Posted by gardenergirl on February 26, 2007, at 12:02:55 [reposted on February 26, 2007, at 12:04:18 | original URL]
In reply to Best Treatment For Agoraphobia, posted by Phillipa on February 25, 2007, at 15:23:52
> What is the best treatment for agoraphobia. Are you allowed to stay home one day or do you have to force yourelf to go out daily as I was told? Thanks Phillipa
That sounds like part of the CBT treatment I think I've mentioned before. It would involve "in vivo exposure", which means facing that which you fear in real life situations; using relaxation and self-talk strategies to cope with the fear, and response prevention, which is essentially staying with the fear situation until the anxiety passes. Some therapists will do the in vivo practice with you, others will assign it to you to do outside of sessions. That's the behavioral part. The cognitive part involves working on the thoughts and beliefs you have that contribute to anxiety and then countering them.
During therapy sessions, you might work on imaginal exposure, where you construct an example of a fear situation with as much detail as possible, and then you visualize that, putting yourself into it as much as you can. When you begin to feel anxious, you stop and apply your relaxation and self-soothing skills until it passes. Then you continue. This is done in a graded way, starting with the easiest and working to the most fearful.
There are different intensities to this kind of work. Going slower can be helpful if a person is especially fearful, if there are safety issues involved (i.e. driving while having a panic attack), other issues such as dependent or other personality traits which contribute to the situation, etc. But, it takes a lot longer to go slow or to have fewer practice sessions. The other end is flooding, the most intensive approach. With flooding, you face the worst fear and just have to stay with it til you "survive" it, til the anxiety and fear pass. You would be prevented from fleeing or otherwise doing something to end the exposure prematurely. I suppose taking medication might also be a response that would be prevented. This often has dramatic and fast results, but it's really difficult. Most therapists would fall somewhere in between in how they treat this.
Daily outings are consistent with daily practice of skills you are trying to learn. If you were to take a day or more off, it interferes with progress. I think if the T said just to go out everyday, he or she is not giving you enough instruction and perhaps not putting much thought into applying this intervention. If you're not doing flooding, then you would need to construct a hierarchy of anxious events, from least to most anxiety provoking. You would start from the least and work your way up to the most. That might not seem as scary or burdensome to practice everyday, especially if you are experiencing progress as you tackle progressively harder situations.
You can find out more about this type of treatment, which is considered to be the "best practice" for agoraphobia in "The Agoraphobia Workbook: A Comprehensive Program to End Your Fear of Symptom Attacks".
I really encourage you to give this a shot, Phillipa. I've seen it work, and there's a lot of empirical support for this approach.
namaste
gg
poster:gardenergirl
thread:736424
URL: http://www.dr-bob.org/babble/psycho/20070215/msgs/736435.html