Técnicas de intervención en agorafobia

• Arturo Bados López ^[1]
  1. [1] Universitat de Barcelona

     Universitat de Barcelona

     Barcelona, España

     
• Localización: Ansiedad y estrés, ISSN 1134-7937, Vol. 3, Nº 2-3, 1997 (Ejemplar dedicado a: Técnicas de reducción de ansiedad), ISBN 84-922464-3-X, págs. 339-358
• Idioma: español
• Títulos paralelos:
  • Treatment procedures in agoraphobia
• Enlaces
  • Texto completo (pdf)
• Dialnet Métricas: 2 Citas
• Resumen
  • español

    La exposición en vivo es considerada un componente básico en el tratamiento de la agorafobia. Por ello, se analizan aquellas variables que pueden afectar a su eficacia y que han sido investigadas: duración, graduación, velocidad, posibilidad de escape temporal, periodicidad, nivel de ansiedad, implicación, empleo de grupos, participación del terapeuta, relación terapéutica y expectativas. Sin embargo, la eficacia de la exposición en vivo es insuficiente, por lo que se consideran otras técnicas que podrían potenciarla, tales como exposición imaginar, realimentación, reforzamiento, colaboración de personas significativas, entrenamiento en aserción, respiración controlada, relajación aplicada, técnicas cognitivas, intención paradójica y exposición interoceptiva. Finalmente, se consideran las posibilidades que ofrece el tratamiento farmacológico de la agorafobia en comparación al tratamiento psicológico.

  • English

    In vivo exposition is considered a basic component in the treatment of agoraphobia. Because of that, those researched variables which can affect its efficacy are analysed: duration, gradation, pace, possibility of escape, frequency, level of anxiety, involvement, use of groups, participation of therapist, therapeutic relationship and expectancies. However, the efficacy of in vivo exposition is insufficient; because of that, other techniques which can strenghten it are taken into account: imaginal exposition, feedback, reinforcement, collaboration of significant others, assertiveness training, controlled breathing, applied relaxation, cognitive techniques, paradoxical intention and interoceptive exposition. Finally, the strengths and weaknesses of pharmacological treatment of agoraphobia are considered beside psychological treatment.

