The changing nature of agoraphobic fears

Recent factor analytic studies have emphasized the importance of both somatic and situational fears in agoraphobia. Franklin (1980) proposed a developmental model of agoraphobic fears in which somatic changes (interoceptive fears), and feared consequences such as panic (outcome fears), produce situational fears through misattribution. Five hypotheses derived from this model were tested on 60 agoraphobics who rated their original and current fears. In all subjects interoceptive and outcome fears relating to panic attacks developed before situational fear and avoidance. Initially outcome fears were significantly greater than interoceptive fears, which were in turn significantly greater than situational fears. Over time situational fears increased significantly, eventually equalling outcome fears, and exceeding interoceptive fears. Panic attack frequency and severity also reduced significantly. All hypotheses were confirmed and the implications for research and treatment are outlined.