED7FE62113A4C25DB1800EFC8F3541C803F74304F18EAEC2FADF53D3ADAFECE4
F32D6EA249A17DA46E4600A9C1E46411D6AC50071FE2CD2EE2EFC43A45EAE99AADF5AC1697514834
CBF16B223BBC0572DE7444A911BF193C81C74A8AFB46D4AF92D3EC56773676FA840B61A9C57770AF
3450A3121CB077DCC53CC4C8666FDEA93F74D76B55EE6F6DED24B68E793635CCBE4C5C13B9F6B363
23A70A7AFD3A91401C858E93A9E8CF677834B92E92DEE7541F63824883013DD1922906E655C04046
339024E9D4567AF8675A8B4DD3E710DE5ABDBDC6A7E65969CD6AEFB2E2E4BA63CF0632A1063F84E1
FB722BB3B3F11E937FE4FD96F04BE75CCB691E11B9963DC5C74E00D8DCF43C60F233A9401E7B77E1
3BB7D235B8ADAC256925F0AC1A6591BA9223399556E328CC0E037CF16483B49E878E3A4B186F34FF
0013EA7BB4F9A7B6D46649D6F51E3D90058513CB70583FDE8C91B430FDE76E689BC63A345702057B
DB993CB12FFA1E9D71720216740C4C68C002637C7AE3238E6B4A7D52D2D7469756B87921B38ADCDC
C8D244EAC9185DC4942370207F0E33DB19A00E3FC2BE19D474CB88EDEF2E35BF3EDB4E7B38EF58D9
790373212D1855F30B65770F35580F9B39279B9E21F0FEA52786AE2D86A1AAEB7235DD9CBE4B3DBC
122A47711BBF96F1AC5862AA792DD40C106BB0A87ED707DB4D9F983ED02312F967A95CE323D79EB8
E9919EA2803888B4ED7AD3426165A6DC439D4FCE8E279619EF6180C782C2495991A52FBB9666C236
324802A941A26BF63A25A2DB69FA80D76D6EAF8DBDD89AD4C5B269BCDFDF0DC328D9504226E0636D
A00DB9F4AA280387D43C3B7EDE2E9AE9DB579ECAEAFAD6E956CDAD045118846079865025C65093E5
9390C46324E5979A56AE6DC696BA335C11AEC5A89D40CB104F2BEDAB3700B6FDCB1FCB8C0E178278
07BBA28039FF001368B26B575A0A059FECF6FA834F70F05CB40E89F669D010C8CADF7DD0614F7E78
CD52F12E95770269F2787AC6EC6A36CB2ADBCF0C917951EF2A584E246DCCAE4024A867F949C83D7A
DA28038BBAB19E5F174BA1C4A0E9976D1EA97583F7369DA63C760EE91B7BE25151268DA8DC7826CF
C3971A449BEC6E34F492595E268AF123B88DA59170C4F2A8CC43804EEC0DC6BB9A28038BB9D17528
353BCD422B06B88A2D752FE3B68DD035C45F61480EDDCC1411265B0C4729EE0D3F44D1351D3F52D1

6EA6B602358B5149A34914FD9BED13A4F1AF5E55447B3E5CF3B7031923B1A2803CF6CBC1FA8A787B
44D363812C658FC2F75A75C488CBFB9B9905BE33B4F2772487232383CF232D4F0CDF5D69F7714F67
AACD34B73A62C8BA8B59794F0C172AEFB04180404DD9DE01202800E315E894500709E3BD235FD5D2
FAC34BB7905B5DE9AD6EB2DB8B705A43BFE499A5CB08F0571E58CE4B72BC1AA4D16A5A9CBE36B1B6
D0E459B539920FB4F9B106B476B1B71FBCF9B24216C8D9BF9CF4E09F48A28038BBAB19E5F174BA1C
4A0E9976D1EA97583F7369DA63C760EE91B7BE2515DA514500145145001451450079DC9A26A6BE01
F1766E35295EE93585834C6863DB979A628C80462462C08232C41DFC0E98D0FB1471FC4D1750D81B
C925FF005D7171A7383640438061B961B4AB60298D4939763FDE15D25AEBBA45F5FCF6169AAD8DC5
E40489ADE1B84792320E0865072307839A9FFB46C7FB43FB3FED96FF006DD9E67D9BCD5F336FF7B6
