Cognitive change during treatment of agoraphobia. Behavioral and cognitive-behavioral approaches.

Last et al. (1984) treated adults with agoraphobia using in-vivo exposure. Some clients also got a short cognitive package. The team tracked both scary thoughts and real-life trips outside.

They used a multiple-baseline design across participants. Each adult started exposure at a different time.

Adding the cognitive talks did not change scary thoughts. Exposure alone or with the talks gave the same final results.

Cognitive scores did not predict who got better. Real-world trips improved, but thoughts stayed put.

Emmelkamp et al. (1986) ran a larger test two years later. Pure exposure beat two full cognitive therapies in only six sessions. Their strong positive result updated the 1984 null finding.

Rojahn et al. (1994) looked deeper. They found that when negative self-talk hit zero during exposure, clients did best. This extends the 1984 work by giving you a clear stop rule: wait for silent thoughts, not just calm feelings.

Dall et al. (1997) tested the same add-on idea in social phobia. Cognitive restructuring helped on its own but did not boost later exposure. This partial replication shows the null cognitive boost is not unique to agoraphobia.

You can skip extra cognitive lessons during exposure for adult agoraphobia. Focus your minutes on real-world trips and watch for the moment the client’s scary self-talk fades. That quiet moment, not a heart-rate drop, signals it is time to end the session. Save talk time for support and praise, not thought-challenging drills.