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[center]Agoraphobia[/center]

[goto=2]The History of Agoraphobia[/goto]
[goto=3]The Development of Agoraphobia[/goto]
[goto=4]Symptoms of Agoraphobia[/goto]
[goto=5]The Causes of Agoraphobia[/goto]
[goto=6]Coping with Agoraphobia[/goto]
[goto=7]Diagnosing Agoraphobia[/goto]
[goto=8]Helping Someone with Agoraphobia[/goto]
[goto=9]How Panic Disorder Can Turn Into Agoraphobia[/goto]
[goto=10]Supporting Someone with Agoraphobia[/goto]
[goto=11]Treatments for Agoraphobia[/goto]
[goto=12]Personal stories[/goto]
[goto=13]Useful articles[/goto]
[goto=14]Recommended reading[/goto]

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The History of Agoraphobia

Agoraphobia first came to light in 1872 when Dr. Westphal first described man’s fear of suffering panic attacks and finding it hard to escape given situations when immersed in his/her surroundings or performing such tasks like traveling, socializing and being in crowded places. When describing the agoraphobia condition Westphal stressed and pointed out the importance of another condition called anxiety that is associated and related with agoraphobia.

During the 1960’s the condition of agoraphobia was then classified as a form of “Public Anxiety Disorder”. The term “agoraphobia” comes from the Greek word “phobos” and “agora” which when translated literally would mean “fear of the marketplace” this definition usually creates a misconception that the condition of agoraphobia is the fear of any open spaces, which is thereby clinically inaccurate. Currently it is among the most common types of conditions considered as phobic seen in the long history of clinical practice.

History of agoraphobia patients suffers sudden panic attacks when they find themselves traveling to places where they develop a fear that getting help would be too difficult to get. During these bouts of panic attacks, adrenalines are expressed in great amounts for a number of minutes causing the person to have this classical term of “flight or fight” condition.

These attacks usually have an abrupt and sudden onset, developing into maximum levels of intensity in the time range of 10 to 15 or more minutes and very rarely it will last much longer than 30 minutes. Symptoms of these attacks that are associated with agoraphobia consist of sweating, palpitations, shortness of breath and trembling. Many agoraphobia patients narrate a feeling of a fear or losing control of behavior or emotions to fear of dying.

In the years that came after the first discovery of the condition of agoraphobia, a lot of treatment techniques have been developed by medical experts around the world. Today agoraphobia can be treated successfully by a wide numbers of different processes like the gradual graduated exposure therapy which is combined with cognitive therapy for better result. Sometimes anti depressant or anti anxiety medications can also do the job. In most cases the treatment methods for patients with panic disorders and agoraphobia are always somewhat similar because of the close relationship between the two conditions.

Experts have since also developed the so called Exposure treatment, this causes many patients with agoraphobia and panic disorders to have a long lasting relief. The main objective of this therapy is to disintegrate the various sub clinical and residual agoraphobic avoidance and not mainly the treatment of what causes the panic attacks.

Currently the studies for the exact diagnosis method for agoraphobia are still being conducted by researchers and experts of the mental health field all over the world. Patients suffering with agoraphobia today are getting the best treatment method than ever before.

Agoraphobia, ever since it was first discovered continues to baffle and mystify the experts as its scope is far ranging and hopefully someday patients suffering from this phobic condition will feel more at ease and have access to effective treatment.

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The Development of Agoraphobia

Agoraphobia, clinically defined as the fear of anxiety and panic brought about by situations that one cannot easily escape from, is said to develop from another anxiety disorder called Panic Disorder. Although Panic Disorder often accompanies Agoraphobia, Agoraphobia may also be diagnosed without it. Agoraphobia has much deeper roots and in fact, the development of Agoraphobia can be traced back to the childhood years of an Agoraphobic individual.

Studies have shown that a baby or a child who exhibits negative behaviors towards new situations, unknown surroundings, and unfamiliar people may be at higher risk of developing an anxiety disorder such as Agoraphobia. If he or she cries, kicks, hides, recoils, draws back, or only wants to be held by someone familiar when faced with such situations, then the child might have a condition called behavioral inhibition. Behavioral inhibition in children, especially those who continue to show such characteristics after a considerable period of time, may develop into Agoraphobia later in their adult life.

Children who are afraid of being separated from their parents also have higher tendencies of developing Agoraphobia as adults. Almost half of the patients diagnosed with Agoraphobia revealed that they experienced separation anxiety when they were still children. One trait of Agoraphobics is that they do not like being away from their “Phobic Companion”, a person that they heavily rely on and would only face difficult situations when they are with that person.

Agoraphobia occurs much more frequently in women than in men and this can be explained by the conventional roles and expectations imposed on women by society. Instead of teaching women how to fend for themselves, some women today are still taught to be apprehensive of crowds and public places, putting emphasis on the dangers that they may face in such situations. These women become fearful and coupled with traditional expectations of women such as being helpless in times of danger, it is no wonder that Agoraphobia is more likely to develop in women than men.

Some people develop Agoraphobia from simply avoiding places and situations. For example, a person who experiences a fearful and panicky situation in a hospital could begin to link hospitals with the feelings of panic, fear, and anxiety that he or she felt during that situation. That person could then start to avoid all hospitals entirely and if he or she begins to forcefully avoid hospitals no matter what the cost, then that may be the onset of Agoraphobia.

Stressful events in a person’s life can also bring about the development of Agoraphobia and other anxiety disorders. A stressful event like a traumatic driving accident could cause a panic attack in a person. When that first panic attack is left untreated, then that person could begin to associate things or places in the accident as the cause of the panic attack. From then on, that person might experience panic attacks whenever faced with anything that he or she relates to the accident. Frequent panic attacks could develop into a Panic Disorder which could further develop into Agoraphobia.