E738F7A00F38D17C377DA7685A32693652D96A771E149E29E664656177B6D8442463D194993683D0
060300532DB4377D16FAD63491925BED2FCCB4B6D1AE2C1536DD2192405D9B7B15FBCE8DC08C1279
CD7A57F68D8FF687F67FDB2DFEDBB3CCFB379ABE66DFEF6DCE71EF505D6BBA458DFC36177AAD8DBD
E4E42C56F2DC22492127002A939393C0C5001A7FF65D8CAFA2E9D1436E6D63499ADA18B6222C8CF8
3C0C64B23938E7B9EA3397A94CB6FE3AD32770EC90E8F7EEE238DA46C79B6A7855049270700024E3
8AE81208629259238911E560D232A805C800024F738007D00AA708D1E176D5E01628D7DE586BC4D8
0DC670B182E3EF67202F27A80280393D70CD6BE3ABCB86BFF1058412E996A892697A59BA595965B9
2C18F91280543A9C71F7FBF6EA27D4F4B9AC526BC4716E6E2DD116EAD245265768CC5857507219D3
9C7CAC0E7054E34219E1B942F04B1CA81D90B230601958AB0E3B860411D8822B3B59D5740D31AD5B
5CBFD36D1B7992D8DECD1C67728C164DE7A80D8C8FEF7BD0047E2AB3B8BDF0FC896D119A58A782E3
C90466558A649190678CB042BCF1CD50B565F10789D2F96C2EA3B0834F9AD65FB6DABC3E7B4AF19D
BB240090A236C9231FBCE33CD684DE2CF0DDBD9DB5E4DE20D2A3B5BADDF6799EF63092ED386DAC4E
1B07838E95A715D5BCF6897714F1496CF18952647051908C860DD08C739A00E423D4FF00B2F58F15
5B49A4EA57735DDEAC96F1C7612B453A9B4B74FF005BB7CB0372303B986307358BAAE817967A75BD
84F673DF5F41A15BDA69573142D22DBDF26F0D26E03F7793E49DED8E108CF63E9504F0DD5BC5716F
2C73412A078E48D832BA9190411C104739A92803CFAFF402FAB6B5AA8D3A57BE1E21D3DADA7F2D8B
2C3B6CD6564F45DBE68661D42907EEF1269BA7CF1F8B6093EC1709A92EA37725F5F340C126B3612F
929E6E36BE3741850495D8DC0EFDED4667856E12DDA58C4EE8CE91961B995480C40EA402CA09EDB8
7AD007955B784EE60F0858DA586952C5797DE0EBAB7BBDC8559EE4C76E234919BA30CC8143741B80
C006B5B541A96BB77E22B8D32CEF6D925B1D3A247BBB475F3952E276994212ACDF2310572A4E4630
1813DFC73C333CC914B1BBC2FB2555604A36D0D86F43B594E0F620F7A9280390F07BDB693622D24B
9C7DB6FDD2D205D267B08E32210E5238A42485C23BEECEDCB1039E2B43C66973FF0008DCB75656D2
5CDDD94B15E450C4A59E431C8AC5540E49650CBF8D6BDC1B48648EEAE7C88DD488A39A4C020C8CAA
1413FDE6DA31DCE3DAAC50079A784B45BED035F956F2DAE7EC3A7E9E2E44AB0BBF993C9142926D0A
32CC0C121DAA09FDEF4E45773E2286F2E3C31AB43A712B7D259CC96E41C11214217F5C56951401E7
13CD12F893EDB657DAF69FA6CFA3D925B3E93A59BA47DAF719463E44BB4A865E3E53F3739ED078B6
DA2D4B4CF13BDC6897F7F7F7966C7479134F959E389AD946DDDB7F74DE67984A1DAC72060F4AF4C8
E34894AC68A8A58B10A30324E49FA9249FC69D401C5FD8A38FE268BA86C0DE492FFAEB8B8D39C1B2
021C030DCB0DA55B014C6A49CBB1FEF0AD2BF996F75FF0D3DA07126E96E250F1B238B630B0219580
2B991A1E08072BEC6BA2A688D04AD284512328567C7240CE013E8327F33400EA28A2800A28A2800A
28A2800A28A2800A28A2800A28A2800A28A2800A28A2800A28A2800A28A2803904D6B46D7FC656D6
E9AAE9EB3E957132C56A2E13ED334C11D1FE4CEE08A0BF18E48CF01416CD32C4A4694597FE1213E2
