Is the exposure principle really crucial in agoraphobia? The influence of client-centered "nonprescriptive" treatment on exposure

Exposure treatment is regarded as a crucial factor for the effective reduct ion of agoraphobic symptoms. Recent empirical studies indicate conflict cen tered therapies to be effective as well. The present study deals with diffe rent effects of client-centered therapy, behavioral exposure treatment, and a combination of them both on patient readiness for exposure to phobic sit uations. The readiness for exposure to phobic situations (behavioral resist ance), as well as the impairment due to phobic symptoms (interference), wer e measured with a "99 mm-visual-analogue-scale." Forty patients diagnosed w ith panic disorder and agoraphobia were included. Twenty of them were treat ed with client-centered therapy, and twenty were treated additionally with behavioral exposure treatment. The results were compared with the data on 7 2 patients, who were treated exclusively with behavioral exposure treatment . Measurements were made at the beginning (T1) and at the end (T2) of thera py, and after six months (T3) and one year follow-up (T4). Behavioral exposure, either alone or combined with client-centered therapy, significantly supported patient determination to exposure to phobic situat ions more than client-centered treatment alone. However, at a one-year foll ow-up, no further differences could be observed. The results indicate there was a delayed but finally equivalent influence of an experiential and conf lict-centered approach-without any exposure instruction-on the readiness to phobic situation exposure. The results are dis cussed in terms of the spec ific mechanisms of change facilitated by different therapeutic strategies, and especially by recent concepts of disorder and process oriented client-c entered treatment. The results raise doubts about whether or not exposure i nstructions and systematic exposure to phobic situations are really crucial in overcoming agoraphobic symptoms.