RESUMO
Night-time is a period of great significance for many people who report paranormal experiences. However, there is limited understanding of the associations between sleep variables and seemingly paranormal experiences and/or beliefs. The aim of this review is to improve our understanding of these associations while unifying a currently fragmented literature-base into a structured, practical review. In this pre-registered scoping review, we searched for relevant studies in MEDLINE (PubMed), PsycINFO (EBSCO), Web of Science and EMBASE using terms related to sleep and ostensibly paranormal experiences and beliefs. Forty-four studies met all inclusion criteria. All were cross-sectional and most investigated sleep paralysis and/or lucid dreaming in relation to ostensibly paranormal experiences and paranormal beliefs. Overall, there were positive associations between many sleep variables (including sleep paralysis, lucid dreams, nightmares, and hypnagogic hallucinations) and ostensibly paranormal experiences and paranormal beliefs (including those of ghosts, spirits, and near-death experiences). The findings of this review have potential clinical implications such as reducing misdiagnosis and treatment development and provide foundations for further research. Our findings also highlight the importance of understanding why so many people report 'things that go bump in the night'.
Assuntos
Paralisia do Sono , Humanos , Sono , AlucinaçõesRESUMO
STUDY OBJECTIVES: Isolated sleep paralysis is a benign but frightening condition characterised by a temporary inability to move at sleep onset or upon awakening. Despite the prevalence of this condition, little is known concerning its clinical features, associated demographic characteristics, and prevention as well as disruption strategies. METHODS: An online cross-sectional study was conducted. The sample comprised 3523 participants who had reported at least one lifetime episode of ISP and 3288 participants without a lifetime episode. Participants answered a survey including questions about sleep quality, sleep paralysis, and sleep paralysis prevention/disruption techniques. RESULTS: A total of 6811 participants were investigated (mean age = 46.9, SD = 15.4, age range = 18-89, 66.1% female). Those who reported experiencing ISP at least once during their lives reported longer sleep onset latencies, shorter sleep duration, and greater insomnia symptoms. Females (vs. male) and younger (vs. older) participants were more likely to experience ISP. Significant fear during episodes was reported by 76.0% of the participants. Most people (63.3%) who experienced ISP believed it to be caused by 'something in the brain'. A minority endorsed supernatural causes (7.1%). Five prevention strategies (e.g., changing sleep position, adjusting sleep patterns) with at least 60.0% effectiveness, and five disruption strategies (e.g., physical/bodily action, making noise) with varying degrees of effectiveness (ranging from 29.5 to 61.8) were identified through open-ended responses. CONCLUSIONS: ISP is associated with shorter sleep duration, longer sleep onset latency, and greater insomnia symptoms. The multiple prevention and disruption techniques identified in this study support existing treatment approaches and may inform subsequent treatment development. Implications for current diagnostic criteria are discussed.
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Distúrbios do Início e da Manutenção do Sono , Paralisia do Sono , Transtornos do Sono-Vigília , Humanos , Masculino , Feminino , Adolescente , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/complicações , Estudos Transversais , Sono , Transtornos do Sono-Vigília/complicações , PercepçãoRESUMO
Previous studies have found significant associations between paranormal beliefs and sleep variables. However, these have been conducted on a small scale and are limited in the number of sleep variables investigated. This study aims to fill a gap in the literature by investigating paranormal beliefs in relation to a wide range of sleep variables in a large sample. Participants (N = 8853) completed a survey initiated by the BBC Focus Magazine. They reported on their demographics, sleep disturbances and paranormal beliefs. Poorer subjective sleep quality (lower sleep efficiency, longer sleep latency, shorter sleep duration and increased insomnia symptoms) was associated with greater endorsement of belief in: (1) the soul living on after death; (2) the existence of ghosts; (3) demons; (4) an ability for some people to communicate with the dead; (5) near-death experiences are evidence for life after death; and (6) aliens have visited earth. In addition, episodes of exploding head syndrome and isolated sleep paralysis were associated with the belief that aliens have visited earth. Isolated sleep paralysis was also associated with the belief that near-death experiences are evidence for life after death. Findings obtained here indicate that there are associations between beliefs in the paranormal and various sleep variables. This information could potentially better equip us to support sleep via psychoeducation. Mechanisms underlying these associations are likely complex, and need to be further explored to fully understand why people sometimes report "things that go bump in the night".
