Generalization of therapeutic changes in agoraphobia: The role of perceived self-efficacy.

Abstract

Investigated the extent and mechanisms of therapeutic generalization across distinct areas of agoraphobic dysfunction. Twenty-seven severe agoraphobics were each given performance-based treatment for some phobic areas while leaving their other phobias untreated. Behavioral tests revealed that (a) the treated phobias improved significantly more than the untreated (transfer) phobias, (b) the transfer phobias improved significantly more than control phobias, and (c) the transfer benefits were highly variable within and between subjects. Analyses of possible cognitive mechanisms revealed that perceived self-efficacy accurately predicted treatment and transfer effects even when alternative factors such as previous behavior, anticipated anxiety, anticipated panic, perceived danger, and subjective anxiety were held constant. In contrast, these alternative factors lost most or all predictive value when self-efficacy was held constant. Agoraphobia thus appears to be neither a unitary entity nor a mere collection of independent phobias, but a complexly patterned problem governed largely by self-perceptions of coping efficacy.

Assessing Generalization in Perceived Self-Efficacy: Multidomain and Global Assessments of the Effects of Self-Defense Training for Women

“…A number of studies have employed contextualized domain-linked measures and found that treatments can generalize from one domain to another. These include studies of the effects of the clinical treatment of agoraphobia (Williams, Kinney, & Falbo, 1989), self-defense training for women (Ozer & Bandura, 1990), and the mastery of a high-risk sport (Brody, Hatfield, & Spalding, 1988). These studies, however, provide limited information about generalization in that the self-efficacy measures used tapped relatively narrow ranges of functioning in domains that were highly related to the treatment domain.…”

Treatment of Social Phobia: Potential Mediators and Moderators

“…For example, Williams and colleagues (Williams, Dooseman, & Kleifield, 1984;Williams, Kinney, & Falbo, 1989;Williams, Turner, & Peer, 1985) presented data suggesting that perceived self-efficacy predicts therapeutic outcome more accurately than arousal during treatment, anticipated danger, or perceived danger in specific phobia and agoraphobia. In addition, Williams et al (1989) found that perceived self-efficacy was the most accurate predictor of therapeutic change regardless of whether the phobia was targeted or not. Williams et al interpreted their findings as supporting evidence for the view that agoraphobia is maintained by low perceptions of self-efficacy, and agoraphobic dysfunctions are alleviated by raising people's perception of self-efficacy.…”

Brief Intervention for Anxiety in Primary Care Patients

“…Finally, ask two simple questions about how much on a scale of 0-10 (none-definitely) the patient thinks treatment might work (“outcome expectancy”) and how confident they are they can help the treatment along (self-efficacy expectancy). Both these measures are powerful determinants of whether patients remain in treatment and whether they improve (35-38). If any problems with treatment adherence arise, these measures can be used productively in a follow-up counseling session with the physician or non-MD team members, employing the motivational interviewing approach outlined below.…”