REDUCCIÓN DE COSTOS

This study has opened up many questions about the phenomenology o f

agoraphobia that could not be answered in this thesis. It would be interesting to explore in another study the hypothesis o f whether critical events that occurred around the same time as the onset o f agoraphobia had similar themes and characteristics as the memories that emerged as being associated to the fear imagery. This could be achieved using a similar methodology to this study, but asking about the memory most closely associated with the beginning o f the agoraphobia. It would also be useful to explore more carefully whether the link between the image and the associated memory is the themes and meanings o f the situation, or whether it has more to do with the similarity in body sensations, which may give a pre-disposition to misinterpreting panic symptoms. This could be studied using a detailed measure o f body sensations and asking about the most salient feature o f the image and the memory.

A further area for research is the fluctuating perspective seen in the fear imagery o f the agoraphobic group. It would be useful to know at what points the imagery changes, and whether the hypothesis about internal perspective relating to the visual aspects o f the fear, and the external perspective relating to watching the

body sensations can be supported. More detail could be asked about perspective in various “hotspots” (periods o f intense emotional distress) o f the imagery and the memory, and asking about where the individual’s attention is most focused.

Another finding that merits further study is whether the decrease in agoraphobic avoidance is maintained at a longer follow up. It would also be useful to have more information about what the changes in behaviour and cognitions were for the agoraphobic group one week after the interview. This could be studied by a replication o f this thesis but a more thorough investigation o f symptom change at follow-up using a structured questionnaire about behaviour change and attributions. An extension o f this work would be to conduct a treatment trial for agoraphobia using imagery rescripting techniques (exposure to the imagery plus modifying and challenging the image and traumatic memories) and monitor the change in imagery content.

It would also be useful to compare the imagery and associated memories o f people with agoraphobia to those with panic disorder. The hypothesis from this study would be that people with agoraphobia are different to those with panic disorder due to the core beliefs about themselves. However, it would be interesting to see whether panic disorder clients have associated memories linked to their fear imagery that are linked by similar themes and characteristics (such as body sensations). This could be studied using the same modified imagery questionnaire as used in this study.

An interesting addition to work into agoraphobia would be a qualitative interview with the agoraphobic clients about what it was like to have

agoraphobia. The mean number o f years that the participants in this study were agoraphobic was 14.3 years (SD=13.4 years). For some o f the participants with agoraphobia, I was the first stranger they had spoken to for many years. Some o f the participants spoke about not having left the house for many years, and only experiencing what life was like outside their house from the television, for example what it was like to be on a train or to go abroad. A qualitative interview focusing on the fears people have concerning changing their way o f life after such a long time may bring out important factors useful in increasing treatment motivation and remaining in treatment (24% drop out rate according to Roth and Fonagy, 1996). It seems that there must be many people with agoraphobia who do not seek treatment, due to the way the referral system works, and as they do not generally cause attention to others, may remain forgotten in their homes. However, getting more people with agoraphobia to attend psychology departments for treatment would be a challenge as can be seen in this study, many people with agoraphobia will not go outside due to a feared catastrophe, believe things will not change due to their low self esteem, and think other people and the world is generally negative. It seems that treatment may have to start in the clients home to get a better treatment attendance rate for those with agoraphobia

Lastly, this thesis has highlighted the importance in exploring the imagery and associated memories in agoraphobia, and other research has shown the

social anxiety, depression, PTSD and health anxiety. It would be useful to extend this work into other disorders such as obsessive- compulsive disorder, body dysmorphic disorder and elective mutism to see whether the use o f imagery, and the uncovering o f early traumatic memories can benefit clients.

As this thesis has shown, although some understanding o f the experience o f agoraphobia is known, much more research needs to be completed to answer some o f the questions posed. It is hoped that this thesis goes some way in adding more knowledge about the experience, development and maintenance o f agoraphobia, and that some o f the ideas will in turn benefit people with