Assuntos
Parapsicologia , Parassonias , Distúrbios do Início e da Manutenção do Sono , Paralisia do Sono , Humanos , SonoRESUMO
Sleep paralysis is an inability to move at sleep onset or upon awakening. It is often a distressing experience that can be associated with significant clinical consequences. Few studies have focussed on pleasant sleep paralysis episodes. The present study aimed to determine the relative prevalence of pleasant episodes of sleep paralysis as well as variables that may make them more likely to occur. Participants (N = 172) with recurrent episodes of sleep paralysis completed a battery of questionnaires investigating sleep paralysis episodes, trauma symptoms, life satisfaction, and Big Five personality traits. Pleasant sleep paralysis was found to be a fairly common experience (i.e. 23%). Episodes were emotionally complex, with pleasant episodes often involving some admixture of fear. In terms of hallucinations, pleasant episodes were more likely to involve vestibular-motor sensations (i.e. illusory body movements) and some individuals reported an ability to induce these hallucinations. Contrary to expectation, neither lower trauma symptomatology nor higher levels of reported life satisfaction predicted pleasant sleep paralysis. However, the ability to lucid dream and higher levels of trait openness to new experiences appeared to make pleasant episodes more likely. Clinical implications are discussed.
Assuntos
Medo/psicologia , Paralisia do Sono/epidemiologia , Adulto , Feminino , Humanos , Masculino , Prevalência , Paralisia do Sono/psicologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Exploding head syndrome (EHS) is a benign sensory parasomnia characterized by the perception of loud noises or a sense of explosion in the head. Few studies have assessed clinical features and little is known about demographic differences or prevention strategies. PATIENTS/METHODS: A cross-sectional study of 3286 individuals with and 2954 without lifetime EHS episodes was conducted via online questionnaires. RESULTS: Those with EHS had shorter sleep durations, longer sleep onset latencies, poorer sleep quality, and less sleep efficiency, but effect sizes for these differences were small. Females were slightly more likely than males to endorse EHS. 44.4% of individuals with EHS experienced significant fear during episodes, but fewer reported clinically significant distress (25.0%) or interference (10.1%) as a result of EHS. Most sufferers believed it to be a brain-based phenomenon, but a small minority endorsed anomalous causes. Five prevention strategies with >50% reported effectiveness were identified. CONCLUSIONS: EHS was assessed in the largest sample to date. Though associated with clinical impacts, no empirically supported interventions yet exist. The five prevention strategies may prove useful for treatment development.
Assuntos
Parassonias , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Estudos Transversais , Feminino , Humanos , Masculino , SonoRESUMO
OBJECTIVE: Isolated sleep paralysis (ISP) is a relatively common parasomnia often accompanied by fear and distress. However, little is known about the range and relative severities of typical ISP symptoms and accompanying hallucinations. Furthermore, there have been inconsistent findings with regard to demographic differences in ISP. PATIENTS/METHOD: In sum, 185 individuals with ISP (and 322 controls) were assessed for 27 symptoms and hallucinations using a clinical interview and trained diagnosticians. Insomnia symptoms were also assessed. RESULTS: Rates of ISP did not differ according to gender or ethnic minority status, but higher levels of insomnia were associated with episodes. The participants with ISP reported a mean of 7.73 symptoms beyond atonia. Hallucinations of the presence of others were relatively common. Specifically, 57.84% of the sample sensed a presence in the room with them during ISP, and the majority believed it to be a non-human presence. In addition, 21.62% of the sample experienced visual hallucinations of others, with the majority perceiving strangers as opposed to known individuals. A panoply of supernatural/paranormal entities were reported by the 24.32% of participants who hallucinated non-human beings. A minority of individuals with ISP experienced clinically-significant distress (10.27%) and/or impairment (7.57%) as a result of episodes. CONCLUSION: ISP episodes were complex and often multisensorial experiences, and the majority of assessed symptoms were associated with clinically-significant levels of fear/distress. Vivid hallucinations of other people and entities were common as well, and it is recommended that ISP be assessed when patients report seemingly anomalous experiences.
