Agoraphobia

What is Agoraphobia?
The word derives from the Greek, the agora being the market place, a place of assembly, and a phobia being an irrational fear. Sufferers typically experience intense fear in a range of situations where they perceive escape is not easily possible or help is not readily available. Examples of such situations are crowded shops, trains and tubes, lifts, motorways and being away from the security of home or a trusted companion. In turn, there may be abnormal worry about possible loss of control, socially inappropriate behaviour, physical illness such as heart attack, incontinence, fainting, going mad or dying. Sufferers may then often avoid a whole range of situations and day-to-day activity and may become housebound.

Panic attacks may be limited to specific phobic situations, but sometimes occur more generally. Many people often experience depressive symptoms, but generally these improve when the agoraphobic problem has been treated.

The extent of the problem
There are various estimated, but probably 1% of the population suffer agoraphobia of such a severity as to cause considerable distress and significant impairment of day-to-day function. However, up to one in ten of the population may have difficulty dealing with one or two of the situations mentioned above.

Causes
No single cause of agoraphobia has been identified. It tends to appear in early adulthood and is triggered in the first instance by an unexpected panic attack. The first panic is reported to occur ‘out of the blue’. The person then begins to fear the occurrence of another such attack and begins to avoid those situations which they believe may cause or worsen these attacks. The cause of the initial panic is only just beginning to be investigated systematically. Some relevant factors may be: life stressors, early experience with loss of control, a tendency to breathe too quickly, fluctuations in various brain chemicals and the misinterpretation of normal anxiety symptoms.

Treatment
Treatment for agoraphobia has traditionally involved the use of medications such as tranquillizers eg. Lorazepam (Ativan). In the last 25 years psychological treatments have been developed which have been proved to be just as or more effective. Currently, more than 70% of people who embark on psychological treatment (involving behavioural and cognitive behavioural methods) achieve 70% of greater reduction in the problem.

There is no doubt that the central component of effective treatment is helping the sufferer to face their fears in graduated doses of difficulty. This treatment is commonly called exposure therapy and may help the sufferer enter the situation they fear. However, exposure therapy can often be carried out with a small amount of guidance from a professional or with a self help method. The principle underpinning this therapy is very simple, i.e. to learn, for example that ‘everyone is not watching me’. In addition some attempt can be made to deal with unexpected panic attacks using breathing exercises and cognitive methods.

Therapy may be carried out by suitably trained mental health professionals, i.e. clinical psychologists, psychiatrists, nurses and social workers, but increasingly these methods can also be used within self help programmes. Books containing such methods may be helpful and there are also a number of organisations, eg. No Panic, Phobic Action, and Triumph Over Phobia, which may assist the sufferer.

Self Help Organisations

Phobic Action:
Hornbeam House, Claybury Grounds, Manor Road,
Woodford Green, Essex IG8 8PR
Tel: 0181 5559 2551

Triumph Over Phobia:
PO Box 1831, Bath BA1 3YX
Tel: 01225 330353

No Panic:
93 Brands Farm Way, Randlay, Telford TF3 2JQ

What are Behavioural and Cognitive Psychotherapies?

Behaviour Therapy, Cognitive Therapy and Cognitive Behaviour Therapy have some common features. They are based firmly on research findings and derive from specific theories. The focus is mainly on the here-and-now, rather than the past, and the main goal of therapy is to help bring about changes in the person’s life which are measured and evaluated. Goals for change may involve:

• A way of acting eg. being more outgoing
• A way of feeling eg. being less scared or less depressed
• A way a thinking eg. learning to problem solve or get rid of self defeating thoughts
• A way of dealing with physical or medical problems eg. lessening the difficulties associated with back pain.
• A way of coping eg. training developmentally disabled people to care for themselves

Cognitive or Behaviour Therapists may work with individuals, groups or families, and therapy is time limited. The approaches can be used to help any person – irrespective of intelligence, insight or other abilities.