A Controlled Retrospective Study of Behaviour Therapy in Phobic Patients

¹ Research Worker, Institute of Psychiatry; Honorary Senior Registrar, The Maudsley Hospital, London, S.E.5
² Lecturer, Institute of Psychiatry, The Maudsley Hospital, London, S.E.5

1. Evidence in the literature for the efficacy of behaviour therapy is still conflicting, and in phobias comparable results have been obtained with several kinds of treatment.

2. Thirty-two phobic patients are reported who received behaviour therapy in this hospital since 1960. These were conveniently divided into 21 with agoraphobia and 11 others with animal and social phobias. Matched controls, not treated by behaviour therapy, were found for all but one. Verbatim extracts of patients' notes after treatment, and at one, three, and twelve months follow up were rated "blindly" by independent assessors on scales of symptom severity and general condition.

3. Behaviour therapy patients had graded practical retraining. Behaviour therapy was longer, more frequent and took more sessions than treatments received by the control patients.

4. Agoraphobic patients who had behaviour therapy did slightly better than controls at the end of treatment but this was related to more frequent and longer treatment. The groups did not differ in general condition. The improvement rate of 55 to 60 per cent. during treatment of both groups of agoraphobic patients masked considerable residual disability at the end of treatment and a year later. There was no evidence that a particular kind of patient responded better to behaviour therapy.

5. Patients with other phobias who had behaviour therapy did much better than controls but some had relapsed a year later.

6. The development of fresh symptoms ("symptom substitution") did not appear to occur during or after behaviour therapy.

7. In complex agoraphobias, behaviour therapy on the lines of graded practical retraining was not particularly useful. In other phobias behaviour therapy produced a useful short-term improvement which diminished with time.

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