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The Cause and Treatment of Agoraphobia-Reply

Donald F. Klein, MD
Arch Gen Psychiatry. 1988;45(4):389-392. doi:10.1001/archpsyc.1988.01800280107017.
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Reply.—  Lelliott and Marks make the following points: 1. First, they claim there are no "systematic" data to indicate that, with drug treatment, panic improves before avoidance. The fact that panic decreases before avoidance in a treatment situation that does not emphasize exposure seemed so glaringly obvious that we did not address this point. However, extensive clinical data indicate that, during drug treatment, panic often disappears while avoidance remains.1 Furthermore, systematic data indicate such a sequence.2 Even Marks3 states: "Once agoraphobics have few spontaneous panics or are comfortable away from their phobic situations, it becomes easier to go out repeatedly to try and conquer their fears."3(p345) 2. In their letter, Lelliott and Marks state that "using Klein's panic scale, Marks et al4 found that panic began to improve after avoidance during exposure." The reference to the Klein et al scale is confusing. Marks et al


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