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Symptoms of Agoraphobia

Agoraphobia is characterized by many different symptoms that can easily be mistaken for other phobias or anxiety disorders. These phobias and disorders, like social phobia, specific phobia, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, or separation anxiety disorder, must first be ruled out before diagnosing an individual with Agoraphobia. Oftentimes, the symptoms of Agoraphobia only manifest themselves when the individual is faced with a panic-causing and anxiety-inducing situation.

So how would you know if an individual is suffering from Agoraphobia? The following are the signs and symptoms of Agoraphobia.

Children who are afraid of being separated from their parents also have higher tendencies of developing Agoraphobia as adults. Almost half of the patients diagnosed with Agoraphobia revealed that they experienced separation anxiety when they were still children. One trait of Agoraphobics is that they do not like being away from their “Phobic Companion”, a person that they heavily rely on and would only face difficult situations when they are with that person.

Panic Attacks More often that not, a person with Agoraphobia experiences panic attacks when faced with a situation wherein he or she cannot easily leave, cannot easily escape from, or where there is no immediate exit. An Agoraphobic fears the anxiety that could be brought about by these situations such as going to school or work, attending a social function, being in a meeting, going to church, shopping for groceries, traveling alone, or even driving on a bridge. Such anxiety-inducing places and events could lead to a panic attack in an Agoraphobic. He or she may experience heart palpitations, sweating, nausea, chest pains, lightheadedness, shortness of breath, headaches, tingling, trembling, dizziness, and shaking. Some also experience having a fear of fainting, dying, and losing control.

Avoidance Because of the anxiety and fear that they could bring about, an Agoraphobic would start to avoid these situations entirely. It is not uncommon for an individual with Agoraphobia to completely change his or her daily routine and lifestyle just to avoid those conditions associated with anxiety. For example, an Agoraphobic would be very willing to take a much farther route and drive a longer distance if it means avoiding a narrow bridge that has no immediate exits.

Housebound An Agoraphobic may become confined to the house from avoiding those anxiety-provoking situations so strongly. Roads, crowded areas, public places, open spaces, confined locations, and in fact any place outside the house could cause fear and anxiety in an Agoraphobic. This would make him or her not want to leave the house at all and the Agoraphobic could eventually become housebound. Some housebound Agoraphobics lead fairly normal lives of studying or working from their homes. Some feel comfortable enough to accept guests and visitors into their houses. Housebound Agoraphobics consider their house as a safe haven or a comfort zone where he or she is in control.

Anticipatory Anxiety When an Agoraphobic is expecting a difficult situation to happen, he or she could become very anxious. This condition of becoming fearful before the event of a dreaded situation is called “Anticipatory Anxiety”. Some even go into a full-blown panic attack hours before the situation has happened.

Other Psychological Problems Agoraphobia is also characterized by other psychological problems. An Agoraphobic might display behaviors of over obsession. He or she might have an excessive fear of being embarrassed and losing control. Some Agoraphobics could also develop low self-esteem and low confidence because of their disorder. Many become frustrated, confused, and depressed.

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The Causes of Agoraphobia

The causes of Agoraphobia have not yet been clearly defined nor have they been fully understood. In spite of the numerous studies that have been conducted on anxiety disorders, the answer to what really causes them still remains vague.

All has not been in vain however as the past decade of research has shed some light on the subject of anxiety disorders. The probability of developing Agoraphobia for instance, depends on not one singular factor but on several. Agoraphobia may result from a complex combination of these different factors.

Genetic Factors It has long been known that genes play a part in the development of Agoraphobia. A research conducted by the National Institute of Mental Health showed that if one identical twin is suffering from an anxiety disorder, it is very much likely that the other twin will have it too. Another research made by Yale scientists on human genes further confirmed that anxiety disorders such as Agoraphobia can be inherited. An individual is three times more likely to develop Agoraphobia if he or she has immediate family members who have been diagnosed with Agoraphobia.

Brain and Biological Factors Scientists have found out that those with anxiety disorders exhibit an unusual amount of activity in the hippocampus and the locus coerulus parts of their brains. They also show an abnormality in their adrenergic system and an irregularity in their benzodiazepine receptors, which are responsible for controlling anxiety. More studies have to be made on the connection between biological factors and anxiety disorders because it is not yet clear if this is what causes the anxiety disorder or is merely a symptom of it.

Psychological Traits An individual’s own temperament also has something to do with the development of Agoraphobia. Some are simply more sensitive and react more intensely to certain life situations. Studies also show that babies and children who demonstrate “behavioral inhibition” are more likely to develop an anxiety disorder in their adult years. Behavioral inhibition is characterized by withdrawing, crying, and seeking comfort when the child is faced with unfamiliar surroundings or strangers.

Learned Behavior and Social Factors When a place or a situation causes anxiety in an individual, he or she will most likely begin to avoid that place or all similar situations. This pattern of avoidance can definitely lead to Agoraphobia. There are also four times more women who suffer from Agoraphobia than men and it is believed that social factors are behind this occurrence. The traditional roles and expectations of women such as being a damsel in distress when faced with difficult situations, emotionally overreacting to stressful events, staying at home, and etc., encourage Agoraphobic-like characteristics in women.

Life Experiences Anxiety disorders often arise around the time when an individual is experiencing a difficult life experience such as the loss of a loved one, death in the family, and etc. Such life experiences can trigger the development of Agoraphobia. Research also shows that Agoraphobics have had experiences of separation anxiety as children from their parents or caretakers, which accounts for their behavior of only feeling safe when they are with their companions.

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Coping with Agoraphobia

Agoraphobia may be curable, but sometimes it may take a while before treatment has any effect on the individual. It might also take some time before the person suffering from Agoraphobia finds the right treatment, therapy, and medication that works for him or her.

In the meantime, the Agoraphobic individual must face this anxiety disorder in his or her day-to-day living. Here are helpful guidelines for the Agoraphobic on dealing with anxiety and the causes of panic. With these, an individual suffering from Agoraphobia can face a brighter future without panic attacks and hopefully without Agoraphobia.

