Agoraphobia is a very treatable problem, once you understand how it works. Agoraphobia treatment based on cognitive behavioral methods is the most effective treatment method available.
Agoraphobia treatment consists of two principal tasks. The first is learning how to respond to panic attacks, and the anticipatory fears of a panic attack, in ways that will reduce the severity of the problem over time. This may seem obvious, but most people get tricked by panic into trying to fight it off or hold it at bay, rather than working with it. These efforts will make the problem worse, rather than better.
The second recovery task, once the first has been achieved, is to begin entering those situations you have come to avoid in order to get some practice using your newly learned responses in actual situations that you fear.This is what's called, in cognitive behavioral treatment, exposure.
Agoraphobia is actually a very treatable problem, yet all too often, people find themselves struggling to make progress in ways that actually hinder their recovery. This is usually due to a common misunderstanding about the nature of agoraphobia treatment with exposure methods.
Let's suppose you have panic attacks in large grocery stores, and you've been working hard to overcome this. You've learned some breathing techniques, and more or less understand that, even though you get very afraid in grocery stores, nothing terrible is likely to happen to you as a result. So you resolve to start practicing with grocery stores.
You might have the idea that exposure means going to the grocery store and not having a panic attack. So you grab a few items from the front displays, pay at the express register, and quickly leave, grateful that you didn't have a full blown panic attack. Or maybe you talk with friends on your cell phone while you shop in an effort to distract yourself from thoughts of panic.
This is a common misunderstanding, so common that even some professional therapists will encourage their patients to follow this approach. It misses the point of exposure therapy, and will likely make your recovery more difficult.
The point of exposure practice is not to enter into a feared situation, like a grocery store, and not have a panic attack. That would be like going to a self defense class but refusing to practice sparring with your classmates. The point of the practice is to have some experience with panic symptoms. You do it a step at a time, at a pace that's acceptable to you, but always aiming to practice with the panic.
In Agoraphobia treatment with exposure therapy methods, the point is to expose yourself to the panic itself. Exposure isn't aimed at the grocery store, or the highway, or the crowded theater. We just go there in order to have the experience of feeling panic. That's the point of exposure. Expose yourself to the panic itself, and practice working with those feelings so that you can lose your fear of fear.
Instead of relying on safety behaviors, such as avoidance and distraction, a person learns how to manage a panic attack. By this, I mean a person learns to accept and work with the panic, rather than against it. This is what Claire Weekes called "floating".
Let's suppose there was a movie that you found particularly scary and unpleasant. Let's also pretend that there was a big reward, maybe $50,000, if you could watch the movie without feeling afraid. I don't mean just pretending that you're not afraid. That won't get you the reward money, because the people running the contest will hook you up to all kinds of sensors that will monitor your pulse, blood pressure, respiration, and so on. To win this prize, you have to become unafraid. How might you do it?
I don't know of any such contest, but if there ever is one, I know what I'll do. I'll rent the DVD and watch that movie 24/7 for several days, until it bores me to tears. That would be the surest way.
This is the essential element of agoraphobia treatment. You practice with the situations and the sensations, and allow them to become boring. (As my wife likes to point out, I get paid to bore people).
This approach asks you to work with, rather than against, something you despise. It probably goes against your natural instincts, and so it takes some getting used to. But it's well worth the effort, for it's the surest way out of the problem of agoraphobia. My Panic Attacks Workbook offers you a step by step guide to this process.
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Last updated on May 16, 2015