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AGORAPHOBIA

Agoraphobia is quite common - and 1 in 70 people will suffer from it and twice as many women are affected as men. It usually begins in the twenties or early thirties and is caused by a combination of things. This could include a genetic predisposition and major upsets in your life, rather than any single cause.

People who suffer from agoraphobia tend to avoid particular sorts of situations because they are afraid they will trigger a panic attack. The most common symptoms of agoraphobia are avoidance of crowded places because of the fear of being trapped, or trips far from home alone. Whatever causes it in the first place, one of the most important factors in keeping it going is avoidance.

If you are a sufferer, you probably avoid busy shops or streets, going on public transport, or standing in queues. You may not like being in large open spaces very much either. If you have severe agoraphobia, you may be housebound and heavily dependent on relatives and friends to do your everyday tasks.

Because anxiety is so unpleasant, the natural reaction is to run away or avoid the situations that produce it. Avoidance provides temporary relief - but the more you avoid, the harder it becomes to face things and the more you lose your confidence. And the more you avoid a situation, the more you believe that you are going to have a heart attack, faint, lose control or whatever, because you never give yourself the opportunity to learn that it just does not happen.

Many sufferers become isolated, demoralised and depressed. In general, once they recover from the agoraphobia their mood improves.

How can I overcome agoraphobia?

Agoraphobia can be overcome. It is a question of learning to regain your confidence by gradually facing up to your fears. That probably sounds absolutely impossible - but I can assure you that there is a programme which has been shown to be very effective in the long term. It has been used over and over again successfully to overcome agoraphobia.

Step One

Make a list of all the things you would like to achieve.
Include all those things that you would like to do if you were completely recovered, such as go on holiday or take your children to the zoo. Whatever they are, make sure these goals refer to what you are actually going to do - not just to general ideas. Let me explain. If you make your goal "stopping my panic attacks", you are really no further forward than you were before you sought help. But if you make your goal "taking the bus to the next town to see a particular friend", you know exactly what you want to do and how you are going to do it. So try to make the goals as specific as possible. To begin with, choose goals that you can practise over and over again rather than one-off events. For example, make your goal "to do my shopping in Sainsburys", so you can visit it daily and just pick up a few things.

Step Two

Now rearrange your first list, putting these goals in order according to how difficult you think it would be for you to face them. Put the least difficult goal at the top of the list and the hardest at the bottom. I know they all seem impossible at present but you will find that some are easier than others if you think hard about it.

Here is a list of goals that one person suffering from agoraphobia made for herself.

1. Walk to the park, sit on park bench and read a book.
2. Walk into town and sit down on a bench in the shopping centre.
3. Go into the library.
4. Queue in the Post Office.
5. Go into Sainsburys to do my shopping.
6. Eat out in McDonalds with my family.
7. Go on the train to visit my brother in the next town.
8. Go on holiday with my family to a cottage in Devon.

Step Three

Now pick the easiest goal and decide how you will confront it. Then return to the same situation again the next day and so on until you are no longer afraid. When you are successful, move on to the next goal and repeat the whole process. You can almost make a game of it!

There are four golden rules for you to remember when you confront your fears.

Rule One

You must stay in the situation long enough for the fear to fade away. The programme just will not work if you leave earlier. I know it feels as if the anxiety will go on forever but research has shown that it will gradually fade over the next hour or so. Repeat to yourself :-
"The anxiety may be unpleasant but I'll come to no serious harm."

Rule Two

Practise regularly and frequently. Try to set aside at least one hour every day for your practice sessions. You will find that the second time you face your fear, it will be much easier than the first. Each time the anxiety will be less and it will fade away more quickly. The third time you face it, it will be even easier, and so on. Keep on practising until you have successfully mastered your first goal. The more you practise, the faster you will overcome your problem. The programme will not work effectively unless you practise regularly and frequently.

Rule Three

Do not do anything to decrease your anxiety artificially. So do not take a tranquilliser or have a drink before you confront your fear. And do not "switch yourself off" so the experience becomes unreal. Always try to practise on your own. You will get less benefit if you go out with a friend or relative.

Resist the temptation to use any aids, such as an umbrella or sucking a Polo mint, to make yourself less anxious. If you find the goal too difficult at first, try to break it down into smaller parts. For example, if you cannot face getting on to the bus, make your first goal just to walk to the bus stop. Then wait for the bus, but when it arrives let it pass without getting on. Next time you will find it that much easier to board the bus. If you cannot face leaving the house at all, make your first goal just walking 50 yards from the house. Remember to wait until the anxiety fades away before you return home. If you cannot face going to a shop, say, get a friend or relative to take you to the shop first and then let you go in on your own. You must then stay inside the shop until your fear recedes.

If you finish your shopping before your anxiety has faded, sit down and pretend you are waiting for a friend. You could read something while you are sitting there. Or just continue looking at the goods for sale. Sometimes you have to have a lively imagination to make up your goals and to make them easier for yourself if they are too difficult.

Rule Four

Keep a diary of your practice sessions. In the first column, write down the date of your session, in the second, how long the session lasted and in the third, write down what you actually did in the session. Use the fourth column to make a note of the level of your anxiety before, during and after the session. You can monitor the level of your anxiety on a rating scale between 0 and 8. Take the 0 to be no anxiety at all, and 8 to be a full panic.

Remember to try not to end the session until your level of anxiety is back to what is normal for you. So, for example, if you normally rate your level of anxiety at 2, your anxiety may go up to a rating of 6 before you go into the supermarket, and up to a rating of 8 during the time you are in the shop. Do not leave the supermarket until your level of anxiety goes back down to at least 2 or 3 or the programme will not work. The biggest mistake that people make is to leave a situation too early when they are still feeling anxious. (You may need the help and support of a friend, or Community Psychiatric Nurse at the beginning.. but you should eventually end up doing these exercises on your own.)

Once you have successfully completed your first goal, you can move on to the next one. You may be able to work on two or even three goals each week. Don't under-rate what you have achieved. Use your diary to look back over your sessions and see how you have progressed. Congratulate yourself for what you have done and give yourself a small present or treat when you do achieve each goal. It may seem slow at first but you will progress quickly if you stick to the rules I have given you.

Do be prepared for the odd setback; some days will be better than others. If you fail in a goal, remember to try to make it easier by breaking it down into smaller goals.

---ooOoo---

A note for relatives or friends of agoraphobics

Relatives and friends can play an important part in helping an agoraphobia sufferer.
As someone close to an agoraphobic you may, up to now, have helped by doing things outside the home for them, or accompanying them when they go out. If you really want to help your relative, you will gradually have to stop doing things for them. Taking things off their shoulders by assisting in this way only maintains the problem - it does not help in the long term. What you can do is to read this leaflet and help your relative make a list of goals, if he/she asks you to, and encourage them to monitor their progress through their diary. Ask how the practice session went each day. Do not help them with things which form part of their goals. The only way your relative or friend will change is if they gradually learn to do things for themselves. Always encourage him/her and praise success. Whatever you do, do not criticise or tell them to pull their socks up, or pull themselves together. (...they are not a pair of curtains!) Remember, for your relative to confront their fear is like you forcing yourself to do a parachute jump for the first time, or having a gun held to your head. The whole experience is a terrifying ordeal.

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