Assuntos
Alucinações/psicologia , Parassonias/psicologia , Paralisia do Sono/fisiopatologia , Etnicidade/psicologia , Medo/psicologia , Feminino , Humanos , Entrevista Psicológica/métodos , Masculino , Parassonias/complicações , Índice de Gravidade de Doença , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Paralisia do Sono/psicologia , Transtornos do Sono-Vigília/complicações , Estresse Psicológico/psicologia , Adulto JovemRESUMO
The Examination for Professional Practice in Psychology (EPPP) is a universal requirement for psychology licensure in the United States and much of Canada. However, in the 53 years of its use, many fundamental questions about this "high stakes" exam remain. Specifically, the EPPP relies exclusively upon content validity evidence, and it is unknown if scores are associated with relevant performance criteria. Limited evidence suggests that failure rates vary according to applicant demographics. To further assess the latter, a Freedom of Information Act request was submitted to a populous US state (N of applicants = 4892). Significant differences in first-time failure rates were found according to ethnicity (i.e., Blacks = 38.50%; Hispanics = 35.60%; Asians = 24.00%; Whites = 14.07%). Men (18.85%) failed more often than women (15.82%) and PsyDs (20.07%) failed more often than PhDs (15.02%), but the magnitude of difference in these two analyses was relatively small. Meaningful interactions between ethnicity, gender, and degree type were not found, but given the ethnic performance discrepancies and limited validity evidence, additional psychometric investigation of the EPPP appears warranted (e.g., in terms of criterion and predictive validity testing). Further, it is recommended that the EPPP Step-2 should undergo similar assessments prior to implementation.
Assuntos
Demografia , Prática Profissional , Psicologia , Adulto , Povo Asiático/estatística & dados numéricos , Canadá , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Estados Unidos , População Branca/estatística & dados numéricosRESUMO
Background Exploding head syndrome (EHS) is characterized by loud noises or a sense of explosion in the head during sleep transitions. Though relatively common, little is known about its characteristic symptoms or associated features. Methods A cross-sectional study of 49 undergraduates with EHS was performed. A clinical interview established diagnosis. Results The most common accompanying symptoms were tachycardia, fear, and muscle jerks/twitches with the most severe associated with respiration difficulties. Visual phenomena were more common than expected (27%). EHS episodes were perceived as having a random course, but were most likely to occur during wake-sleep transitions and when sleeping in a supine position. Only 11% reported EHS to a professional, and 8% of those with recurrent EHS attempted to prevent episodes. Conclusions EHS episodes are complex (Mean (M) = 4.5 additional symptoms), often multisensorial, and usually associated with clinically-significant fear. They are rarely reported to professionals and treatment approaches are limited.
