Treatment of Agoraphobia

Advances in the understanding and treatment of Agoraphobia have been made since the days when my mother suffered from it most severely. I feel that back then, the doctors failed to understand the condition, and the few times she actually consulted with a psychiatric specialist they simply talked about what might be wrong, but failed to provide any actual help or support.

Now the treatment for agoraphobia will almost invariably involve psychotherapy. To be more specific, a type of therapy known as cognitive behaviour therapy, commonly referred to as CBT. In addition anti-depressants and anti-anxiety medicines can also be used to help relieve the symptoms of agoraphobia.

It is my understanding that in recent years, cognitive behaviour therapy (CBT) has achieved some success in treating people with agoraphobia. It works on the principle that the way you feel is in part dependent on the way you perceive things. In earlier posts we looked at how an agoraphobic will think that a panic attack will occur if they are in a certain environment outside of their comfort zone. Cognitive delivered exposure is designed to put the person into the very situation they are afraid of, but with support, so that they can live through the situation with the realisation that their fear was in fact unfounded.

Many psychologists describe agoraphobic thought and behaviour as a vicious circle. This occurs because the person is afraid that if they put themselves into the situation that they fear then they will have a panic attack. As a result, they avoid putting themselves into that situation. Because of this the anxieties are not resolved, but instead become worse, leading to an increased fear of having a panic attack. The vicious circle keeps revolving but it's intensity or effect becomes worse. Cognitive delivered exposure attempts to break the vicious circle by placing the patient into real-life environments.

I have recently read a report where the use of cognitive delivered exposure was described thus; "if you were worried that you would hyperventilate if you had to walk to the corner shop, your therapist would accompany you to the corner shop to see if this was the case."

Wow - a therapist that would walk to the corner shop with you. Are they living in the real world? That would truly be a far cry from the treatment that my dear old mum got.

However, the principle seems sound and is used to overcome many forms of phobia. It basically means to expose the person to the very thing that they fear, but in a controlled and supportive way.

The person who fears that they would experience a panic attack if they walked to the corner shop, can indeed be helped if they are accompanied by a friend or helper (if not a professional therapist). The first steps should involve only short journeys, it will feel less scary for them if they remain close to their "safe zone". the process should be approached slowly and with constant support. Often, people's perceived predictions of how they will react in certain situations are a lot worse than how they actually react.

Cognitive delivered exposure should begin by setting small goals before moving on to more ambitious tasks which are complete by the person alone as their confidence increases.

Therapists are aware that many people with agoraphobia by the very nature of their condition would find it impossible to visit a therapist so they will arrange home visits. Also, an increasing number of effective programmes can be conducted via the Internet, or through the use of interactive software. We will investigate these further next time.