0FB504FF0096860FB4EEF33D767D9BE4DDD3F87AF15E83450079F19625234A2CBFF0909F107DA827
FCB4307DA77799EBB3ECDF26EE9FC3D78A7E9B35DE99AD5CC235559B53B8D5646934B31202D6CD29
DB2938DE76C45486CEDF9426335DF514011C33C37285E09639503B216460C032B1561C770C0823B1
04571BA6DB4ADE263A03C6C2D34AB993515623865972615FA0779F1E9E4AD75D65656FA75A25ADA4
7E5C29920649249249249E49249249E49249AB1401CDF83A78574C9ADDA58C4EFA9EA8E91961B995
6F650C40EA402CA09EDB87AD5FF105FCD65631C36840BEBD996D6D89190AEC092E4770AAACF8EFB7
1577EC56FF00DA1F6F31E6E845E48909276A672401D064E338EB85CE7031628038ED6AC349D13FB2
5E2F10FF00635DDADBCF059AB346E6E8318D9C14705A43B9109D843124F3CD59D562D7F58D1F4A11
E9D625668D65D46CEEAEDE0F9B68222CAC6F95DC4EE1C67681C82457514500737F0F8CCDF0E7C366
78E347FECCB70023961B7CB1B4E481C95C123B12464E32797F056A91DCDAF84DAD359BDBFD4EE6DD
0EAD15C5DC92B247F6666DED1B1C27EF0440360160D9CB6735E9955EC2CADF4CD3EDAC2CE3F2ED6D
A258614DC4ED450028C9E4E001D680086FECEE3ECFE45DC12FDA6233C1B240DE6C636E5D71F797E7
5E471F30F515CDEBD1EA52F8EB445D2EEED2DA7FECCBE2CF756CD3A95F36D380AB2210738E73D8F1
CF1D27D8ADFF00B43EDE63CDD08BC912124ED4CE4803A0C9C671D70B9CE062C5007995C5E4DA65BF
8846AD76AF34BAF471493DB5C3E9B07363011E649B9DA24C00321892DB477C5278727B8F105CE8D6
177AADE848E1D596E23B6D42405BCBBA80441A41B5DB11BA90C76B10C0F4620FA751401E63ABDEDA
DC3AADEEA73AEB63C416C9F60174DB5605D42311130E768531846DF804938CF38AD48EFA4FB3F896
582FE497C570C57BE4E9ED76C7646AEDE432DBEEDB82A223BF6E496233C915DD51401E7D63712CD1
6A72F87753BCD4ACAC52D6EA177BA798CD30F33CF8373139CC613E53C2B383818C0CFD5B55D46F85

BEB02F160D0F5133346F71AACBA7471A204580F98AAC417CCB26080181507EE807D468A00E27458E
EB55F11C66FF00569AE05BE8BA6DC916376EB6D34CCF71BA41B71B95B60E3A30C641C0C76D451400
51451400514514005145140051451400514514005145140051451400514514005145140051451400
51451401E5DFD95671E9179E21D4B4FB2D5B4FB5BDD4567B3BD8C3F948B7D70C6484302379CE0A91
F36D5008C60979651FFC26DAAEA32E9F628A9E21B1886A6B262F158C16A044ABB398D8B00DF3F477
3B78CD77CFE1CD0A4BD8AF64D174E6BB898B473B5AA174258B921B1904B3337D589EA69E741D1CEA
C7563A4D89D48E33786D93CEE0607CF8DDD001D7A50079C5FCADA57C3BF164AECC6CB506D6A3624F
114FE7DC2AFD038017FDE0BDDCD7A9C71B23CCCD3492077DCAAC17118DA06D5C0071904F393963CE
30043269B612D94B652595B3DA4C59A581A2531B9662CC59718396249CF5249A9A382185E678A28D
1E67DF2B2A805DB685CB7A9DAAA327B003B500709E35B7BAB38F53BF5D3BED978EABFD9578254436
726D0AB18C9DD969067E4077EFDAD8033577C4BE1AD035ED760B09B44D366BCB902E2F6EDED51A51
026001BC8CE58ED41CFDD0D8C102BA3FEC3D206ACDAB0D2ECBFB49B19BCFB3A79C78C7DFC6EE800E
