Agoraphobia
The
word derives from the Greek, the agora being the market place, or 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 therefore 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 estimates, but probably 1%
of the population suffer agoraphobia of such 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 occurence 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 e.g.
Lorazepam (Ativan). In the last 25 years psychological treatments (involving
behavioural and cognitive behavioural methods) achieve 70% or 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 sometimes require a therapist to 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. that if you
stay in the situation and this exposure is repeated systematically, the
anxiety fades away. In some cases the therapist may use methods which help
the client re-evaluate their anxious thoughts by the use of cognitive
techniques, 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 may assist the sufferer.
BABCP
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