Only Way Tackle Agoraphobia

Those of us who have emerged from the shadow of agoraphobia know that there is only one way to tackle it, and that is by exposure to the situations which you feel you cannot face - exposure to the situation and exposure to the unpleasant symptoms. Agoraphobics are inclined to judge their progress on their ability not to feel panic. Two or three panic-free trips to the supermarket; they are doing really well. Then on the next occasion the old frightening feelings come flooding back and it's back to square one again.

Face the fear. Enter into the phobic situation. Sounds simple and easy to do, but it can seem an insurmountable task for the agoraphobic. The most traumatic approach is known as flooding, where the patient is exposed to her most dreaded situation and encouraged to remain within it, experiencing the worst sensations that her phobia can produce, facing the panic feelings and the distress that follows until the peak is past and the symptoms gradually evaporate. This might take a few minutes, or it might take an hour or two, but the important point is that the sufferer stands her ground until the anxiety starts to lessen, and has to be prepared to remain "until it does.

The patient's fear is that her system cannot tolerate the acute phase of a panic attack, that there must be some terrible climax which will prove fatal. This is not so; when the panic feelings reach a peak there is only one way they can go -down. They will gradually subside and the sufferer will find herself sick and shaky but still in one piece ... and a step nearer recovery.

There is no doubt that such an experience is more exhaust¬ing than exhilarating, but it cannot be denied that if she is well prepared by her therapist and has the motivation and the courage to co-operate, this can be the fastest way to overcome agoraphobia.

Systematic desensitisation was popular in the 1970s as this as a more acceptable form of therapy for the patients. It involved learning to relax completely before visualising the phobic situations that the agoraphobic most feared. Learning o curb her out-of-control imagination was difficult, but the therapist would then guide her to the next stage - actually going to these places and finding that she could tolerate them without experiencing a panic attack.

This approach was very time-consuming for the therapist and unrealistic for the patient who, happily acclimatising herself to the phobic situations, was unprepared when a panic attack did materialise, didn't know how to cope with it and became disillusioned with the treatment.

These days the patient is instructed to take a different view of her phobia, changing her negative attitude towards e problem ('I know I shall have a panic attach) and telling herself instead, 'I shall probably feel panicky but I am no longer frightened by the thought of this as I understand how to over¬come it!

Instead of the flooding approach, where the agoraphobic was plunged into her worst nightmare and forced to endure the panic until it peaked then subsided, she is now instructed by her therapist to take it a step at a time.

She is told to 'construct a hierarchy' - making a list of her phobic situations ranging from the very mild to the most alarming. Listing them from one to ten, she will then proceed up the scale, learning to tolerate each one before progressing to one she finds more difficult.

The object of the exercise is not to try and avoid a panic attack but to actively encourage it to do its worst. Knowing that it is not going to damage her in any way, the agoraphobic goes through the experience, emerging at the end unscathed. Unlike the flooding technique the process is gradual, and the patient does not have to tackle her worst fears until she is well prepared.



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