Hi my name is Dr. Andrew Iles and I'm a Consultant Psychiatrist at the Priory
Wellbeing Centre in Oxford and I'm talking today about agoraphobia and how
you can manage this phobia during the current crisis COVID-19. So firstly,
what is agoraphobia? well for the people who have the condition, you will know well
the signs and symptoms of agoraphobia but agoraphobia is something which often
develops after one or several panic attacks and it's when people start to
feel ill, nervous, embarrassed or fearful about maybe leaving the home, travelling
on public transport, standing in a long queue, basically situations where someone
can't get out of that situation. So in this current crisis there are particular
issues that are going to potentially aggravate those symptoms for people with
agoraphobia or for people who may be developing symptoms of agoraphobia. Now
the problem is that people who are receiving treatment for agoraphobia will
often be encouraged to expose themselves to the thing which they're trying to
avoid, so it may be that people are being encouraged to go out and to meet people
and to go about their daily business and yet now we find ourselves in a social
distancing period where we are encouraged only to go out for health problems, to
attend to a vulnerable person, to have one single episode of exercise per day,
or to go and buy essential items. Now the key thing there is whilst it is
difficult to go out, there are the opportunities to go out and absolutely
if you have agoraphobia, the worst thing you could do is to stay in your home to
avoid going out, to avoid doing the things which usually bring you anxiety,
because it could set back your treatment; so take those opportunities where
possible to still engage in day-to-day life. Make sure that you go out and do
some of the shopping but at the same time keep in with government guidelines.
For some people who have developed an actual fear or sense of embarrassment
about going outside because they have been
in those situations, that maybe is easier to understand the link between
agoraphobia and fears of anxiety. But what happens if you have been at home, have
been isolating and start to develop and fear about going outside?
Maybe it's because you have fears about contamination, maybe you're obsessed
about cleanliness, maybe you have health anxieties and are worried about
catching illnesses or diseases. Well obviously this time is going to present
very unique challenges for you because we're being told of the risks, we know
how prevalent COVID-19 is, how many fatalities there have been and obviously
it's going to cause concern for people - so as I have said earlier if you are
developing concerns like that and it is starting to make you avoid situations
the advice I've already mentioned is really important. Make sure that you
maintain contact with the outside world, make sure that you're speaking to people,
make sure that you're leaving the front door, make sure that you're doing some of
those things which you might be avoiding because the longer you avoid them, the
harder it will be to overcome them. Remember if somebody has agoraphobia,
you might be wondering about how you can support them - the advice that I have
already given is an important message to give to your family member; it's really
important that everybody is singing from the same hymn sheet and that you
emphasise the right way forward, the things that they should be doing to
reinforce the therapeutic models of care, so the things that people might have
been learning with their therapist or things that we know to be appropriate
and to be helpful to people with agoraphobia, make sure that you reinforce
those things. Try not to do everything for the person who has agoraphobia, try
not to treat them like an elderly vulnerable person who can't go out and
do their own shopping. If somebody doesn't have any co-morbid physical
health problems and is not seemed to be a particular risk in this time, then
encourage them to go out and to do some of their shopping themselves; encourage
them to go out to their daily walk - these
things are important to recovery and as a family member you can play an
important part in making sure that this message is driven home. Building on what
I just said about how you might be able to help yourself and how your friends or
your carers might be able to support you, you might be left wondering about what
you can do in terms of accessing specialist help or maybe you might be
the carer or family member who wants to seek specialist help for your loved one.
Well it's important to do remember that there is help available even in these
times - you can still seek help from your GP, maybe from a district nurse. If you
are already plumbed in with mental health services you might want to
approach your community psychiatric nurse or other team members, maybe your
psychiatrist. Perhaps you don't have any specialist support available and in that
instance then you might be left thinking well where am I going to get specialist
help during this time? Now there are different organisations that you can
approach - there are charitable organisations such as 'Mind'. If you were
in a very difficult position you might feel that you need some crisis help and then
you might need to approach somebody about the Samaritans. Or at the Priory Group
where I work, we're still operating a service and we're able to support people,
We've moved to do virtual therapy so you can meet the psychiatrist and then you
can have some support from a talking therapist, to help with your problem. If
you weren't going to go for specialist help in that regard you might want to
have some support using an app for example, or you may use an app alongside
specialist support and you can find out about apps on the NHS website; so if you
go to www.NHS.uk/app