Communicate Openly It certainly helps a lot if you are open about your Agoraphobia. This allows people to better understand you and find better ways of helping you. Getting things off your chest will relieve you of your stress and lower your anxiety levels that could help reduce panic attacks. Talk with your trusted companions, doctor, and therapist. Tell them about your hardships with Agoraphobia, daily struggles, feelings, experiences, and anything that concerns you. It also helps to ease stress and anxiety if you communicate with yourself by keeping a journal and writing down your personal concerns about your Agoraphobia.

Find Support It is a common trait for a person with Agoraphobia to find a “Phobic Companion”, someone that he or she needs the assistance of to face situations that are too difficult for the Agoraphobic to face alone. However, the Agoraphobic needs to surround him or herself with a group of people that can provide care and support. Your family, friends, local community, and doctors can be part of your support group. These people will play vital roles in helping you succeed in overcoming your anxiety disorder.

Face Your Fears One goal of Agoraphobia treatment is to help you conquer your phobias. Doctors do this through behavioral modification and other therapy techniques. Help yourself overcome your own fears by facing them yourself and by putting a stop to avoiding everything that causes your feelings of anxiety and panic. Arm yourself with things that help you control the dreaded situation. Like for example, carry a map of the panic-causing place to know exactly where you are or use a stress ball to distract you and prevent your anxiety levels from escalating. Take baby steps and take as long as you want because only you can assess what is easy and comfortable for you.

Diet and Exercise There are many things that we can put in and do to our bodies that can significantly increase levels of stress and cause panic attacks. Some of these are smoking, drinking caffeine-laced beverages, and consuming alcohol. By eliminating these from your diet and combining it exercise that can improve your mood, you can lower your anxiety levels and control your own panic attacks.

Relax Deal with anxiety by learning to relax yourself. Some simple relaxation techniques are to listen to music, lighting some incense, taking a bath, and doing some breathing exercises. Some people choose to meditate because meditation is an effective way of relaxing, breathing properly, and focusing your thoughts away from the anxiety and panic.

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Diagnosing Agoraphobia

By definition agoraphobia is usually associated with panic disorders and panic attacks. In layman’s term agoraphobia is like having a “fear of experiencing another episode of panic attack” or fear of any events that may produce a form of panic attack.

There are a lot of ways in diagnosing agoraphobia and medical experts always have different approach and style in determining the causes and diagnosis of agoraphobia. According to the U.S. Diagnostic Manual which is stated in the DSM IV TRAND in ICD 10, it stated that the patient’s obvious symptoms should not be in any way related to substance abuse; in cases that they have a relation to a determining general medical condition, the patients must show some excessive symptoms related with that particular condition. The U.S. diagnostic manual also specifies that the affliction of agoraphobia must be clearly defined as related to PD, and that any kinds of diagnosis of any social and specific phobias should be considered next.

One example, a patient suffering with Crohn’s disease usually have worries about having diarrhea in any public places but should not be in any way diagnosed easily as suffering from agoraphobia unless his/her fear of having diarrhea becomes too exaggerated . While the European diagnostic manual doesn’t require a patient to suffer agoraphobia within a range of circumstances or events in order to hit a diagnostic criterion.

In somewhat a contrasting style the European diagnostic manual separates and distinguished specifics between agoraphobia and other obsessive or delusional disorders, and episodes of depressiveness. In addition to that the ICD-10 stated that the individual’s anxiety or fear should be restricted to show primarily set within four or two particular situations like for example fear of public places, being with crowds, traveling far away from home or simply traveling alone. The one thing that both the European and American diagnostic manuals agreed upon is that they both specify that the patient’s avoidance or fear of the said situations fall into the agoraphobia diagnostic criterion.

Here are some diagnostic criteria for Agoraphobia - Patient is experiencing amount of anxiety about being put in a situation where he/she feels being trapped, or that can be somewhat embarrassing and difficult that may trigger some panic attack - Some situations are endured or avoided with a great amount of anxiety and distress about having a panic attack - Avoidance is not merely caused by other kinds of phobia like social phobia or other kinds of disorder like post traumatic disorder, separation anxiety or obsessive compulsive disorder.

Doctors or physicians usually make their diagnosis of agoraphobia based generally on the description of the patient’s experiences such as anxiety in certain situations like fear of being alone. One thing about realizing a possible affliction of agoraphobia is knowing a person’s further avoidance of types of situations where he/she are already being impaired to socialize, work and function properly which usually involves fear of crowds also.

As of 2002, no definite imaging studies for agoraphobia diagnostics have been made in order to be used in diagnosing agoraphobia.

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Helping Someone with Agoraphobia

Those suffering from Agoraphobia have to deal with anxiety, panic, and fear in their everyday lives. Agoraphobia presents many serious situations, challenging conditions, and terrifying experiences to the sufferer. Much of the recovery will come from within the individual, but the healing process will be prove to be very difficult and excruciatingly slow if the person is left to overcome Agoraphobia on his or her own. This person requires the help, care, and support of his or her family and friends.

What are you to do if you are the support person or one of the people in the support group of an individual suffering from Agoraphobia? Here are some tips to help your loved one overcome Agoraphobia.

The first thing that you should do is to educate yourself on Agoraphobia. Educating yourself about the phobia and the anxiety disorder that your loved one is suffering from will help you become sympathetic to that person’s situation. It will help you understand that he or she is actually facing real fears that are truly terrifying. It will also show the sufferer that you sincerely want to help and to give the support that he or she needs.

Once you have informed yourself about Agoraphobia, you will find out that there is no need to belittle this illness or the person suffering from it. Agoraphobia is a real illness that must be treated like any other tormenting disease. Embarrassing or lecturing the sufferer will only make him or her draw away from you and not trust you.

It is very important to be patient when dealing with someone with Agoraphobia. Understand that Agoraphobia poses a serious challenge to the sufferer and that it may take a while before he or she is ready to face that challenge. Recovery for an Agoraphobic will often be a “two steps forward, one step backward” situation and will require a lot of time and patience.

