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. 2023 Mar;53(4):1233-1243.
doi: 10.1017/S0033291721002713. Epub 2021 Aug 23.

The Oxford Agoraphobic Avoidance Scale

Sinead Lambe  1   2   3 , Jessica C Bird  1   2 , Bao Sheng Loe  4 , Laina Rosebrock  1   2   3 , Thomas Kabir  5 , Ariane Petit  1   2   3 , Sophie Mulhall  1   2 , Lucy Jenner  1   2 , Charlotte Aynsworth  6 , Elizabeth Murphy  7 , Julia Jones  8 , Rosie Powling  9 , Kate Chapman  9 , Robert Dudley  6   10 , Anthony Morrison  7   11 , Eileen O Regan  8 , Ly-Mee Yu  12 , David Clark  2   3   13 , Felicity Waite  1   2   3 , Daniel Freeman  1   2   3
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The Oxford Agoraphobic Avoidance Scale

Sinead Lambe et al. Psychol Med. 2023 Mar.

Abstract

Background: 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 in situ 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.

Method: 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.

Results: 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: a = 1.24-5.43; distress: a = 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.

Conclusions: 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.

Keywords: Assessment; agoraphobic avoidance; psychosis; social withdrawal.

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