Mobility Inventory For Agoraphobia Research Articles

CBT-Based and eHealth-Supported Case Management for Patients with Panic Disorder or Depression in Primary Care: Results of a Proof of Concept

Evaluation of a team-based intervention in primary care that includes cognitive behavioural therapy elements and case management and was supported by eHealth components in patients with panic disorder with or without agoraphobia (PD ± AG) and/or depression. In a two-armed cluster-randomised controlled trial (cRCT), mental health conditions were assessed by the Mental Health Index (MHI-5), Patient Health Questionnaire (PHQ-9), Overall Anxiety Severity and Impairment Scale (OASIS), Panic and Agoraphobia Scale (PAS), Mobility Inventory for Agoraphobia (MIA), and Patient Assessment of Chronic Illness Care (PACIC) at baseline (T0), after 6 months (T1), and after 12 months (T2). Scores were analysed as differences from baseline using a mixed linear model with general practitioner (GP) as a random intercept and treatment, time point, and respective baseline value as fixed factors. The majority of participants (mean age 54 years, SD 12.8 years) were women (n = 40, 67.8%). We found consistent mean effects in favour of the intervention group (MHI-5 index, 6.66 [−7.38; 20.70]; PACIC, 15.92 [4.58; 27.26]; PHQ-9, −3.43 [−5.71; −1.14]; OASIS, −2.89 [−5.41; −0.37]). A cautious interpretation indicates promising effects of the intervention. Obstacles to recruitment included the workload for GPs and medical assistants (MAs), potential reservations regarding eHealth, and the onset of the COVID-19 pandemic.Trial registration:The study was registered at the German Clinical Trials Register (DRKS00016622) on February 22nd, 2019. https://drks.de/search/de/trial/DRKS00016622.

Avoidance Behavior in Patients with Chronic Dizziness: A Prospective Observational Study.

Avoidance behavior in adults with chronic dizziness is common. Here, we analyzed factors that are associated with avoidance behavior in a sample of adults with chronic dizziness and/or vertigo. Therefore, 595 patients with chronic vertigo and dizziness who had been subjected to our 5-day multimodal treatment program in a tertiary care outpatient clinic for vertigo and dizziness were prospectively investigated. Both general and dizziness/vertigo-specific data were collected at baseline (n = 595) and at 6-month follow-up (n = 262). Avoidance behavior was measured using the Mobility Inventory for Agoraphobia (MI). The Hospital Anxiety and Depression Scale was used to estimate anxiety (HADS-A) and depression (HADS-D). At baseline, higher MI (higher level of avoidance) was associated with female gender, higher HADS-D, higher HADS-A, and of a higher age. HADS-D provoked the strongest effect on public places, while gender had the strongest effect on open spaces. The majority (79%) reported improvement of MI and 21% reported that MI had worsened or remained stable at follow-up. In the Generalized Estimating Equations, female gender, higher HADS-A, higher HADS-D, and of a higher age predicted higher MI at follow-up. In particular, older female persons with depressive and anxiety symptoms have a high risk for avoidance behavior related to dizziness.

French adaptation and validation of the Panic Disorder Severity Scale—self-report