The sufferer will need lots of support and encouragement, so don’t hesitate to offer these willingly. However, remember to not push the person into situations that are too uncomfortable or difficult for him or her. The Agoraphobic must set the limitations and control his or her own personal recovery. Also remember that every small step towards recovery is already a big accomplishment for the Agoraphobic.

It is best to have a group of people composed of family, friends, and even health care providers to be the support system of the person suffering from Agoraphobia. This way, not just one person is left to be responsible for the needs of the Agoraphobic and the Agoraphobic may get the support that he or she needs from various sources.

Lastly, open up and admit when the situation is proving to be too difficult and too taxing for you. Being honest with each other will not only help you properly handle the situation, but will also relieve the strain that it could possibly put on your relationship. Remember that in order to take care of others, you must take care of yourself.

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How Panic Disorder Can Turn Into Agoraphobia

About 30 percent of people in any given year will experience having at least one panic attack. Those who suffer from frequent reoccurring panic attacks and obsessively fear future panic attacks have the clear signs of a Panic Disorder.

Panic Disorder is one of the most commonly diagnosed anxiety disorders, occurring in about 1.7 percent of people between the ages of 18 to 54. And of those people diagnosed with Panic Disorder, a substantial 36 percent further develop Agoraphobia.

How does Panic Disorder develop into Agoraphobia?

It begins with the first panic attack. Most of the time, the individual can recognize what will cause the panic attack and can avoid it. But sometimes, a panic attack can happen unexpectedly and without warning and this is when the individual is at high risk of developing Agoraphobia.

Let’s give a sample scenario. A single unwed woman is expecting her first child. She also has to deal with the high expectations from her work and her overzealous boss. In the meantime, her family is pressuring her to find a suitable father for the unborn child and to do well in her career at the same time. The woman is trying to handle and cope with all these stresses by herself, thinking that she is perfectly capable of doing so.

One regular day of shopping at a grocery store, the woman suddenly experiences an increase in heart rate, chest pains, nausea, dizziness, shortness of breath, tingling in her hands, and difficulty in breathing – all symptoms of a panic attack. The woman is rushed to the hospital and all sorts of tests are conducted on her and she is made to take various medications. These worrisome examinations could heighten her anxiety and fear about the panic attack that she just experienced.

If she leaves this first panic attack untreated and the doctors merely treat her symptoms, then this is where the problem begins. Instead of identifying the true causes of her panic attack (stress from pregnancy, work, and family), she could become confused and associate the grocery store with the panic attack. She might begin to think that what caused her feelings of anxiety, fear, and panic is the grocery store.

From here on, the woman might experience panic attacks even when she just knows that she will be going to the grocery store. The woman will begin to fear the anxiety and panic that she might experience once she goes there. The woman could then begin to avoid going to the grocery store entirely or would only want to go there when she is with a support person. The fear and avoidance could become so severe that the woman could eventually become confined to the house or housebound.

Panic attacks, fear of experiencing anxiety and panic, needing the assistance of a support person, avoidance, being housebound – these are classic symptoms of a case of Agoraphobia.

This is how a relatively harmless panic attack can become a full-blown Panic Disorder and even develop into Agoraphobia.

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Supporting Someone with Agoraphobia

The Importance of Support for an Agoraphobic Overcoming a phobia is a daunting task for anybody who suffers from it. The treatments may differ for every patient. What is effective for one may not yield the same positive result to the next person. Furthermore, there is a need to determine what type of remedy will address the problem at hand, whether therapy or medicines, or both will be sufficient. Alternative treatments such as hypnosis or meditation may likewise be looked into. Amidst all these concerns, there is an essential variable that must be accounted for and that is the person concerned.

Ask anyone who has managed to recover from agoraphobia about his or her experience while battling this condition. They are bound to tell you that a vital, intangible aspect that hugely helped them in their recovery would be the support as well as love that their family and friends have extended to them while undergoing treatment. For those individuals that are afflicted with this type of phobia, having another person whom they can confide in their worries are responsible for giving them the courage to face their fears.

If you know someone who is an agoraphobic, then you should be able to help him help himself. The following are three valuable tips on how you ought to extend your support to one who suffers from agoraphobia.

Show your support by being a good listener As you might have personally experienced it, it really feels good to have somebody that is willing to listen and hear what you have to say. This is exactly what an agoraphobic needs, someone whom he can express his fears to, unfounded these may be, and who is trying to understand what he is going through. It will lessen the burden he is carrying if one who deals with such phobia can turn to a trusted friend or confidante that will give him strength to conquer this disorder. Learning by reading more about this phobia can aid you in providing positive reinforcements to him.

Acceptance and patience must be exercised at all times Although complete recovery is possible, this may take weeks, months or even years to achieve. You should think that if this is difficult for you, imagine how harder the situation is for the agoraphobic. Agoraphobia is not a condition that he wished to have and yet, his challenge is to regain his normal behavior. As a relative or friend, your role requires you to accept him for what he is and assist him to defeat his apprehensions. While undergoing therapy, setbacks may take place, which is normal. You should be patient and realize that this is battle will not be that easy to win.

Have faith and confidence in the agoraphobic The knowledge that someone believes that you can beat your phobia will certainly give you the confidence that you can and will overcome. Majority of people need somebody to give them the necessary push that will encourage them to work for their immediate recuperation. Knowing that you are not alone in facing this disorder is an incentive that you should utilize to your advantage.

Unconditional love and support are factors that you definitely cannot buy from a pharmacist or a therapist. However, these can work a miracle to a person who is agoraphobic.

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Treatments for Agoraphobia

Dealing with any kind of phobia is a huge burden on the individual concerned, which may also directly affect the other people around you such as your immediate family. How you lead you everyday life would greatly depend on your coping mechanisms and your determination in controlling your fear.