• Referencias bibliográficas
  • American Psychiatric Association (1994). Diagnostic and statistic manual of mental disorders (4ª ed.). Washington: Autor.
  • Arnow, B.A., Taylor, C.B., Agras, W.S. y Telch, M.J. (1985). Enhancing agoraphobia treatment outcome by changing couple communication patterns....
  • Arntz, A. y van den Hout, M. (1996). Psychological treatments of panic disorder without agoraphobia: Cognitive therapy versus applied relaxation....
  • Bados, A. (1995a). Agorafobia - I: Naturaleza, etiología y evaluación. Barcelona: Paidós.
  • Bados, A. (1995b). Agorafobia - II: Tratamientos psicológicos y farmacológicos. Barcelona: Paidós.
  • Barlow, D.H. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. Nueva York: Guilford.
  • Beck, J.G. y Zebb, B.J. (1994). Behavioral assessment and treatment of panic disorder: Current status, future directions. Behavior Therapy,...
  • Bouchard, S., Gauthier, J., Laberge, B., French, D., Pelletier, M-H. y Godbout, C. (1996). Exposure versus cognitive restructuring in the...
  • Boyer, W. (1995). Serotonin uptake inhibitors are superior to imipramine ans alprazolam in alleviating panic attacks: A metaanalysis. International...
  • Brown, T.A. y Barlow, D.H. (1995). Long-term outcome in cognitive-behavioral treatment of panic disorder: Clinical predictors and alternative...
  • Chambless, D.L. (1990). Spacing of exposure sessions in treatment of agoraphobia and simple phobia. Behavior Therapy, 21, 217-229.
  • Chambless, D.L. y Gillis, M.M. (1993). Cognitive therapy of anxiety disorders. Journal of Consulting and Clinical Psychology, 61, 248-260.
  • Clark, D.C. y Salkovskis, P.M. (1987). Cognitive treatment for panic attacks: Therapist's manual. Oxford: Autor.
  • Clum, G.A. (1989). Psychological interventions vs. drugs in the treatment of panic. Behavior Therapy, 20, 429-457.
  • Clum, G.A., Clum, G.A., y Surls, R. (1993). A meta-analysis of treatments for panic disorder. Journal of Consulting and Clinical Psychology,...
  • Côté, G., Gauthier, J.G., Laberge, B., Cormier, H.J. y Plamondon, J. (1994). Reduced therapist contact in the cognitive behavioral treatment...
  • Cottraux, J., Note, I.D., Cungi, C., Legeron, P., Helm, F., Chneiweiss, L., Bernard, G. y Bouvard, M. (1995). A controlled study of cognitive...
  • Cox, B.J., Endler, N.S., Lee, P.S. y Swinson, R.P. (1992). A metaanalysis of treatments for panic disorder with agoraphobia: Imipramine, alprazolam,...
  • Craske, M.G. y Barlow, D.H. (1993). Panic disorder and agoraphobia. En D.H. Barlow (Ed.), Clinical handbook of psychological disorders (2ª...
  • Craske, M.G y Lewin, M.R. (1997). Trastorno por pánico. En V.E. Caballo (Dir.), Manual para el tratamiento cognitivo-conductual de los trastornos...
  • Craske, M.G., Rowe, M., Lewin, M. y Noriega-Dimitri, R. (1997). Interoceptive exposure versus breathing retraining within cognitive-behavioural...
  • de Beurs, E. (1994). The assessment and treatment of panic disorder and agoraphobia. Amsterdam: Thesis Publishers.
  • de Beurs, E., van Balkom, A., Lange, A., Koele, P. y van Dyck, R. (1995). Treatment of panic disorder with agoraphobia: Comparison of fluvoxamine,...
  • den Boer, J.A. y Westenberg, H.G.M. (1995). Serotonergic compounds in panic disorder, obsessive-compulsive disorder and anxious depression:...
  • Echeburúa, E. y Corral, P. (1997). Tratamiento psicológico de la agorafobia. En V.E. Caballo (Dir.), Manual para el tratamiento cognitivo-conductual...
  • Fava, G.A., Zielezny, M., Savron, G. y Grandi, S. (1995). Long-term effects of behavioural treatment for panic disorder with agoraphobia....
  • Fiegenbaum, W. (1988). Long-term efficacy of ungraded versus graded massed exposure in agoraphobics. En I. Hand y H.U. Wittchen (Eds.), Panic...
  • Gould, R.A. y Clum, G.A. (1995). Self-help plus minimal therapist contact in the treatment of panic disorder: A replication and extension....
  • Gould, R.A., Otto, M.W. y Pollack, M.H. (1995). A meta-analysis of treatment outcome for panic disorder. Clinical Psychology Review, 15, 819-844.
  • Hegel, M.T., Ravaris, C.L. y Ahles, T.A. (1994). Combined cognitive-behavioral and time-limited alprazolam treatment of panic disorder. Behavior...
  • Hecker, J.E., Losee, M.C., Fritzler, B.K. y Fink, C.M. (1996). Self-directed versus therapist-directed cognitive behavioral treatment for...
  • Hoffart, A. (1995). A comparison of cognitive therapy and guided mastery therapy of agoraphobia. Behaviour Research and Therapy, 33, 423-434.
  • Ito, L.M., Noshirvani, H., Basoglu, M. y Marks, I.M. (1996). Does exposure to internal cues enhance exposure to external cues in agoraphobia...
  • Jacobson, N.S., Wilson, L. y Tupper, C. (1988). The clinical significance of treatment gains resulting from exposure-based interventions for...
  • Johnston, D.G., Troyer, I.E., Whitsett, S.F. y Dalby, J.T. (1995). Clomipramine treatment and behaviour therapy with agoraphobic women. Canadian...
  • Lidren, D.M., Watkins, P.L., Gould, R.A., Clum, G.A., Asterino, M. y Tulloch, H.L. (1994). A comparison of bibliotherapy and group therapy...
  • Margraf, J., Barlow, D.H., Clark, D.M. y Telch, M.J. (1993). Psychological treatment of panic: Work in progress on outcome, active ingredients,...