BackgroundThe aims of this study were to conduct a cross-cultural validation of the Panic Disorder Severity Scale – Self-Report (PDSS-SR) and to examine psychometric properties of the French-Canadian version.MethodsA sample of 256 adults were included in the validation study based on data from the baseline interview of a clinical trial on transdiagnostic cognitive-behavioral therapy for mixed anxiety disorders. Participants completed the Anxiety and Related Disorders Interview Schedule (ADIS-5), and self-report instruments including the PDSS-SR, Beck Anxiety Inventory (BAI), Mobility Inventory for Agoraphobia (MIA), Sheehan Disability Scale (SDS), Patient Health Questionnaire (PHQ-9), Social Phobia Inventory (SPIN), Insomnia Severity Index (ISI) and Penn State Worry Questionnaire (PSWQ). The cross-cultural adaptation in French of the PDSS-SR included a rigorous back-translation process, with an expert committee review. Sensitivity to change was also examined with a subgroup of patients (n = 72) enrolled in the trial.ResultsThe French version of the PDSS-SR demonstrated good psychometric properties. The exploratory factor analysis supported a one factor structure with an eigenvalue > 1 that explained 64.9% of the total variability. The confirmatory factor analysis (CFA) corroborated a one-factor model with a good model fit. Internal consistency analysis showed a .91 Cronbach’s alpha. The convergent validity was adequate with the ADIS-5 clinical severity ratings for panic disorder (r = .56) and agoraphobia (r = .39), as well as for self-report instruments [BAI (r = .63), MIA (accompanied: r = .50; alone: r = .47) and SDS (r = .37)]. With respect to discriminant validity, lower correlations were found with the SPIN (r = .17), PSWQ (r = .11), ISI (r = .19) and PHQ-9 (r = .28). The optimal threshold for probable diagnosis was 9 for the PDSS-SR and 4 for the very brief 2-item version. The French version showed good sensitivity to change.ConclusionsThe French version of the PDSS-SR has psychometric properties consistent with the original version and constitutes a valid brief scale to assess the severity of panic disorder and change in severity over time, both in research and clinical practice.

Using 360-degree videos for virtual reality exposure in CBT for panic disorder with agoraphobia: a feasibility study.

Cognitive behavioural therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PDA). However, implementation of some of the procedures involved, particularly in vivo exposure, can be time consuming and taxing for routine health care services. CBT with exposure taking place in virtual reality (VR-CBT) is a more time-efficient option and has shown promising results in the treatment of PDA. However, VR-CBT requires expensive equipment and appropriate virtual environments, which historically has been costly and cumbersome to produce. Thus, access to VR-CBT has been sparse in regular care environments. The aim of this study was to investigate whether VR-CBT using filmed virtual environments produced with a low-cost 360-degree film camera can be a feasible and acceptable treatment for PDA when implemented in a primary care context. This was an open feasibility trial with a within-group design, with assessments conducted at pre-test, post-test, and 6-month follow-up. Participants (n = 12) received a 10-12 week treatment programme of VR-CBT and PDA-related symptoms were assessed by the primary outcome measure The Mobility Inventory for Agoraphobia (MIA) and the Panic-Disorder Severity Scale-Self Rated (PDSS-SR). The results showed that treatment satisfaction was high and participants were significantly improved on PDA-related measures at post-treatment and at 6-month follow-up with large effect sizes (Cohen's d range = 1.46-2.82). All 12 participants completed the treatment. These findings suggest that VR-CBT with 360-degree video virtual environments delivered to primary care patients with PDA is feasible, acceptable, and potentially efficacious.

The Mobility Inventory for Agoraphobia Avoidance Alone Scale: Factor Structure and Psychometric Properties of Subscales.

In this study, we investigated the factor structure of situational fears in agoraphobia by examining four models of the Avoidance Alone items in the Mobility Inventory for Agoraphobia. A main sample of 327 agoraphobic patients and an independent control sample of 64 agoraphobic patients were studied. A confirmatory factor analysis supported a four-factor model including a public places, an enclosed spaces, a public transportation, and an open spaces factor both for pre- and posttreatment data. The convergent and divergent validity of subscales derived from the four factors were supported by an expected pattern of correlations with interview-based measures. These subscales also proved to have satisfactory internal consistencies in the independent sample.

Poster #51 CANNABIS USE AND BRAIN STRUCTURAL ALTERATIONS OF CINGULATE CORTEX AND HIPPOCAMPUS IN FIRST EPISODE PSYCHOSIS PATIENTS AND AT RISK MENTAL STATE SUBJECTS

