To the Editor.—
In the February issue of the Archives, we were able to read contradictory articles concerning the treatment of phobias (Archives 1983: 40;125-138, 153-162). Zitrin et al reported a significant effect of imipramine hydrochloride in agoraphobia and mixed phobias, while Marks et al favored the use of self-exposure homework and found no differences between imipramine and placebo in a group of agoraphobic patients.The explanation for the differences in these results may lie in the controversy over the relevance of the recurrent spontaneous panic attacks (RSPAs) mentioned by Matuzas and Glass in their comments (Archives 1983;40;220-221). In the data of Marks et al, weekly RSPAs were scored as 3 (in a severity scale ranging from 0 to 8) at the beginning of treatment for both the imipramine and the placebo groups. In both groups the frequency of the RSPAs decreased to a score of 1.5 at week 14,
Grunhaus L. Panic Attacks in Phobia Treatment Studies. Arch Gen Psychiatry. 1983;40(10):1150–1151. doi:10.1001/archpsyc.1983.01790090112022
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