CBT therapy specialising in anxiety disorders
The Fear of Fear
The word 'agoraphobia' originates from Greece and means "fear of the marketplace" but today we use the word to encompass much more than this. Agoraphobia in its basic understanding simply means 'fear of fear' but in reality it is the fear of having a panic attack where escape can be tricky or where help cannot be found quickly if needed. Agoraphobia is a manifestation of panic disorder. The extreme shock to the nervous system caused by panic attacks motivates the person to avoid a number of activities and places, for fear of future panic attacks. This may include many situations that they used to experience no problems whatsoever. Unfortunately, for them though it is precisely this motivation to protect themselves from panic that creates the more complicated problem of agoraphobia. Typical examples would be where a person avoids crowds, concerts, meetings, traffic, driving on motorways, planes, trains, revolving doorways, large shopping complexes, forests, hairdressers, unfamiliar places and much more. I experienced panic in all of these places to some degree until I finally overcame my agoraphobia. Some of my other panic inducing situations included walking with my friends, particularly when I was up high in the hills or in thick cloud and being in rooms such as public toilets or meeting rooms where there were no windows or easy 'escape' routes.
Panic disorder does not always manifest into agoraphobia, one usually has to endure a succession of panic attacks without any professional help, and this is often the case in panic disorder as the sufferer often feels shameful or too embarrassed about their condition to seek help. When I developed panic disorder at the age of fourteen I felt extremely shameful and embarrassed about what was happening to me. I never told a single soul not even my parents at the time, I just pretended that everything was fine, and inevitably, I later developed agoraphobia. You should never feel shameful or embarrassed about having panic attacks or agoraphobia, it is not your fault and only complicates matters! There is a way out!
Everybody who has agoraphobia has a 'safe zone', a place from which they feel 'protected' from the onslaught of a panic attack. This place is usually their home or nearest hospital and they are very reluctant to travel too far from these places in case they feel 'trapped'. Some agoraphobic people can travel a radius of 1 mile outside of their safe zone, and some more. For me, it was no more than a few hundred feet at its worst and I managed to get to a 5 mile radius consistently for about three years until I sought help. I truly sympathise with all the people who are totally housebound with agoraphobia and I know what this must feel like, but remember there is a way out. I used to run agoraphobic workshops and I remember I once helped a young lady who had been totally housebound for more than twenty years! She had clenched so tightly to the comfort of her 'safe zone' that her whole world had become more and more contained until she could no longer face the real world. That woman travelled to the Norfolk Broads twelve months later to visit her sister!
Avoidance is the killer
Avoidance from panic provoking situations never offers long term solutions, only short term. If agoraphobia is your problem then your recovery should be based on building up your tolerance to panic until you can begin to tolerate these situations more and more. There are mechanisms within the brain that record avoidances and these mechanisms work against us in future situations making our lives more and more contained. Recovery lies in seeing panic through and this is the surest way to undo this conditioning.
My personal safety behaviours or 'crutches' as I like to call them included me taking nasal spray, chewing gum and a paper bag with me whenever I went out of my safety zone. Everybody has their own crutches and some don't even make any sense but to the sufferer they bring a sense of safety. Safety behaviours, just like avoidance, are a double edged sword and will not do you any justice in the future, crutches have a habit of giving way! Having said that I always think it is important to gradually give these up and I never recommend my clients go completely cold turkey. This can have negative repercussions. It was a steady process for myself that saw me gradually lose my crutches and I can definitely say it is the wisest way to go about losing them. If the brain is gradually reconditioned, the results are far more fixing and long term.
Firstly, I stress (wholeheartedly) that agoraphobia is very treatable. I know this because I had it very severe myself and now I do not. I know first hand why so many people find it particularly difficult to overcome because like me, back then they think the way out is to first find a way to get rid of the panic, and then begin to face the situations they have come to avoid. This problem will always persist as long as you fear panic attacks and treat them as danger and rely on safety behaviours in an effort to avoid panic attacks. So recovery lies in learning how to cope with panic. Panic is the killer.
As with all anxiety disorders though, recovery first begins with understanding. Always remember with anxiety disorders that knowledge is power and when you get the right knowledge and guidance you will be well on your way to facing those dreaded panic attacks. A foundation of knowledge must first be firmly laid.
Once you are ready to face your fears then a hierarchy of progressively challenging situations should be made. This is extremely important. For a lasting cure one must gradually face and learn how to cope with panic and build an natural inner strength. This inner strength then becomes your permanent crutch. That is how it is cured. This kind of treatment is often called exposure treatment, and is the most effective treatment available for panic and agoraphobia.
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