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Brief Clinical Reports
Introduction
Agoraphobia (with or without a history of panic disorder) is often chronic and disabling. CBT is well established as an effective treatment for mild to moderate agoraphobia (e.g. Clark et al., 1994). However, more severely agoraphobic clients find it hard to access services. Once engaged, avoidance often leads to missed appointments and drop-outs. More severe agoraphobia is associated with greater depression, low self-esteem, dependency and low self-efficacy than panic disorder (see Hackmann, 1998). Such factors can prolong treatment, or create stumbling blocks. Finally, whilst clinicians may accept the value of doing therapist-assisted behavioural experiments outside of the clinic, these can be hard to fit into busy schedules. Even where treatment is available, clients may not get the help they need.
NICE guidelines place emphasis on increasing access to effective psychological therapies. Aware of limitations in local provision, the authors reflected on alternative methods of providing effective treatment. We needed a workforce with sufficient mobility, flexibility and time to provide accessible cognitive therapy for agoraphobic clients. Our hypothesis was that appropriately trained volunteers would be able to provide an effective, inexpensive service to clients finding it hard to access care through normal channels.
Method
Service development
We appreciated that we needed to provide volunteers with suitable training and close supervision. We also intended to ensure proper selection of volunteers, referrals, and measures, good record keeping, and extra support for volunteers if needed. Initially, we approached potential volunteers with experience of working in mental health settings. We explained the nature of the work that would be required, and 12 research assistants (who were keen to gain clinical experience) expressed interest in the project. Most were psychology graduates, available for 6 months to a year, and able to treat at least one client each during that time. They were interviewed by the project leader and references were sought. They were issued with honorary contracts following CRB checks and clearance from Occupational Health. Volunteers were offered training, supervision and travelling expenses. Training sessions were offered every 6 months, and extra volunteers were recruited as required to ensure an adequate cohort.
Training, supervision and treatment
The training was offered by a consultant clinical psychologist in two full-day workshops, separated by...