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Parassonias , Transtornos de Sensação , Estudos Transversais , Feminino , Humanos , Masculino , Estudantes , Síndrome , Adulto JovemRESUMO
OBJECTIVE: To identify variables predicting psychotherapy outcome for panic disorder or indicating which of 2 very different forms of psychotherapy-panic-focused psychodynamic psychotherapy (PFPP) or cognitive-behavioral therapy (CBT)-would be more effective for particular patients. METHOD: Data were from 161 adults participating in a randomized controlled trial (RCT) including these psychotherapies. Patients included 104 women; 118 patients were White, 33 were Black, and 10 were of other races; 24 were Latino(a). Predictors/moderators measured at baseline or by Session 2 of treatment were used to predict change on the Panic Disorder Severity Scale (PDSS). RESULTS: Higher expectancy for treatment gains (Credibility/Expectancy Questionnaire d = -1.05, CI95% [-1.50, -0.60]), and later age of onset (d = -0.65, CI95% [-0.98, -0.32]) were predictive of greater change. Both variables were also significant moderators: patients with low expectancy of improvement improved significantly less in PFPP than their counterparts in CBT, whereas this was not the case for patients with average or high levels of expectancy. When patients had an onset of panic disorder later in life (≥27.5 years old), they fared as well in PFPP as CBT. In contrast, at low and mean levels of onset age, CBT was the more effective treatment. CONCLUSIONS: Predictive variables suggest possibly fruitful foci for improvement of treatment outcome. In terms of moderation, CBT was the more consistently effective treatment, but moderators identified some patients who would do as well in PFPP as in CBT, thereby widening empirically supported options for treatment of this disorder. (PsycINFO Database Record
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Terapia Cognitivo-Comportamental , Transtorno de Pânico/terapia , Psicoterapia Psicodinâmica , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/psicologia , Inquéritos e Questionários , Resultado do Tratamento , Adulto JovemRESUMO
Although widely used, the Hamilton Rating Scale for Depression (HRSD) and Hamilton Anxiety Rating Scale (HARS) discriminate poorly between depression and anxiety. To address this problem, Riskind, Beck, Brown, and Steer (J Nerv Ment Dis. 175:474-479, 1987) created the Reconstructed Hamilton Scales by reconfiguring HRSD and HARS items into modified scales. To further analyze the reconstructed scales, we examined their factor structure and criterion-related validity in a sample of patients with major depressive disorder and no comorbid anxiety disorders (n = 215) or with panic disorder and no comorbid mood disorders (n = 149). Factor analysis results were largely consistent with those of Riskind et al. The correlation between the new reconstructed scales was small. Compared with the original scales, the new reconstructed scales correlated more strongly with diagnosis in the expected direction. The findings recommend the use of the reconstructed HRSD over the original HRSD but highlight problems with the criterion-related validity of the original and reconstructed HARS.
Assuntos
Transtorno Depressivo Maior/diagnóstico , Transtorno de Pânico/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Psicometria/instrumentação , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
This review summarizes the empirical and clinical literature on sleep paralysis most relevant to practitioners. During episodes of sleep paralysis, the sufferer awakens to rapid eye movement sleep-based atonia combined with conscious awareness. This is usually a frightening event often accompanied by vivid, waking dreams (ie, hallucinations). When sleep paralysis occurs independently of narcolepsy and other medical conditions, it is termed "isolated" sleep paralysis. Although the more specific diagnostic syndrome of "recurrent isolated sleep paralysis" is a recognized sleep-wake disorder, it is not widely known to nonsleep specialists. This is likely due to the unusual nature of the condition, patient reluctance to disclose episodes for fear of embarrassment, and a lack of training during medical residencies and graduate education. In fact, a growing literature base has accrued on the prevalence, risk factors, and clinical impact of this condition, and a number of assessment instruments are currently available in both self-report and interview formats. After discussing these and providing suggestions for accurate diagnosis, differential diagnosis, and patient selection, the available treatment options are discussed. These consist of both pharmacological and psychotherapeutic interventions which, although promising, require more empirical support and larger, well-controlled trials.
RESUMO
OBJECTIVE: To compare cognitive-behavioral therapy (CBT), panic-focused psychodynamic psychotherapy (PFPP), and applied relaxation training (ART) for primary DSM-IV panic disorder with and without agoraphobia in a 2-site randomized controlled trial. METHOD: 201 patients were stratified for site and DSM-IV agoraphobia and depression and were randomized to CBT, PFPP, or ART (19-24 sessions) over 12 weeks in a 2:2:1 ratio at Weill Cornell Medical College (New York, New York) and University of Pennsylvania ("Penn"; Philadelphia, Pennsylvania). Any medication was held constant. RESULTS: Attrition rates were ART, 41%; CBT, 25%; and PFPP, 22%. The most symptomatic patients were more likely to drop out of ART than CBT or PFPP (P = .013). Outcome analyses revealed site-by-treatment interactions in speed of Panic Disorder Severity Scale (PDSS) change over time (P = .013). At Cornell, no differences emerged on improvement on the primary outcome, estimated speed of change over time on the PDSS; at Penn, ART (P = .025) and CBT (P = .009) showed greater improvement at treatment termination than PFPP. A site-by-treatment interaction (P = .016) for a priori-defined response (40% PDSS reduction) showed significant differences at Cornell: ART 30%, CBT 65%, PFPP 71% (P = .007), but not at Penn: ART 63%, CBT 60%, PFPP 48% (P = .37). Penn patients were more symptomatic, differed demographically from Cornell patients, had a 7.2-fold greater likelihood of taking medication, and had a 28-fold greater likelihood of taking benzodiazepines. However, these differences did not explain site-by-treatment interactions. CONCLUSIONS: All treatments substantially improved panic disorder with or without agoraphobia, but patients, particularly the most severely ill, found ART less acceptable. CBT showed the most consistent performance across sites; however, the results for PFPP showed the promise of psychodynamic psychotherapy for this disorder. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00353470.
