Treating the personality disordered agoraphobic patient with individual and marital therapy:. A multiple replication study

Agoraphobic patients with concurrent personality disorder may be less responsive to individual behavior therapy because of their intense conflicts concerning independent functioning and their difficulties in interpersonal relationships. This study used a multiple replication, time series design to determine the efficacy of Behavioral Marital Therapy (BMT) in the enhancement of marital concordance and the decrease in panic disorder (PD) and agoraphobic symptoms in four female patients suffering from both PD and a personality disorder. Two couples reported high marital conflict both on self-report inventories and during interview. Two couples reported low conflict in self-report scores and during initial clinical interviews, but were later found to exhibit high levels of marital distress. Subjects were administered four measures of symptom severity during each session of four treatment phases: Baseline (3 sessions), Individual Treatment (10 sessions), Marital Treatment (10 sessions), and Follow-up (3 consecutive months). Trend analysis of variance and post hoc tests indicated that subjects from self-labeled discordant marriages exhibited an enhancement of marital concordance and a decrease in panic/agoraphobic symptoms after BMT. Couples who initially did not report marital conflict exhibited little or no change following BMT and had variable results following individual treatment. Idiographic analysis of personality and family factors must be considered prior to determining the most efficacious treatment for dually diagnosed patients.