Discussion Intensive External Exposure Agoraphobia
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Intensive External Exposure: Agoraphobia
Watch for the principles of external exposure, habituation, and expectation violation. What role does the therapist play?
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What is agoraphobia?
Agoraphobia is an anxiety disorder that causes intense fear of becoming overwhelmed or unable to escape or get help. Because of fear and anxiety, people with agoraphobia often avoid new places and unfamiliar situations, such as:
Open or enclosed spaces.
Places outside your home.
How many people have agoraphobia?
About 1% to 2% of adults in the United States have been diagnosed with agoraphobia. Roughly 2% of adolescents experience it. Agoraphobia is more common among women. It usually starts before age 35.
What are the risk factors for agoraphobia?
Risk factors for developing agoraphobia include:
Discussion Intensive External Exposure AgoraphobiaHaving panic attacks or other phobias.
Experiencing stressful life events, such as the death of a loved one, being attacked, or being abused.
Having a nervous or anxious nature.
Responding to panic attacks with excess fear and apprehension.
Having a relative with agoraphobia.
SYMPTOMS AND CAUSES
What causes agoraphobia?
It is not clear what causes agoraphobia. However, it is often associated with an existing panic disorder. Panic disorder causes short, intense attacks of fear for no particular reason. About a third of people who have panic disorder develop agoraphobia. But agoraphobia also can occur alone.
What does agoraphobia feel like?
Everyone experiences anxiety sometimes. But an anxiety disorder causes excessive worry that affects daily activities. Agoraphobia can make you feel extreme fear and stress, which may cause you to avoid situations.
The signs of agoraphobia are similar to a panic attack. You may experience:
Chest pain or rapid heart rate.
Fear or a shaky feeling.
Hyperventilation or trouble breathing.
Lightheadedness or dizziness.
Sudden chills or flushing (red, hot face).
Excessive sweating (hyperhidrosis).
DIAGNOSIS AND TESTS
How is agoraphobia diagnosed?
If you think you have agoraphobia, and the anxiety is interfering with your daily life, you should talk to a primary care provider or psychiatrist. If you are afraid to visit a medical office in person, you may be able to schedule a telephone or video appointment.
The healthcare provider may ask you:
Do you get stressed about leaving your house?
Are there any places or situations you avoid because you’re afraid? Why are you afraid?
Do you rely on others to do your shopping and errands?
A healthcare provider can diagnose agoraphobia based on your symptoms, how often they happen and how severe they are. It is important to be open and honest with your healthcare providers. Your provider may diagnose agoraphobia if you meet specific standards developed by the American Psychiatric Association. To have a diagnosis of agoraphobia, a person must feel extreme fear or panic in at least two of the following situations:
Discussion Intensive External Exposure AgoraphobiaUsing public transportation.
Being in an open space.
Being in an enclosed space, such as a movie theater, meeting room or small store.
Standing in a line or being in a crowd.
Being out of your home alone.
MANAGEMENT AND TREATMENT
How is agoraphobia treated?
Agoraphobia treatment usually involves a combination of treatment methods: therapy, medication and lifestyle changes.
A therapist can help you work through your fears. Using cognitive behavioral therapy (CBT), a mental healthcare provider can help you recognize thoughts that cause you anxiety. Then you’ll learn ways to react more productively.
Using relaxation and desensitization techniques, your provider may have you imagine a scary situation and manage the feelings. Eventually, you will be able to take part in activities that produce anxiety, and you will know how to manage your emotions. Over time, therapy can train the brain to think differently.
Your healthcare provider also may suggest medications called selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Those medications can treat depression and anxiety disorders.
You can manage agoraphobia with lifestyle changes:
Avoid alcohol, drugs and caffeine (coffee, tea and soda, for example).
Eat a healthy, well-balanced diet.
Practice breathing exercises.
How can I reduce my risk of agoraphobia?
There is no proven way to prevent agoraphobia. However, it is easier to manage in its earlier stages. The more you avoid situations, the more fearful you may become. Some people with severe agoraphobia are unable to leave their home at all and are totally dependent on others for help. Agoraphobia can also lead to other health problems if left untreated, including depression, alcohol or drug abuse and other mental health disorders. These are reasons why it’s important to seek mental health help early.
OUTLOOK / PROGNOSIS
What is the outlook (prognosis) for people with agoraphobia?
About a third of people with agoraphobia overcome the disorder and become symptom-free. Another half learn to manage their symptoms better but still have some anxiety.
You and your loved ones will need to have patience as you heal from agoraphobia. Many people need 12 to 20 weeks of CBT (talk therapy) if they also take medication. Without medication, therapy might take up to a year.
How can I learn to cope with agoraphobia?
Take good care of yourself, take your medications as prescribed and practice techniques you learn from your therapist. And don’t allow yourself to avoid situations and places that spark anxiety. The combination can help you do things you enjoy with less fear.
A note from Cleveland Clinic
Many people avoid talking about anxiety disorders. Agoraphobia can make you feel afraid and isolated. But with treatment, you can manage the symptoms and lead a full life. If agoraphobia or any anxiety disorder affects the way you live your life, call your healthcare provider. An open, honest conversation can lead to the help you need to live a full life.