- What is agoraphobia like, and how do you help it?
What do we do about it?
That's what I'm going to talk about in this video today.
I'm Dr. Tracey Marks, a psychiatrist
and I publish weekly videos about mental health
education and self-improvement.
Agoraphobia is the fear of being in certain places
where you have anxiety and you're
unable to escape or get help.
The diagnostic manual for mental disorders
lists five kinds of places that you fear going to
because of this issue of not being able to escape
when you have anxiety, and the five scenarios are
using public transportation like trains, planes and buses,
being in open spaces like parking lots,
shopping malls, bridges,
being in an enclosed space like a shop or a theater,
Standing in line or being in a crowd,
and the last one would be being outside of your home alone.
With agoraphobia, you fear or avoid these situations
because you fear that you may not be able to escape
in the event that you become panicked
or in the event you have some other
incapacitating or embarrassing symptom.
An example of this could be a person
who manifests anxiety with nausea,
so let's look at Tom.
Every time he gets an attack of anxiety,
he feels dizzy and thinks he's gonna faint.
He also starts to feel very nauseous
and thinks that he's gonna throw up.
So Tom does not like to attend office meetings
because he fears he'll get in the meeting
and throw up in front of people.
Another example is an elderly person who fears falling
so this person may avoid any situation outside of their home
because they fear that they'll fall
in an unfamiliar environment and not be able to get help.
Another aspect of this is you actively avoid the situation,
or require someone to accompany you in a situation.
Unfortunately agoraphobia tends to be pretty chronic
and more than one-third of the people who get agoraphobia
become completely homebound and unable to work.
It's often associated with panic disorder
where people have attacks of anxiety
and because of the anxiety, the person fears
being out in these situations, having an anxiety attack
and they can't escape or they can't get help for it.
If this is the case, you would be considered to have
panic disorder with agoraphobia.
But agoraphobia can be its own entity
that can occur all by itself.
That would be like in the case of
the elderly person who fears falling.
They don't necessarily have big eruptions of panic attacks,
their fear is about being somewhere and falling.
So therefore, the agoraphobia works in to
where they avoid a bunch of stuff because of that fear
because you may think, "Well, that's a reasonable concern,"
and of course it is, but if you get to the point
where you're homebound because of the concern
that you just may fall and there'll be no one there
or you can't do anything about it,
that would be considered agoraphobia.
So what can people do to get help?
The treatment for agoraphobia is cognitive behavior therapy
with or without medication.
The kind of cognitive behavior therapy
is typically exposure therapy
with or without along cognitive restructuring.
With exposure therapy, the goal is to desensitize you
to the thing that you fear, and it's a standard treatment
used for other phobias as well.
Because the more you avoid the thing that you fear
the bigger the monster becomes.
Now, with exposure therapy you wouldn't just be
thrown back into the situation that you don't wanna be in.
You and your therapist would come up with
a hierarchy of fears.
So you would come up with a list of situations
from least anxiety provoking to the worst possible scenario
that you can imagine.
Then you would little bit by little bit
expose yourself to these situations.
Now, depending on what kind of situation it is
that you need to be exposed to, the exposure can be
a real one where you actually go to the place
or it can be an imagined exposure where the therapist
helps you create the scenario in your mind
because it's not one that's practical
for you to actually be in.
An example of this would be someone who has
posttraumatic stress disorder from combat.
It's not practical put themselves back in actual combat
so they'd create a scenario in their minds that's
similar to the situation.
There's also technology now that simulates virtual reality.
It simulates scenarios to help people
re-expose themselves to these anxiety provoking situations
and it's called virtual reality graded exposure therapy.
I think it's more commonly used with military personnel,
but nevertheless it's an emerging field
that will probably become more popular in time.
Another common therapy approach for agoraphobia
would be cognitive restructuring.
Cognitive restructuring helps identify
unrealistic or irrational beliefs that you have
about your situation.
We call these cognitive distortions.
An example of a cognitive distortion is catastrophizing.
Catastrophizing involves assuming the worst-case scenario
every single time, even if you've never gotten close to
experiencing a worst-case scenario.
Each and every time, you think this is the time
that it's really gonna happen.
And with agoraphobia, many times there's a lot of
cognitive distortions around your phobia
that a therapist can help you work through.
For some people cognitive behavioral therapy
is sufficient to treat their agoraphobia
but in more severe cases like someone who is
completely homebound or someone who just needs
a faster recovery than they can get with therapy,
medications may be the way to go.
Agoraphobia is an anxiety disorder
so the medications that we use are antidepressants
like Zoloft, Lexapro, Cymbalta.
Because antidepressants don't work immediately
and can take weeks to see an effect,
sometimes you could be started on a benzodiazepine
like Klonopin or Ativan to help reduce your anxiety
in the meantime while the antidepressant
takes its time to take effect.
Then once you're stabilized on the antidepressant,
the Klonopin would then be tapered off.
So that's agoraphobia and how we treat it.
It can be pretty life altering,
so getting help can make a huge difference
in how you feel and the quality of your life.
If you know someone who could benefit from this video,
please share it, and leave me a comment
even if it's just to say hi.
Take care, see you next time.