A person with agoraphobia has three alternatives in addressing this condition. One would be to continue to struggle with your normal life with anxiety attacks being experienced occasionally. Another option is to limit your movements within your comfort zone or areas where you feel comfortable to function properly. In some instances, you would prefer to be with a “safe person” who serves as your security blanket to avoid panic attacks. In a worst case scenario, an agoraphobic may find herself being housebound, not leaving her home for any reason whatsoever.

Various treatments for agoraphobia have been developed to correct the situation of those people suffering from it. There is, however, no tried and tested cure for this condition, as such treatment will vary for every patient and will be ascertained on the degree of the phobia felt. The remedy may involve the prescription of the appropriate medication or requiring some form of therapy or a combination of the two.

Under therapy treatment, there are many the choices - cognitive therapy, relaxation therapy, hypnosis, psychotherapy, assertiveness training, meditation or exposure therapy. Cognitive behavioral therapy (CBT) combines cognitive with behavioral therapy. CBT is further classified into different forms such as thought replacing, thought stopping, focusing, paradoxical thinking, the worst-case scenario and visualization/ guided imagery. With respect to medication treatments, the most recommended medicines are anti-depressants, beta blockers, benzodiazepines, buspar and anti-convulsants.

CBT entails the correction of negative thinking that triggers the abnormal reactions to what may be deemed normal circumstances. An effective, short-term process requires your participation to change the way you think that will eventually benefit your emotional state. You will be conditioned on how to react effectively given a situation that can trigger your anxiety. The session may last for ax long as 12 weeks or shorten to 8 weeks, depending on how well the patient respond to the exercises involved.

Exposure therapy is a technique focusing on your behavior and analyzing your fears from the least to the worst. It is claimed to be effective in at least 75% of the cases, which it has been applied. Using this method, you will be taught on ways how to keep yourself calm and to cope with an otherwise stressful position.

There may be cases that a patient might progress faster if the therapy is performed within a group. The interaction with other persons having the same fears will encourage the person to do better in terms of facing her fears. Guidance from therapist though is essential for the treatment to be beneficial for all members in the group.

A reputable doctor must prescribe the medications and the dosage ought to be observed. Most of these drugs address the symptoms of panic attacks, either by blocking the happening or reducing the anxiety being experienced.

If you have agoraphobia, you should resort to the treatment, which you are comfortable. You should consult a medical practitioner for what will be the suitable for your existing condition.

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Personal stories
By: Shelly Wiseberg
My personal story living with agoraphobia, social phobia, and chronic anxiety disorder. I was diagnosed in September of 2000, a month after my father died. I take medications and have had therapy which has helped me greatly
in my life. I have done alot of soul searching and truth seeking throughout my life, through spiritual and healing books, meditation, yoga relaxation, therapy,and meeting other deep souls that were my private messengers of positive thinking.

It all started an an early age when I first met up with a child molester at the age of seven. This can easily change your points of view about society. Other experiences similar to that happened at different stages of my life growing up
and at different ages. Living with agoraphobia, panic,and anxiety is a challenge in itself.

We rob ourselves of many opportunities because of our own fears and need to always feel safe in our environment. If you come from an abusive background without any emotional support you end up creating your own safe haven in a private world of self protection, your family life, the environment you grew up in, relationships with parents and siblings, behavior
and patterns of thought, of so called role models who need it more than we do!

By: Stephen Price
I was an accidental jogger. The day I started running I was actually trying to “desensitize” myself to being outside to overcome my agoraphobia. My plan was just to see how far I could walk away from my house every day without feeling too much panic.

I would try to go just a little bit further each day than the day before, then turn around and go home when I started to get too anxious. I started by walking to my mailbox. A few days later I made it to the end of my cul-de-sac about three houses away. A few days after that, I turned the corner and went a little ways down the street.

Once I made it off my cul-de-sac, I suited up in running attire for my walks. I thought if anyone saw me from inside one of the houses, they might wonder why some teenage kid was walking down the same stretch of sidewalk every day. Since I didn’t want anyone to suspect I had agoraphobia, I disguised myself as a jogger to give me a socially acceptable reason to be out on the sidewalk so often.

My ultimate goal was to make it around the whole block. It took about a month to make it almost halfway so I expected to meet my goal in about two months. Long story short, my calculation was wrong. I made my goal in half the time and this is where the running comes in.

On the day I made it exactly halfway around the block, I realized to my utter horror that finishing the block would be just as far as turning back the way I came. I don’t know why I hadn’t thought of this before, but my anxiety shot into overdrive when I discovered this.

I had a choice to make. I could finish the block or turn back. Either way it would be just as far. In a split second, I decided to meet my goal of finishing the block and ran home as if running for my life. At that point the jogging suit didn’t matter. I didn’t care if people thought I was crazy. I could have been running naked for all I cared. I just wanted to make it home before I passed out from panic and hyperventilation.

I made a discovery as I ran from the panic. While running my hardest, I quit hyperventilating. Not because my breathing got slower, but because my need for oxygen increased.

When I thought about it later, it made perfect sense. Whenever I panicked anywhere, my “fight or flight” response was activated, which is the body’s natural inclination to fight or flee when faced with perceived danger. In most cases, there is nothing to fight and nowhere to run without looking odd. Running is not possible while sitting in a car, a classroom, in church, or while walking through a mall trying to look normal and calm.

Though the body doesn’t actually run in these scenarios, the respiratory system is activated just the same, provides lots of unneeded oxygen, and sends energy to the muscles just in case. If the body remains motionless, this activation can lead to light-headedness and tingling sensations in the hands and feet. If the body is running, then all the fast breathing and adrenalin rush is actually used to fuel the body’s activity. Instead of producing panic symptoms, the body gets the oxygen it needs to support its “flight.”

Whether running from a tiger or just running to be running, to my body it was all the same. There was no way to hyperventilate when my body actually needed all the extra air.
After I stopped running that day, I made a couple of other discoveries. First, since my breathing had fallen into the rhythm of my activity while running, it naturally slowed down when my body slowed down. Second, I enjoyed a tired euphoric feeling brought on by the release of endorphins into the bloodstream.