The aim of this study was to investigate the psychometric properties of Internet administered questionnaires used in panic research. Included were 494 people who had registered for an Internet-based treatment program for panic disorder (PD). Participants were randomly assigned to fill in the questionnaires either on the Internet or the paper-and-pencil versions, and then to fill in the same questionnaires again the next day using the other format. The questionnaires were the body sensations questionnaire [BSQ; Chambless, D. L., Caputo, G. C., Bright, P., & Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090–1097], agoraphobic cognitions questionnaire [ACQ; Chambless, D. L., Caputo, G. C., Bright, P., & Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090–1097], mobility inventory [MI; Chambless, D. L., Caputo, G., Jasin, S., Gracely, E. J., & Williams, C. (1985). The mobility inventory for agoraphobia. Behaviour Research and Therapy, 23, 35–44], beck anxiety inventory [BAI; Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897], beck depression inventory II [Beck, A. T., & Steer, R. A. (1996). Beck Depression Inventory. Manual, Svensk version (Swedish version). Fagernes, Norway: Psykologiförlaget, AB], quality of life inventory [QOLI; Frisch, M. B., Cornell, J., Villanueva, M., & Retzlaff, P. J. (1992). Clinical validation of the quality of life inventory. A measure of life satisfaction for use in treatment planning and outcome assessment. Psychological Assessment, 4, 92–101], and montgomery Åsberg depression rating scale [MADRS; Svanborg, P., & Åsberg, M. (1994). A new self-rating scale for depression and anxiety states based on the comprehensive psychopathological rating scale. ACTA Psychiatrica Scandinavica, 89, 21–28]. Results showed largely equivalent psychometric properties for the two administration formats (Cronbach’s α between 0.79 and 0.95). The results also showed high and significant correlations between the Internet and the paper-and-pencil versions. Analyses of order effects showed an interaction effect for the BSQ and the MI (subscale Accompanied), a main effect was identified for ACQ, MI-Alone, BAI and BDI II. However, in contrast to previous research, the Internet version did not consistently generate higher scores and effect sizes for the differences were generally low. Given the presence of an interaction effect, we recommend that the administration format should be stable in research across measurement points. Finally, the findings suggest that Internet versions of questionnaires used in PD research can be used with confidence.

Psychometric Properties of the Mobility Inventory for Agoraphobia: Convergent, Discriminant, and Criterion-Related Validity

Aims of this study were (a) to summarize the psychometric literature on the Mobility Inventory for Agoraphobia (MIA), (b) to examine the convergent and discriminant validity of the MIA's Avoidance Alone and Avoidance Accompanied rating scales relative to clinical severity ratings of anxiety disorders from the Anxiety Disorders Interview Schedule (ADIS), and (c) to establish a cutoff score indicative of interviewers’ diagnosis of agoraphobia for the Avoidance Alone scale. A meta-analytic synthesis of 10 published studies yielded positive evidence for internal consistency and convergent and discriminant validity of the scales. Participants in the present study were 129 people with a diagnosis of panic disorder. Internal consistency was excellent for this sample, α = .95 for AAC and .96 for AAL. When the MIA scales were correlated with interviewer ratings, evidence for convergent and discriminant validity for AAL was strong (convergent r with agoraphobia severity ratings = .63 vs. discriminant rs of .10–.29 for other anxiety disorders) and more modest but still positive for AAC (.54 vs. .01–.37). Receiver operating curve analysis indicated that the optimal operating point for AAL as an indicator of ADIS agoraphobia diagnosis was 1.61, which yielded sensitivity of .87 and specificity of .73.

Psychometric properties of the panic disorder severity scale: clinician‐administered and self‐report versions

The Panic Disorder Severity Scale (PDSS) is a seven-item scale designed to assess overall severity of panic disorder symptoms. Although the PDSS is widely used, there have been limited independent studies confirming reliability and validity, particularly of the self-report version of the PDSS, and even fewer studies directly comparing the two versions. Given the need for psychometrically sound measures that comprehensively assess the main features of panic disorder, this study examined the psychometric properties of both the clinician-administered and self-report versions of the PDSS. As the PDSS targets symptom severity across a number of specific domains, PDSS items were compared to several scales designed to measure similar constructs, including the Anxiety Sensitivity Index, Illness Intrusiveness Ratings Scale, Mobility Inventory for Agoraphobia and Agoraphobic Cognitions Questionnaire. Results indicated acceptable reliability for both the clinician-administered and self-report versions. Results indicated acceptable validity for the clinician-administered PDSS and promising validity for the self-report. However, correlations between both versions of the PDSS and comparison measures were lower than predicted. Results also indicated that scores on the self-report and clinician-administered versions were significantly associated, although correlations between specific PDSS items on the two versions were also lower than expected. Results suggest that total scores on each of the PDSS versions provide a useful indication of panic-related severity. However, clinicians and researchers are cautioned against relying on scores from individual items to measure specific constructs due to their poor specificity.

