J. Behav. Ther. & Exp. Psychiat. Vol. 10, pp. 109-113. ©Pergamon Press Ltd., 1979. Printed in Great Britain. 000'·7908/79/ ()(,()1-0109 $02.00/ 0 THE TREATMENT OF AGORAPHOBIA WITH BIOFEEDBACK AND SYSTEMATIC DESENSITIZATION GABRIELE CHIARI and ROBERTO MOSTICONl Institute of Psychiatry, University of Rome Summary-The aim of this study is to use biofeedback techniques in combination with systematic desensitizatic;m jn the treatment of generalized phobias with high anxiety, such as agoraphobia. We state the advantages accruing from the combination of these two techniques. Four cliniC111 cases of agoraphobia are presented, in each of which some of the above-mentioned advantages are evident. INTRODUCTION The biofeedback technique permits the voluntary control of physiological functions which are not normally apparent. It does this by supplying the subject with information on the function itself, by means of an auditory or visual signal (feedback). For some years this technique has been used in therapy with promising results. It has been employed to facilitate the systematic desensit- ization technique (Wolpe, 1958). In particular, EMG-feedback training has been used in a case of test anxiety (Wickramasekera, 1972) and in various generalized phobias (Budzynski and Stoyv'a, 1973). training has been used in a case of anxiety related to a variety of death-related themes (Budzynski and Stoyva, 1973), and GSR-feedback training has been used for a spider phobia (Jave! and Denholtz, 1975). The usefulness of _biofeedback in systematic desensitization is based on the following factors: (a) Greater specificity of relaxation The physiological correlates of anxiety lead to higher arousal levels. This occurs particularly on the autonomic, cortical or muscular-skeletal level according to individual characteristics determine a response specificity (Lacey and Lacey, 1958). It follows that, in order to obtain a low arousal conditio-n rapidly and effectively, the monitoring of several psychophysiological variables in stress situations can be useful. In this way it is possible to train the patient in the specific control of the electrodermal, electroencephalo- graphic or electromyographic activity. In a short time this will lead to a low arousal level which strongly favors the therapeutic process of systematic desensitization (Budzynski, 1973; Budzynski and Stoyva, 1973; Stoyva and Budzynski, 1974). (b) Brevity of the training period and greater depth of relaxation With the use of biofeedback techniques, the patient can reach sufficiently deep levels of relaxation, muscular or otherwise, in just two or three sessions. With an adequate training period, it is possible to induce deep relaxation even in those patients who, either due to their anxiety level or their fear of losing control, are particularly resistant to muscle relaxation induced by traditional methods. (c) Possibility of measuring relaxation level and evoked anxiety The continued monitoring of the patient's relaxation level permits the therapist to present Requests for reprints sho_uld be addressed to Gabriele Chiari, Centro di Psicoterapia Comportamentale, via degli Scipioni, 245, 00192 Roma, Italy. 109