  • Marks, I.M. y O'Sullivan, G. (1992). Psicofármacos y tratamientos psicológicos en la agorafobia/pánico y en los trastornos obsesivo-compulsivos....
  • Marks, I.M., Swinson, R.P., Basoglu, M., Kuch, K., Noshirvani, H., O'Sullivan, G., Lelliot, P.T., Kirby, M., McNamee, G., Sengun, S. y...
  • Mattick, R.P., Andrews, G., Hadzi-Pavlovic, D. y Christensen, H. (1990). Treatment of panic and agoraphobia: An integrative review. Journal...
  • McNally, R.J. (1994). Panic disorder: A critical analysis. Nueva York: Guilford.
  • Michelson, L. y Marchione, K. (1991). Behavioral, cognitive and pharmacological treatments of panic disorder with agoraphobia. Critique and...
  • Michelson, L., Marchione, K.E., Greenwald, M. Testa, S. y Marchione, N.J. (1996). A comparative outcome and follow-up investigation of panic...
  • Michelson, L., Mavissakalian, M. y Marchione, K. (1988). Cognitive, behavioral, and psychophysiological treatments of agoraphobia: A comparative...
  • Neron, S., Lacroix, D. y Chaput, Y. (1995). Group vs individual cognitive behavior therapy in panic disorder: An open clinical trial with...
  • Oehrberg, S., Christiansen, P.E., Behnke, K., Borup, A.L., Severin, B., Soegaard, J., Calberg, H., Judge, R., Ohrstrom, J.K. y Manniche, P.M....
  • Öst, L-G. (1988). Applied relaxation vs progressive relaxation in the treatment of panic disorder. Behaviour Research and Therapy, 26, 13-22.
  • Öst, L-G. (1989). A maintenance program for behavioral treatment of anxiety disorders. Behaviour Research and Therapy, 27, 123-130.
  • Öst, L-G., Jerremalm, A. y Jansson, L. (1984). Individual response patterns and the effects of different behavioral methods in the treatment...
  • Öst, L-G. y Westling, B.E. (1995). Applied relaxation vs cognitive behavior therapy therapy in the treatment of panic disorder. Behaviour...
  • Öst, L-G., Westling, B.E. y Hellström, K. (1993). Applied relaxation, exposure in vivo and cognitive methods in the treatment of panic disorder...
  • Otto, M.W., Pollack, M.H. y Sabatino, S.A. (1996). Maintenance of remission following cognitive behavior therapy for panic disorder: Possible...
  • Page, A.C. (1994). Panic provocation in the treatment of agoraphobia: A preliminary investigation. Australian and New Zealand Journal of Psychiatry,...
  • Pollack, M.H. y Otto, M.W. (1994). Long-term pharmacologic treatment of panic disorder. Psychiatric Annals, 24, 291-298.
  • Priest, R.G., Gimbrett, R., Roberts, M. y Steinert, J. (1995). Reversible and selective inhibitors of monoamine oxidase A in mental an other...
  • Rodriguez, B.I. y Craske, M.G. (1993). The effects of distraction during exposure to phobic stimuli. Behaviour Research and Therapy, 31, 549-558.
  • Rosenbaum, J.F., Pollock, R.A., Jordan, S.K. y Pollack, M.H. (1996). The pharmacotherapy of panic disorder. Bulletin of the Menninger Clinic,...
  • Roy-Byrne, P.P. y Cowley, D.S. (1994/1995). Course and outcome in panic disorder: A review of recent follow-up studies. Anxiety, 1, 151-160.
  • Salkovskis, P.M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy,...
  • Schulte, D., Künzel, R., Pepping, G. y Schulte-Bahrenberg, T. (1992). Taylor-made versus standardized therapy of phobic patients. Advances...
  • Sharp, D.M., Power, K.G., Simpson, R.J., Swanson, V., Moodie, E., Anstee, J.A. y Ashford, J.J. (1996). Fluvoxamine, placebo, and cognitive...
  • Spiegel, D.A., Bruce, T.J., Gregg, S.F. y Nuzzarello, A. (1994). Does cognitive behavior therapy assist slow-taper alprazolam discontinuation...
  • Steketee, G. y Shapiro, L.J. (1995). Predicting behavioral treatment outcome for agoraphobia and obsessive compulsive disorder. Clinical Psychology...
  • Stern, R. y Marks, I.M. (1973). Brief and prolonged flooding: A comparison in agoraphobic patients. Archives of General Psychiatry, 28, 270-276.
  • Telch, M.J., Schmidt, N.B., Jaimez, T.L., Jacquin, K.M. y Harrington, P.J. (1995). Impact of cognitive-behavioral treatment on quality of...
  • Trull, T.J., Nietzel, M.T. y Main, A. (1988). The use of meta-analysis to assess the clinical significance of behavior therapy for agoraphobia....
  • van Balkom, A.J.L.M., de Beurs, E., Koele, P., Lange, A. y van Dyck, R. (1996). long-term benzodiazepine use is associated with smaller treatment...
  • van den Hout, M.A., Arntz, A. y Hoekstra, R. (1994). Exposure reduced agoraphobia but no panic, and cognitive therapy reduced panic but no...
  • van Dyck, R. y Spinhoven, P. (1997). Does preference for type of treatment matter? A study of exposure in vivo with or without hypnosis in...
  • Wardle, J., Hayward, P., Higgit, A., Stabl, M., Blizard, R. y Gray, J. (1994). Effect of concurrent diazepam treatment on the outcome of exposure...
  • Williams, S.L. y Falbo, J. (1996). Cognitive and performance-based treatments for panic attacks in people with vaying degrees of agoraphobic...
  • Wilkinson, G., Balestrieri, M., Ruggeri, M. y Bellantuono, C. (1991). Meta-analysis of double-blind placebo-controlled trials of antidepressants...
  • Yucksel, S., Marks, I., Ramm, E. y Ghosh, A. (1984). Slow versus rapid exposure in vivo of phobics. Behavioural Psychotherapy, 12, 249-256