Nine-year follow-up of panic disorder in chest pain patients: clinical course and predictors of outcome

Objective The aim was to investigate the association between panic disorder (PD) and long-term outcomes in terms of psychiatric morbidity, psychological distress and health-related quality of life (HRQOL), and to identify predictors of poor outcome for PD in chest pain patients. Method Nine-year follow-up study of chest pain patients ( n=199) referred to cardiology outpatient investigation. Assessments included Structured Clinical Interview for DSM-IV, Symptom Checklist-90-R (SCL-90-R), Illness Attitude Scale, Agoraphobia Cognitions Questionnaire, the Mobility Inventory for Agoraphobia, Personality Diagnostic Questionnaire and the Medical Outcome Study Short Form-36. At baseline, 76 patients suffered from PD. Results Of 184 eligible patients, 150 participated in the follow-up study. Panic disorder at baseline was associated with a higher prevalence of comorbid Axis I disorders, psychological distress and poorer HRQOL at follow-up compared with patients without PD. Of the participants with PD at baseline ( n=55), 14 suffered from persistent PD at follow-up. Patients with persistent PD had particularly poor outcomes regarding comorbid Axis I disorders, suicidal ideation (21%) and HRQOL. A mean baseline SCL-90-R somatization score above 1.4 predicted a 5-fold increased risk of persistent PD. Conclusion Chest pain patients with PD have a negative long-term outcome and those who score high on somatization require special attention because of particularly poor outcomes.

Agoraphobia between panic and phobias: clinical epidemiology from the Sesto Fiorentino Study

In the last few decades, there has been a long debate on the existence of agoraphobia (AG) without a history of panic attacks (PAs). In the present study, the problem of the relationships between AG and PAs is addressed trough a reevaluation of the cases who had been diagnosed with AG in the community survey of Sesto Fiorentino. Forty-one of the 75 subjects who met the criterion of AG in the Sesto Fiorentino Study were reinterviewed by experienced clinical psychiatrists. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV) and the Composite International Diagnostic Interview were used to make the diagnoses. The Mobility Inventory for Agoraphobia (MIA) and a specific adjunctive question, “why do/did you avoid?,” were used to compare AG subjects with or without PD. Of the 41 subjects with a lifetime history of AG, 12 cases had original diagnosis of AG without PAs and the remaining 29 had PD with AG. After the reassessment, in 10 cases, the criteria for the diagnosis of AG without PAs were confirmed, totaling a lifetime prevalence of 0.4% (confidence interval, 0.2-0.8). Agoraphobia subjects with and without PAs were comparable as regard to sex, age, age of onset, duration of illness, family history for anxiety or mood disorders, MIA scores, number, and type of situations avoided. Thus, AG seems to exist also in absence of a history of PAs, and the one-way relationship between the occurrence of PAs and a following development of AG, postulated by DSM-IV, should be reconsidered for the future classifications.

Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research

The aim of this study was to investigate the psychometric properties of Internet administered questionnaires used in panic research. Included were 494 people who had registered for an Internet-based treatment program for panic disorder (PD). Participants were randomly assigned to fill in the questionnaires either on the Internet or the paper-and-pencil versions, and then to fill in the same questionnaires again the next day using the other format. The questionnaires were the body sensations questionnaire [BSQ; Chambless, D. L., Caputo, G. C., Bright, P., & Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090-1097], agoraphobic cognitions questionnaire [ACQ; Chambless, D. L., Caputo, G. C., Bright, P., & Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090-1097], mobility inventory [MI; Chambless, D. L., Caputo, G., Jasin, S., Gracely, E. J., & Williams, C. (1985). The mobility inventory for agoraphobia. Behaviour Research and Therapy, 23, 35-44], beck anxiety inventory [BAI; Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893-897], beck depression inventory II [Beck, A. T., & Steer, R. A. (1996). Beck Depression Inventory. Manual, Svensk version (Swedish version). Fagernes, Norway: Psykologiforlaget, AB], quality of life inventory [QOLI; Frisch, M. B., Cornell, J., Villanueva, M., & Retzlaff, P. J. (1992). Clinical validation of the quality of life inventory. A measure of life satisfaction for use in treatment planning and outcome assessment. Psychological Assessment, 4, 92-101], and montgomery Asberg depression rating scale [MADRS; Svanborg, P., & Asberg, M. (1994). A new self-rating scale for depression and anxiety states based on the comprehensive psychopathological rating scale. ACTA Psychiatrica Scandinavica, 89, 21-28]. Results showed largely equivalent psychometric properties for the two administration formats (Cronbach's @a between 0.79 and 0.95). The results also showed high and significant correlations between the Internet and the paper-and-pencil versions. Analyses of order effects showed an interaction effect for the BSQ and the MI (subscale Accompanied), a main effect was identified for ACQ, MI-Alone, BAI and BDI II. However, in contrast to previous research, the Internet version did not consistently generate higher scores and effect sizes for the differences were generally low. Given the presence of an interaction effect, we recommend that the administration format should be stable in research across measurement points. Finally, the findings suggest that Internet versions of questionnaires used in PD research can be used with confidence.

Adaptation of Panic-Related Psychopathology Measures to Russian.

The study reports results of adaptation of panic-related psychopathology measures to Russian, including the Anxiety Sensitivity Index (ASI), the Agoraphobic Cognitions Questionnaire (ACQ), and the Mobility Inventory for Agoraphobia (MIA). Psychometric properties (e.g., reliability, factor structure, endorsement) and external validity of the adaptations were evaluated in a representative sample of Moscow residents (N = 390) and Ukrainian undergraduates (N = 492). The adapted ASI was generally equivalent to the original English-language version. The ACQ showed structural equivalency but did not exhibit expected specificity to panic. Finally, the MIA displayed notable structural discrepancies but had external validity comparable to the original.

Do panic-agoraphobics overestimate distances?

Twenty-five subjects suffering from Panic Disorder with agoraphobia (PDA) and 25 normal controls (NC) were asked to estimate distances of familiar places of their town and non-distance stimuli. PDA subjects also completed the Mobility Inventory for Agoraphobia (MIA). Subjects with PDA significantly overestimated distances as compared to NC, whereas no significant difference was found on estimates of non-distance stimuli. Within the PDA group, significant correlations were found between distance estimates and subsets of MIA concerning the ways of moving through the environment. Although with caution, given the small sample size and the preliminary character of this study, the results could be interpreted as consistent with a cognitive dysfunction associated with PDA, probably at the level of representational mechanisms of the extrapersonal space.

The relationship of adult attachment dimensions to depression and agoraphobia

AbstractWe examined the unique relations between the five dimensions of the Attachment Style Questionnaire (ASQ; Feeney, Noller, & Hanrahan, 1994) and depression and agoraphobic behavior (i.e., avoidance of situations where high anxiety is experienced). In addition, we examined mediation models in an attempt to clarify the link between adult attachment and these two dimensions of psychopathology. In testing these models, we administered the ASQ, General Self‐Efficacy Scale, Agoraphobic Catastrophic Cognitions Questionnaire, Beck Depression Inventory, and the Mobility Inventory for Agoraphobia (a measure of the degree to which situations are avoided that are typically anxiety provoking for people with agoraphobia) to 122 participants (44 with agoraphobia, 25 with a current major depressive disorder, and 53 with no current psychopathology). The results showed that the insecure attachment dimensions of need for approval, preoccupation with relationships, and relationships as secondary were uniquely associated with depression and that general self‐efficacy partly mediated the relationship between need for approval and depression. In contrast, only preoccupation with relationships was uniquely associated with agoraphobic behavior, and catastrophic cognitions about bodily sensations partly mediated this association.

