Performance-related anxiety in agoraphobia: Treatment procedures and cognitive mechanisms of change

Abstract

We contrasted two theoretically derived treatments for high performance-related anxiety in subjects with agoraphobia, and evaluated recently proposed cognitive mechanisms of therapeutic change. Subjects were 45 individuals with agoraphobia who could perform community tasks but became highly anxious doing so. They were assigned at random to either (a) exposure treatment, which seeks to extinguish anxiety by exposing people to scary stimuli, (b) guided mastery treatment, which seeks to raise self-efficacy by guiding people to execute coping tasks proficiently, or (c) delayed treatment. The two treatments proved more effective than delayed treatment but did not differ from one another, a result which is interpreted in light of several previous studies that have found guided mastery to be advantageous. Analyses of cognitions revealed that (a) anticipated anxiety and panic were the most accurate predictors of performance-related anxiety, and (b) self-efficacy for controlling scary thoughts also contributed to the prediction of anxiety, whereas (c) perceptions of danger and self-efficacy for overt performance were less accurate predictors of performance-related anxiety.