Assuntos
Agorafobia/terapia , Terapia Cognitivo-Comportamental , Transtorno de Pânico/terapia , Psicoterapia Psicodinâmica , Terapia de Relaxamento , Adulto , Agorafobia/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/complicações , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Resultado do TratamentoAssuntos
Transtornos da Percepção Auditiva/diagnóstico , Explosões , Transtornos de Sensação , Transtornos da Transição Sono-Vigília/diagnóstico , Transtornos da Percepção Auditiva/classificação , Encéfalo , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Transição Sono-Vigília/classificaçãoRESUMO
OBJECTIVE: The contributions of disorder severity, comorbidity and interpersonal variables to therapists' adherence to a cognitive-behavioural treatment (CBT) manual were tested. METHOD: Thirty-eight patients received panic control therapy (PCT) for panic disorder. Trained observers watching videotapes of the sixth session of a 24-session protocol rated therapists' adherence to PCT and their use of interventions from outside the CBT model. Different observers rated patients' behavioural resistance to therapy in the same session using the client resistance code. Interview measures obtained before treatment included the Panic Disorder Severity Scale, the anxiety disorders interview schedule for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and the structured clinical interview for DSM-IV, Axis II. Questionnaire measures were the anxiety sensitivity index at intake, and, at session 2, the therapist and client versions of the working alliance inventory-short form. RESULTS: The higher the patients' resistance and the more Axis II traits a patient had, the less adherent the therapist. Moreover, the more resistant the client, the more therapists resorted to interventions from outside the CBT model. Stronger therapist and patient alliance was also generally related to better adherence, but these results were somewhat inconsistent across therapists. Pretreatment disorder severity and comorbidity were not related to adherence. CONCLUSIONS: Interpersonal variables, particularly behavioural resistance to therapy, are related to therapists' ability to adhere to a treatment manual and to their use of interventions from outside of the CBT model. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Patients' behavioural resistance to therapy may make it more difficult for cognitive-behavioural clinicians to adhere to a structured treatment protocol and more likely for them to borrow interventions from outside the CBT model. Patients' Axis II traits may make adherence to treatment CBT protocol more difficult, although whether this is true varies across therapists. Therapists' adherence to a structured protocol and borrowing from outside of the CBT model do not appear to be affected by disorder severity or Axis I comorbidity.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Transtorno de Pânico/terapia , Cooperação do Paciente/psicologia , Relações Profissional-Paciente , Adolescente , Adulto , Idoso , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Comorbidade , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Transtorno de Pânico/complicações , Transtorno de Pânico/psicologia , Cooperação do Paciente/estatística & dados numéricos , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto JovemRESUMO
Exploding head syndrome is characterized by the perception of loud noises during sleep-wake or wake-sleep transitions. Although episodes by themselves are relatively harmless, it is a frightening phenomenon that may result in clinical consequences. At present there are little systematic data on exploding head syndrome, and prevalence rates are unknown. It has been hypothesized to be rare and to occur primarily in older (i.e. 50+ years) individuals, females, and those suffering from isolated sleep paralysis. In order to test these hypotheses, 211 undergraduate students were assessed for both exploding head syndrome and isolated sleep paralysis using semi-structured diagnostic interviews: 18.00% of the sample experienced lifetime exploding head syndrome, this reduced to 16.60% for recurrent cases. Though not more common in females, it was found in 36.89% of those diagnosed with isolated sleep paralysis. Exploding head syndrome episodes were accompanied by clinically significant levels of fear, and a minority (2.80%) experienced it to such a degree that it was associated with clinically significant distress and/or impairment. Contrary to some earlier theorizing, exploding head syndrome was found to be a relatively common experience in younger individuals. Given the potential clinical impacts, it is recommended that it be assessed more regularly in research and clinical settings.