Psychological features of subjects with idiopathic environmental intolerance

Objectives: Idiopathic environmental intolerance (IEI) is associated with unexplained symptoms attributed to nonnoxious levels of environmental substances. Clinically, some of the symptoms of IEI overlap with those of panic disorder (PD). We have recently reported a link between IEI and panic responses to a single inhalation of 35% carbon dioxide (CO 2), a reliable panic induction challenge. This study assessed depression, stress, anxiety, and agoraphobic symptoms among IEI subjects from our previous study versus healthy controls. Methods: Thirty-six IEI and 37 control subjects with no preexisting psychiatric history were compared on self-report psychological questionnaires. Results: IEI subjects scored significantly higher than controls on the Agoraphobic Cognitions Questionnaire (ACQ), Depression Anxiety Stress Scales (DASS), and Mobility Inventory for Agoraphobia (MI) (Student's t, P<.05). Conclusions: IEI subjects represent a group with morbidity significantly higher than a control population but less than what would be expected for a clinical psychiatric population.

Detecting panic disorder in emergency department chest pain patients: a validated model to improve recognition.

To develop and validate a detection model to improve the probability of recognizing panic disorder in patients consulting the emergency department for chest pain. Through logistic regression analysis, demographic, self-report psychological, and pain variables were explored as factors predictive of the presence of panic disorder in 180 consecutive patients consulting an emergency department with a chief complaint of chest pain. The detection model was then prospectively validated on a sample of 212 patients recruited following the same procedure. Panic-agoraphobia (Agoraphobia Cognitions Questionnaire, Mobility Inventory for Agoraphobia), chest pain quality (Short Form McGill Pain Questionnaire), pain loci, and gender variables were the best predictors of the presence of panic disorder. These variables correctly classified 84% of chest pain subjects in panic and non-panic disorder categories. Model properties: sensitivity 59%; specificity 93%; positive predictive power 75%; negative predictive power 87% at a panic disorder sample prevalence of 26%. The model correctly classified 73% of subjects in the validation phase. The scales in this model take approximately ten minutes to complete and score. It may improve upon current physician recognition of panic disorder in patients consulting for chest pain.

Accuracy of fear inventories and self-efficacy scales in predicting agoraphobic behavior

Self-rating fear inventories are widely used as primary dependent measures of therapeutic change in agoraphobia, but objective behavioral evidence of their validity has been largely unavailable. In contrast, self-efficacy scales are rarely used in agoraphobia research despite evidence that they correlate highly with agoraphobic behavior. In the present study, 37 agoraphobics completed the Marks and Mathews Fear Questionnaire, the Mobility Inventory for Agoraphobia, a set of agoraphobia-related self-efficacy scales, and a set of agoraphobia-related behavioral avoidance tests in the natural community environment. The Fear Questionnaire and Mobility Inventory items proved to be only modestly predictive of agoraphobic dysfunction, whereas the self-efficacy scales were highly predictive of agoraphobic dys-function. Although self-efficacy scales are not intended to be substitute measures of behavior, the findings indicate that they estimate agoraphobia much more accurately than do the standard fear inventories.

Irrational beliefs and phobic anxiety:: A controlled clinical replication and a cautionary note

A correlational investigation was undertaken examining the relationships between irrational beliefs, as measured by the Rational Behavior Inventory, and phobic anxiety, as measured by the Mobility Inventory for Agoraphobia. Two samples of subjects were studied, a clinically anxious group ( N=47) and a non- anxious group ( N=73). Modest and statistically significant correlations were found between irrational thinking and anxiety, but these relationships were strongest among the analog sample of subjects, not the clinical sample. These results call for caution in generalizing results obtained from analog samples to clinical ones, and highlight the necessity for cognitive research to develop investigatory strategies designed to isolate the causal relationships between maladaptive thinking patterns and the anxiety disorders.