Endorphins are neurotransmitters produced by the brain following exercise. They cause a pleasurable euphoria that some people call “the runner’s high.” The euphoria is felt because endorphins interact with opiate receptors in the brain to decrease pain. Their physical effect is similar to drugs like morphine and codeine.

I can tell you from experience that endorphins rival Valium, Xanax, or any other anti-anxiety pill on the market in terms relaxation properties. The difference is that endorphins are a natural substance produced in the body and are not addictive.

A running program can help you eliminate the “fight or flight” response (or panic attacks) by satisfying the need to flee in the most natural way. Running will also give you confidence that you can get your body and breathing under control.

If you have agoraphobia or a serious panic disorder you’ve probably ruled out running or doing anything outside because you can’t get far enough out of your house. I can identify. I experienced debilitating panic every time I walked out my front door when I first started my running program. Ironically, I found running to be the most natural way to respond to the urge to fight or flee that comes with a panic attack.

Running also gave my body a use for the extra air I sucked in while hyperventilating. The effort forced my breathing into a consistent pattern, bringing it under control. The endorphins, or natural tranquilizers, produced in the bloodstream by running for long periods were an added bonus.

The more regularly I did running workouts, the more I proved to myself that my lungs were healthy, and gained confidence in my physical body so I could start going places. Though it was not always convenient, I learned that I could always stop a panic attack or hyperventilation spell by running. This gave me the sense of control over my body and breathing that I needed during a “fight or flight” response.

I could also overcome my fear of open spaces by breaking new ground while running. Wherever I ran, it was nearly impossible to panic. After I started the running program, I wasn’t out of the woods with the agoraphobia, but at least I knew I could run anywhere!

Needless to say, a good running program can help you in your recovery from agoraphobia.

Moving day with agoraphobia
Cathleen Henning Fenton,
The alarm pierced through the dark early morning air, shattering my restless sleep. As I slapped the shrill sound into silence, I felt familiar anxiety pushing into my stomach as I thought about the journey ahead.

I hated getting up when it was still dark outside. My apartment, normally filled with the disruptive sounds of the busy streets below, was nearly quiet. I felt alone in the world, and I tried to think of the people awake and active in other time zones in other countries around the world. But the chilly darkness wouldn't allow me to feel comforted.

Moving day. It seems a contradiction that someone with agoraphobia would be moving. However, for a variety of reasons, it had to be done. I had planned for this move for quite some time, trying to wait until I was "ready" and trying to push my recovery from agoraphobia along a little faster.

When the day came, I felt completely unprepared.

However, as I took a shower and dressed, I knew that I was as prepared as I could be -- as prepared as anyone could be. As usual, my anxious thoughts tried to sabotage my peace of mind. I knew I would be spending the day sorting the unreasonable from the reasonable. Each negative thought would have to be followed by its logical counterpart.
The process of moving has forced me to deal with two important problems. The first is my undying need to be in control. That I am a "control freak" is no surprise to me, but we control freaks need to be reminded of our vice now and then. As with any situation, moving reminded me that I can't control everything.

Interestingly, I also realized that even when I could exercise some control over a situation, it could easily slip out of my control at any time. For example, even though I arranged to have my electricity turned on the day before I moved in, my new landlord was out of town for the weekend and didn't turn the main switch on until the evening after I moved in.

My second moving lesson has been a reminder that it's not easy for anyone to move. Whether you move to a different state, like I have, or just across town, moving is a disruption in your life. Every move involves a different set of circumstances, but even if all those circumstances are positive, moving causes stress.

This second lesson pushed me to give myself some slack. Although it's good to push myself to stretch my boundaries, I needn't be so hard on myself when something is difficult. In the process of moving, I would start to think, "If only I didn't have panic disorder, this would be easier." Perhaps it would, but the fact is that I do have panic disorder. And the fact is that moving is difficult. It's been a lesson in accepting my feelings as they are and not thinking constantly about them as symptoms of panic disorder and agoraphobia.

It has been eleven days since that silent morning when I started my journey to a new home. I'm not completely unpacked. My car is not registered in my new state. I haven't yet established all those basic routines that keep us secure. And I miss my best friend.

No, it hasn't been easy. But I did it. I'm here. And I've made it eleven days so far. I know I can do it.

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Useful articles
The Agoraphobia Mindset: Fatalistic Thinking by Stephen Price
People with agoraphobia often engage in fatalistic thinking.

Fatalistic thinking is thinking of yourself as powerless to make choices or affect the outcomes of your own life. Fatalistic thinking is holding the belief that the forces that govern your life circumstances lie completely beyond your control. This is a way of not taking responsibility for your decisions and behavior.

For people with agoraphobia, it is also a way of avoiding responsibility for doing things that might cause anxiety. People who engage in fatalistic thinking often say “I can’t” when they really mean “I don’t want to,” “I am afraid to,” or “I won’t.

Examples of fatalistic thinking:

You are supposed to go to a conference for work, but it will mean flying in a plane and you are afraid to fly. You say to a co-worker, “I can’t go to the conference because the company can’t really afford to send another person.”

You don’t want to go to class because you are afraid to take a test. You tell yourself, “I can’t go to class today because I feel too sick.”

Fatalistic thinking may start out as consciously making excuses for things someone with agoraphobia would be afraid to do. However, people who talk this way often start believing that their life circumstances really are out of their control. When you perceive the important outcomes of your life as in the hands of fate, you are setting yourself up for feelings of powerlessness, fear, and anxiety.

For most people with agoraphobia, fatalistic thinking gets combined with rigid expectations to cause even more anxiety. That’s because when people holding rigid expectations for themselves succumb to fatalistic thinking, they live in a world caught between what they “should” do but “can’t” do.

An example of this “should-but-can’t” thinking is if someone with agoraphobia experienced the death of her mother, the funeral was to be held out of town and would require a drive of several hours. This person might think, “I really should attend the funeral or I am not being a good daughter. Missing my own mother’s funeral would be absolutely unthinkable. But I can’t make it because I can’t drive. What if I had a panic attack and got into a major wreck.”

