The Oxford Agoraphobic Avoidance Scale

Abstract

Background Agoraphobic avoidance of everyday situations is a common feature in many mental health disorders. Avoidance can be due to a variety of fears, including concerns about negative social evaluation, panicking, and harm from others. The result is inactivity and isolation. Behavioural avoidance tasks (BATs) provide an objective assessment of avoidance and in situ anxiety but are challenging to administer and lack standardisation. Our aim was to draw on the principles of BATs to develop a self-report measure of agoraphobia symptoms. Method The scale was developed with 194 patients with agoraphobia in the context of psychosis, 427 individuals in the general population with high levels of agoraphobia, and 1094 individuals with low levels of agoraphobia. Factor analysis, item response theory, and receiver operating characteristic analyses were used. Validity was assessed against a BAT, actigraphy data, and an existing agoraphobia measure. Test–retest reliability was assessed with 264 participants. Results An eight-item questionnaire with avoidance and distress response scales was developed. The avoidance and distress scales each had an excellent model fit and reliably assessed agoraphobic symptoms across the severity spectrum. All items were highly discriminative (avoidance: a = 1.24–5.43; distress: a = 1.60–5.48), indicating that small increases in agoraphobic symptoms led to a high probability of item endorsement. The scale demonstrated good internal reliability, test–retest reliability, and validity. Conclusions The Oxford Agoraphobic Avoidance Scale has excellent psychometric properties. Clinical cut-offs and score ranges are provided. This precise assessment tool may help focus attention on the clinically important problem of agoraphobic avoidance.

Automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis (gameChange): a multicentre, parallel-group, single-blind, randomised, controlled trial in England with mediation and moderation analyses

“…These distress scores were summed to provide an overall distress score; 23 or less was interpreted as average distress, 24–46 as moderate distress, 46–66 as high distress, and 67 or greater as severe distress. The psychometric properties of the scale are excellent, 16 including the test-retest reliability. The avoidance and distress scores have been shown to correlate positively with O-BAT scores, 11 Agoraphobia Mobility Inventory scores, 17 Generalised Anxiety Disorder-7 scores, 18 and overall activity levels assessed by actigraphy.…”

“…The primary outcome was avoidance of, and distress in, everyday situations, assessed using the Oxford Agoraphobic Avoidance Scale (O-AS). 16 Secondary outcomes were agoraphobia measured by the Agoraphobia Mobility Inventory-Avoidance scale, 17 suicidal ideation measured by the Columbia Suicide Severity Rating Scale, 19 paranoia measured by the Revised Green et al Paranoid Thoughts Scale, 20 paranoia worries measured by the Paranoia Worries Questionnaire, 21 depression measured by the Patient Health Questionnaire-9, 22 and activity levels measured using actigraphy (over 7 days), and a time budget assessing meaningful activity (that considers complexity of activities and effort required). 23 Agoraphobic avoidance was also assessed using a behavioural assessment task, the O-BAT.…”

“…Also, many locations (eg, cafés, shops) used in the O-BAT were closed. We had already developed a new self-report questionnaire version of the O-BAT—the O-AS 16 —for clinical services to use after the trial. The O-AS was being completed as a secondary outcome measure, including in the period before the pandemic, and became the primary outcome measure on Sept 3, 2020.…”

Virtual reality (VR) therapy for patients with psychosis: satisfaction and side effects

“…Oxford -VR Side Effects Checklist (O-VRSE). A long list of items was generated by the University of Oxford clinical (Lambe et al, 2021). The O-AS lists eight simple tasks progressing in difficulty from 'Stand outside your home on your own for 5 min' through 'Travel on your own on the bus for several stops' to 'Sit in a café on your own for 10 min'.…”

Understanding agoraphobic avoidance: the development of the Oxford Cognitions and Defences Questionnaire (O-CDQ)

“…When out, I did everything as quickly as possible 10. I listened out for trouble Oxford Agoraphobic Avoidance Scale (O-AS;Lambe et al, 2021)…”