Assuntos
Parassonias/epidemiologia , Som , Estudantes/estatística & dados numéricos , Universidades , Medo , Feminino , Humanos , Masculino , Parassonias/diagnóstico , Parassonias/psicologia , Prevalência , Sono , Paralisia do Sono/diagnóstico , Estresse Psicológico , Estudantes/psicologia , Síndrome , Vigília , Adulto JovemRESUMO
OBJECTIVE AND METHOD: Two psychodynamic therapists and researchers from different generations reflected upon the past and present state of psychodynamic therapy research as well as possibilities for the future. RESULTS AND CONCLUSIONS: Several issues (e.g., decreased research funding, increased medicalization of mental health problems, and declining psychodynamic representation among research faculty) were identified as potential impediments for future high-quality research. In addition to encouraging the field to face these challenges directly, a number of specific recommendations were provided. These included not only suggestions for traditional process and outcome research, but also recommendations to modify our current assessment practices, improve our field's cohesiveness, increase our public visibility, and improve relationships with our non-psychodynamic colleagues. In is argued that, if the field confronts these many challenges in a creative and flexible manner, psychodynamic therapy research will not only continue to be relevant, but will also thrive.
Assuntos
Transtornos Mentais/terapia , Psicoterapia Psicodinâmica/tendências , Pesquisa/tendências , Humanos , Medicalização/tendências , Apoio à Pesquisa como Assunto/tendênciasRESUMO
Exploding head syndrome is characterized by the perception of abrupt, loud noises when going to sleep or waking up. They are usually painless, but associated with fear and distress. In spite of the fact that its characteristic symptomatology was first described approximately 150 y ago, exploding head syndrome has received relatively little empirical and clinical attention. Therefore, a comprehensive review of the scientific literature using Medline, PsycINFO, Google Scholar, and PubMed was undertaken. After first discussing the history, prevalence, and associated features, the available polysomnography data and five main etiological theories for exploding head syndrome are summarized. None of these theories has yet reached dominance in the field. Next, the various methods used to assess and treat exploding head syndrome are discussed, as well as the limited outcome data. Finally, recommendations for future measure construction, treatment options, and differential diagnosis are provided.
Assuntos
Transtornos da Transição Sono-Vigília/fisiopatologia , Percepção Auditiva , Diagnóstico Diferencial , Humanos , Polissonografia , Transtornos da Transição Sono-Vigília/diagnóstico , Transtornos da Transição Sono-Vigília/etiologia , Transtornos da Transição Sono-Vigília/terapia , SíndromeRESUMO
Aims of this study were (a) to summarize the psychometric literature on the Mobility Inventory for Agoraphobia (MIA), (b) to examine the convergent and discriminant validity of the MIA's Avoidance Alone and Avoidance Accompanied rating scales relative to clinical severity ratings of anxiety disorders from the Anxiety Disorders Interview Schedule (ADIS), and (c) to establish a cutoff score indicative of interviewers' diagnosis of agoraphobia for the Avoidance Alone scale. A meta-analytic synthesis of 10 published studies yielded positive evidence for internal consistency and convergent and discriminant validity of the scales. Participants in the present study were 129 people with a diagnosis of panic disorder. Internal consistency was excellent for this sample, α=.95 for AAC and .96 for AAL. When the MIA scales were correlated with interviewer ratings, evidence for convergent and discriminant validity for AAL was strong (convergent r with agoraphobia severity ratings=.63 vs. discriminant rs of .10-.29 for other anxiety disorders) and more modest but still positive for AAC (.54 vs. .01-.37). Receiver operating curve analysis indicated that the optimal operating point for AAL as an indicator of ADIS agoraphobia diagnosis was 1.61, which yielded sensitivity of .87 and specificity of .73.