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Drug Therapy for Agoraphobia-Reply

Donald F. Klein, MD
Arch Gen Psychiatry. 1988;45(4):387-388. doi:10.1001/archpsyc.1988.01800280105015.
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Reply.—  Scott and Fleming disagree with our conclusion that "if [the agoraphobic] wishes to become free of panic, then drug therapy is distinctly superior to exposure therapy."1 They raise several objections concerning length of exposure therapy, when its benefits become apparent, the disadvantageous contrast of exposure therapy with desensitization as compared with drug with placebo, the validity of our spontaneous panic measure, and the mechanism of drug action. First, with regard to length of formal exposure, the ten-week formal exposure period was selected on expert advice and exceeded that of many studies. For the exposure-placebo group to improve as much as either imipramine group would have required a sudden, discontinuous, beneficial acceleration that has not been observed in any other study. Second, Scott and Fleming argue that "the absence of a panic effect for the exposure treatment was demonstrated only in the 26-week evaluation—13 weeks after the termination


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