The woman in this example is caught in the classic bind between rigid expectations and fatalistic thinking. There is something she “should” do but feels like forces beyond her control will prevent her. She is likely to feel guilty about missing her mother’s funeral and anxious at the same time because she doesn’t think she can do anything about it. She is likely to compound her anxiety with self-criticism.

Most people with agoraphobia experience these binds all the time, and live in a near constant state of self-criticism and anxiety as a result.

The Agoraphobia Mindset: Holding Rigid Expectations By: Stephen Price
People with agoraphobia often hold rigid expectations.

Holding rigid expectations is thinking of personal preferences, wants, or choices in terms of absolute rules. Rigid expectations are usually expressed with words like “should,” “ought to,” “have to,” and “must.”

This type of thinking leads to anxiety because you end up focusing on something you think is wrong and are likely to become critical of whomever or whatever is not meeting your rigid expectations. Because in many cases, the rigid expectations are applied to you, this type of thinking tends to promote a lot of self-criticism.

When you hold rigid expectations, you think of anything that falls short of the inflexible standard you have set as totally unacceptable. In effect, you have entered an idealistic fantasy world where everything is supposed to be exactly how you think it should be or you feel anxiety.

Examples of rigid expectations:

“I should be liked and accepted by everyone or I am not a worthwhile person.”

“I have to be able to finish my workout before 7 AM every morning or it won’t be a good day.”

The Agoraphobia Mindset: Negative Mind Reading By: Stephen Price
People with agoraphobia often engage in a type of faulty thinking called negative mind-reading. Negative mind reading is assuming that other people are thinking and feeling negative things about you without any real evidence to support your assumption.

Some people with agoraphobia live as though they were psychic, always assuming the worst-case scenario when interpreting other people's comments, expressions and behaviors. People with agoraphobia suffer from a lot of unnecessary anxiety that comes from always assuming the worst when it comes to how other people might be perceiving them and wondering what they might be doing wrong to cause such negative reactions from others.

Examples of negative mind reading:

You pass someone you know in a crowded shopping mall and try to catch her attention to say hello. She walks right on by and does not even glance your way. You think, "She must be mad at me about something. I wonder what I could have done to make her angry?"

You turn in a report to your boss at work. You have put a lot of effort into the report and anxiously await your boss’s feedback. A week passes and your boss says nothing about the report. You start to worry and think, "I guess he really didn't like my work. I wonder if he is not talking to me because he is trying to think of a way to fire me?" You go to work every day thinking that it may be your last.

Of course, anyone reading these examples can probably think of a lot of different explanations for someone passing by in a mall and not seeing you, or for a boss at work not taking some time to give you feedback about a report. People in crowded shopping malls just might not hear or see you and a boss could be too busy to review a report right away.

People with agoraphobia tend to focus on one possible explanation - the worst one.

For people with agoraphobia, negative mind reading can be compounded by catastrophic thinking as in the example with the boss and the report. Thinking the boss might not be pleased with a report might turn into the certainty of being fired in the mind of someone developing agoraphobia or related anxiety disorder.

The Agoraphobia Mindset: Personalizing By: Stephen Price
Personalizing is a type of faulty thinking practiced by people with agoraphobia.

Personalizing is assuming the blame for something that you might have influenced but was not totally under your control. This leads to anxiety that comes from feeling too responsible for other people’s emotions, decisions, or behavior.

Examples of personalizing:

A friend invites you to his party and you say that you have other plans and can’t make it. Your friend gets very angry and tells you that he feels hurt and rejected. You think to yourself, “It was wrong of me to say I couldn’t make it. Now I have really let my friend down and probably ruined his party.”

You ask your spouse to run an errand and she/he gets into a car accident on the way. You reason, “The accident is all my fault. If I had never asked her/him to go to the store, it would have never happened.”


Are You Benefitting Too Much From Agoraphobia To Want to Recover? By: Stephen Price
Besides choosing a good therapist and getting started on a course of treatment, there is another key ingredient to recovery from agoraphobia – wanting to recover.

Believe it or not, some people with agoraphobia don’t really want to recover. Although they might not admit this consciously, some part of them just doesn't want to let go of agoraphobia so they cling to the disorder like a dear friend. This is because they are receiving benefits from having agoraphobia that they do not want to let go of.

Some agoraphobics enjoy the attention and care they receive from others. They might not have experienced the same level of attention and care before they developed agoraphobia and may fear losing it if they recover. This attention and care could come in the form of financial support, emotional support, or just having someone to do everything for them.

Other agoraphobics might fear getting well because it would mean making changes. They may not feel confident that they would be able to cope with or handle the responsibilities of a normal life, and the idea of recovery leaves them feeling unsure and overwhelmed.

Still other agoraphobics may inherently feel like they don't deserve a better life. They may feel guilty about something and feel they deserve to suffer. Agoraphobia, for these people, could be like a prison they have put themselves in to serve out a sentence they feel they have coming.

Some agoraphobics might not feel responsible for their disorder and receive a psychological benefit from blaming it on other people. In other words, having a psychological problem like agoraphobia provides a way of getting back at someone (like their parents) whom they wish to make feel guilty.

Some agoraphobics with agoraphobia might fear freedom. They may not trust their impulses or they may doubt their level of self-control . They might be afraid that they would go out of control in some way (emotionally, physically, financially) if they were to get well and have to handle new freedoms.

Some agoraphobics may simply be unmotivated. They know that recovering from agoraphobia would be a lot of work and they don't have any reason to put out the effort. They may not have a sense of purpose for their lives, so they have no reason to work toward getting well.

Still other agoraphobics may have people who are reaping a psychological benefit from their illness. Their close friend or family member might derive a sense of self-worth having someone with agoraphobia being totally dependent on them. That person could be sabatoging their recovery, enabling them instead of challenging them to face their fears and get better.