BD055B1042B70F7022413BA2A348146E65049009EA402CD81EE7D6803CDBC4DA7C377A8F89EFE6B7
B59ADAC845E65DCC0FDAECC8895DFECA71C7C854AF2BFBC66EBD2BB99B55BC8B541689E1FD4A680B
AAFDB524B711007196C34A1F033CFCB9E0E01E3335CE8BA55E5FC37F75A6594F790FFAAB89605692
3FF7588C8FC2AF50079FED8C7FC4D085FF008483FE120FB2EFCFEF3C8FB4EDF2FF00DCFB37CFB7A7
F175E6BAC8755BC9754368FE1FD4A1803B2FDB5E4B731103386C2CA5F071C7CB9E4640E7168E9960
7511A89B2B637C13CB173E52F9A17FBBBB19C7B66AD50071BA2E956BA478D5E1874AD3F490F69318
21D35404B98C4918324B855C38CA80B838DEF866E7189E14D3E1B7BBF0D6A525BDAC66F4CBE45E40
08BABC0D13B27DAB8E7E404B727F79B7A74AEFB4CD0F48D144834AD2EC6C0498DE2D6DD22DD8E99D
A06696DB45D2ACAFA6BEB4D32CA0BB9FFD6CF140AB249DFE660327F1A00E6F47F0D680DE2C9351D3
344D36CA3D28B5BC525ADAA44D24ECBFBC3950090AA768F767CF415AF1EA6DA841750EAFE1EBCB0B
0F21CCD26A0F6CF0B2630CAC125738209CE46300E4FAEBC30436E85208922567672A8A141662598F
1DC92493DC9344F043756F2DBDC451CD04A85248E450CAEA460820F0411C628038C8B4DB5D2B40F1
26A56F6EFA3E9371625A2B6B28C46F12A23969D5060248C186075F9173839020F0EE876F67ADC769
7FA66956D25E692E25B7D393305CAEE8C48D302304FCCA1739E0C9C9AEBB4DD0746D184C34AD26C2
C44D8F345ADB245E66338DDB40CE327AFA9A6DB787B45B3B7BAB7B5D1F4F821BB056E238AD915660
410438030C0827AFAD00725636F71A3D9F8AE3D3B4EB3D37548B4F5961D3F4E1BADD5B6CDE5BA9DA
B97660437CAA708BC1E099347D212D269ED2D20D223D4AFB4C9248757B0B7FDE4609503CD7625A4C
9218312376C6E062BB0D3B4AD3B48B736FA6585AD9405B718EDA158D73EB85006699168BA5416F75
6F0E99671C177BBED31A40A166DC30DBC0186C8E0E7AD00727A3B4B61E2A960B2D024B28E3D36492
EEDA29E376B89C3A796DF7B1961E680EE559B9DD8C56DCF7D6DA96917ABE21F0F4F6D62813743A8A
DBCCB39DDC0548DE4C9DC170080492B8C9E9A9A7695A76916E6DF4CB0B5B2809DC63B685635CFAE1
4014FBEB0B3D4ECE4B3BFB482EED64C6F8678C488D8208CA9E0E0807F0A00CBF0BE92DA4D8DCAFD9
D2D21B8B969E0B28F1B2D50AA80831C0E54B10380CE40C8E4EE553D3749D3746B76B7D2F4FB4B181
9CBB476B0AC4A5B0064850067000CFB0AB9400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051

45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
45140051451400514514005145140051451400514514005145140051451400514514005145140051
451400514514005145140051451401FFD9}
}}}}\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn666\par
d\li53\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li53\ri0\sl-213\slmult0 \fs18\cf0\p
ar\pard\li53\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li53\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li53\ri0\sl-320\slmult0 \fs24\cf0\f1\charscalex100 {http://www.spr
inger.com/978-0-387-28369-2}\par}