Alstrom 1984b.
| Methods | Single‐centre RCT, between 1973 and 1979, parallel design with 4 arms | |
| Participants | Inclusion criteria: 18‐60 years old, sought help for agoraphobic syndromes at outpatient services Exclusion criteria: any form of continuous treatment for the previous 6 months; drug abuse; dementia; neurological signs of brain damage; symptoms of endogenous depression, schizophrenia, obsessive‐compulsive neurosis or mental retardation; poor knowledge of Swedish language. Study included 73 agoraphobic women. They were all assessed as not suitable for insight‐oriented psychotherapy |
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| Interventions | Common to each group ‐ psychoeducation, information on prolonged exposure in vivo, encouragement to participate in anxiety‐provoking situations. Participants could continue to take medications
Control: basal therapy ‐ included the above, and meetings once a month for 20‐30 min Intervention 1: behavioural therapy (prolonged exposure in vivo) Intervention 2: relaxation therapy Intervention 3: psychodynamically oriented supportive therapy, based on Dewald 1964, 30‐min appointments once/week for 3 months (˜ 12 appointments). No mention of manual for therapy, measures of therapist adherence |
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| Outcomes | Measured pre‐treatment, end (post‐) treatment, and 9 months follow‐up Measures were scales constructed by the authors to measure indirect manifestations of anxiety (target phobia, other phobias, OCD symptom), interpersonal relations, direct manifestations of anxiety, ego‐restriction and social functions, and a global rating. In addition, intellectual ability was measured with the Synonyms Reasoning Block test, personality with the Eysenck Personality Inventory, and the Cesarec‐Marke Personality Schedule. Therapist rated measures. Global scale and free anxiety measures were used in this review | |
| Notes | Both Alstrom 1984a and Alstrom 1984b in this review used the same methods Free anxiety measures, interpersonal relations and global symptom data used. Could not use 9‐month follow‐up data as more than 20% of sample lost to follow‐up | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Comment: inadequate description |
| Allocation concealment (selection bias) | Unclear risk | Comment: inadequate description |
| Blinding (performance bias and detection bias) All outcomes | High risk | Comment: therapists were raters of some cases and may have been unblinded: high risk Blinding participants to treatment group not possible No psychotherapist was blinded to the treatment delivered |
| Incomplete outcome data (attrition bias) All outcomes | High risk | Comment: significant dropout rate (12/73 participants) but how handled was not described |
| Selective reporting (reporting bias) | Unclear risk | Comment: insufficient information to permit judgement. No published report on pre‐specified outcomes |
| Other bias | Unclear risk | Comment: insufficient information to permit judgement |