Whatever the case, some people with agoraphobia might have more reasons to stay sick than to get well. If this sounds like you, you really need to find a reason to get well. Your recovery may depend on it.

First, look over this list of benefits you (or someone else) may be receiving from your disorder.

• Extra attention and care
• Having someone do everything for you
• Financial support
• Emotional support
• Not having to face the fear of change
• Not having to face the fear of freedom to make your own choices
• Feeling you deserve to have agoraphobia
• Blaming agoraphobia on parents or others and having disorder makes them feel guilty.
• Significant person in your life is deriving self-worth or receiving psychological benefit from having you dependent on him or her.

Acknoweldge to yourself which of these psychologcal benefits you may be receiving through your illness and prepare to let them go. In order to do this, you must come to believe the following:

• You are capable of giving and receiving love without having a disorder like agoraphobia to draw attention, care, and support from others.
• You, and you alone, are responsible for your recovery.
• You deserve a better life than being trapped in your house having panic attacks.
• Your life has a purpose that is worth facing any fear, including fear of change, fear of freedom.
• The benefits of recovery far outweigh any benefits you or anyone else is deriving from your being sick with agoraphobia.

If you need to, affirm these statements in yourself until you wholeheartedly believe them.

Third, and finally, find a purpose greater than your fear. This is one of the most important factors in anyone's recovery, discovering a reason for living that makes fear irrelevant.

Think hard about your dreams and fantasies for your life. Concentrate on your desires. Consider your skills and interests and decide what would bring you the most satisfaction in life.

People who are driven to action by a heartfelt cause seldom worry about what might happen if they fail. People who have a reason for living are seldom afraid of freedom, choices, or change. Their focus is usually on making a difference in the world rather than on being afraid of what dreadful thing might happen to them.

The Myth of Hopelessness with Agoraphobia
by Stephen Price
I believe hopelessness is a myth when it comes to agoraphobia.

If anyone was a hopeless case of agoraphobia, then I was. For two years I could hardly leave my home without being totally overwhelmed by debilitating panic. During the daytime, I fought a constant battle to keep from hyperventilating and scanning my body to make sure all my vital organs were working. At night I paced around the house, worrying that I might stop breathing and die at any moment.

Each morning, I awoke to the sounds of acid churning in my
stomach. Just taking a shower exhausted me and I could hardly
swallow food at breakfast. I couldn't go to school, work, or
church. I couldn't even go visit a friend and I was terrified when
the telephone would ring and I though it was for me.

I had panic attacks even when I was at home and at times I was
confined to one "safe" room by my fear.

I tried therapy, a support group, and medications - but nothing
seemed to help me. I thought about giving up and seriously
questioned the value of my life.

But I did recover.

Many people with agoraphobia believe that if therapy, support groups, and medication don't help them then nothing can
help them. There are many agoraphobics like I was who go through times of thinking they are a hopeless case.

There were two major turning points in my recovery:

1) Doing reading on my own to get educated about my disorder.

2) Meeting someone who had made a personal recovery from
agoraphobia with panic attacks.

When I met someone who had experience with recovering from panic disorder and agoraphobia, not only could she understand what I was going through from her own experience – she knew what to do to get better. I could have confidence in her suggestions because she had made a complete recovery from agoraphobia and panic attacks herself.

Meeting someone who had recovered from the same thing I was going through was like being lost in a forest and meeting someone with a map who could show me the way out.

What Doctors Didn't Tell Me About Ativan by Michelle Pitcairn
Many doctors prescribe Ativan (Lorazepam) for anxiety. In my case, I never had a problem with anxiety until I took Ativan to stop nausea during chemotherapy. When I tried to quit taking it, I experienced anxiety, panic, and other symptoms of agoraphobia. Here's my story:

In March of 2002 I was diagnosed with tonsil cancer. After surgery I agreed to eight weeks of intense radiation and chemotherapy. While I was receiving my first dose of chemotherapy, the nurse brought me samples of three different kinds of medication for nausea. I was told to try all three and stick with the one that kept me from being nauseated.

I chose Ativan.

I was not told that Ativan is highly addictive and that it is also used to treat anxiety disorders like agoraphobia. For eight weeks, I continued taking Ativan during my chemotherapy.

In August of 2002, I quit taking Ativan because it had been three weeks since my last chemotherapy treatment and I was feeling better. I had a major panic attack and was unable to leave my apartment until I had more Ativan in my system. It was as if I had agoraphobia and I didn't even know Ativan was addictive until this happened.

After that first panic experience, I never left home without Ativan. I knew I had a major problem because when it was time to take the Ativan my body would begin to shake and I would experience nervousness and anxiety. For the next year, I saw a detox doctor and struggled to be free from dependence on Ativan.

My doctor put me on several other kinds of medication so I could decrease the amount of Ativan I took but nothing worked! The more the Ativan got decreased the more the anxiety and panic symptoms increased. I was so hurt and angry after because after everything I had been through with the cancer, I began to realize that the real suffering had just begun.

I felt the Ativan dependence could have been avoided if the nurses had given me something else that day for nausea that wasn't addictive or at least warned me.

In February of 2003, I had a total breakdown. The panic and anxiety got so bad that I called my mom in Arkansas to come and get me. I knew I needed more than a detox doctor to get myself free from dependence on Ativan.

Shortly after moving in with my mother I went into a detox hospital for five nights. My mother cared for me over the next six months while I slowly recovered. I remember being too afraid to leave her trailer for at least two months. I was deathly afraid of any contact with other people. I couldn't even watch television because it was so overwhelming. I pretty much had agoraphobia at that point.

Four months later, I got a waitressing job and saved enough money to come home. I have still not recovered from my panic and anxiety disorder.

I am free from dependence on Ativan but am currently on other medications for anxiety and depression. My symptoms fluctuate from moderate anxiety to major panic depending on how stressed I get. I am hardly able, at times, to work and care for my son. I struggle daily to get well and sometimes wonder if I will ever be free from the suffering of this horrible illness brought on by taking Ativan.

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