The Oxford Agoraphobic Avoidance Scale

• Published in: Psychological medicine Vol. 53; no. 4; pp. 1233 - 1243
• Main Authors: Lambe, Sinead, Bird, Jessica C., Loe, Bao Sheng, Rosebrock, Laina, Kabir, Thomas, Petit, Ariane, Mulhall, Sophie, Jenner, Lucy, Aynsworth, Charlotte, Murphy, Elizabeth, Jones, Julia, Powling, Rosie, Chapman, Kate, Dudley, Robert, Morrison, Anthony, Regan, Eileen O., Yu, Ly-Mee, Clark, David, Waite, Felicity, Freeman, Daniel
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.03.2023
• Subjects: Actigraphy; Agoraphobia; Agoraphobia - diagnosis; Agoraphobia - epidemiology; Agoraphobia - psychology; Anxiety; Anxiety Disorders; Avoidance behavior; Clinical assessment; Factor analysis; Fear; Fear & phobias; Humans; Item response theory; Mental disorders; Mental health; Original; Original Article; Panic Disorder - epidemiology; Population; Post traumatic stress disorder; Psychological distress; Psychosis; Quantitative psychology; Questionnaires; Reliability; Reproducibility of Results; Research ethics; Schizophrenia; Self report; Social anxiety; Symptoms; agoraphobic avoidance; social withdrawal; psychosis; Assessment
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291721002713

Agoraphobic avoidance of everyday situations is a common feature in many mental health disorders. Avoidance can be due to a variety of fears, including concerns about negative social evaluation, panicking, and harm from others. The result is inactivity and isolation. Behavioural avoidance tasks (BATs) provide an objective assessment of avoidance and anxiety but are challenging to administer and lack standardisation. Our aim was to draw on the principles of BATs to develop a self-report measure of agoraphobia symptoms. The scale was developed with 194 patients with agoraphobia in the context of psychosis, 427 individuals in the general population with high levels of agoraphobia, and 1094 individuals with low levels of agoraphobia. Factor analysis, item response theory, and receiver operating characteristic analyses were used. Validity was assessed against a BAT, actigraphy data, and an existing agoraphobia measure. Test-retest reliability was assessed with 264 participants. An eight-item questionnaire with avoidance and distress response scales was developed. The avoidance and distress scales each had an excellent model fit and reliably assessed agoraphobic symptoms across the severity spectrum. All items were highly discriminative (avoidance: = 1.24-5.43; distress: = 1.60-5.48), indicating that small increases in agoraphobic symptoms led to a high probability of item endorsement. The scale demonstrated good internal reliability, test-retest reliability, and validity. The Oxford Agoraphobic Avoidance Scale has excellent psychometric properties. Clinical cut-offs and score ranges are provided. This precise assessment tool may help focus attention on the clinically important problem of agoraphobic avoidance.