Paradoxical instruction in the elimination of avoidance behavior in an agoraphobic girl

The case is described of a 16-yr-old girl whose agoraphobia was of recent onset. In the light of a rapidly increasing pattern of escape and avoidance behavior associated with several phobic situations, treatment consisted of a paradoxical instruction to embellish subjective anxiety and elicit anticipated negative consequences during prolonged in vivo exposure. Treatment was associated with the elimination of avoidance behavior and a dramatic reduction in self-reported anxiety, and obsessive-compulsive complaints, as well as anxiety ratings during exposure. These improvements were maintained and enhanced at both 3- and 9-month follow-up. The implications of this approach with severe fears and the need for additional empirical evaluations are discussed.