Agoraphobia is a psychological disorder strongly associated with anxiety crises. Although agoraphobia may occur without first suffering from anxiety or anxiety disorders, in most cases, these psychopathologies are present together. For this, today we believe it is necessary to give a complete description of the two concepts; in this way, the reader will better understand the meaning of the term “agoraphobia”.
The anxiety crisis, otherwise called ” panic attack ” or “anxiety”, leads to the immediate appearance of intense fear or malaise in an isolated and temporary form. Usually it is accompanied by some characteristic physiological symptoms (palpitations or tachycardia, sweating, tremor, feeling choking or drowning, feeling chest tightness, nausea or abdominal pain, feeling fainting) and cognitive (sense of unreality, also called derealization, alteration of self-perception or de-personalization, belief of losing control, crazy or dying).
Clearly, when an individual suddenly experiences all these physiological manifestations and, consequently, his thinking pattern becomes catastrophic, he is attacked by an even greater dose of fear . The first symptoms of anxiety, therefore, increase even more.
The subject will be more determined to be on the point of dying or losing control of the situation and the symptoms will intensify.
In this way, a cycle begins to increase anxiety to a point where the person asks for help or concerns about the people around him, who then ask for help in his place. Other behavioral features of this kind of anxiety push the subject to avoid places that are sources of illness or to escape or take anxiety if he is already there.
Such reactions are called “security behaviors” and are designed to prevent the possible catastrophe imagined in the patient’s head. What is the problem of security behaviors? They only work in the short term.
Let’s explain better: if the individual, when he or she notices these symptoms, takes anxiety, drinks water or escapes, he will see that the unpleasant feelings are reduced. This is how the escape will act as a positive reinforcement, leading the subject to act in the same way in the future. The individual will then be limited every day more because his tendency to avoid things does not allow him to understand that in reality nothing is going to happen terrible : he will not die, will not lose control of the situation and will not go mad.
Escape does not allow him to realize it. It makes sense to itself , thinking it is healthy and safe only through its escape or the activation of security behaviors.
In fact, the patient’s interpretation is prevented. He is mistakenly convinced that his symptoms may kill him because they actually resemble, in part, those of infarction or psychosis. But we have to understand that the fact that they do not mean they are really the same.
these are symptoms of anxiety caused by having endured many adversities in life and that, as if they were put in a pressure pot, they broke out, sending the subject to the message that it is time to stop and regain its own peace inner and equilibrium.
When does agoraphobia emerge?
Agoraphobia is born when the person who has experienced this anxiety crisis several times contracts a terrible fear that the symptoms will resume in concrete situations. This fear is motivated by the idea of reliving an attack without being able to get help.
In this case, the subject experiences the so-called “fear of fear,” which is comparable to the fear that a child feeds on his shadow and leads him to escape from it. Because of this fear, therefore, the individual avoids all the situations during which he has experienced the symptoms already mentioned, even the similar ones.
For example, if the panic attacks are fired in a supermarket, it is likely that, in time, the subject associates supermarkets to places such as cinemas , malls, and public transport
As the patient stops receiving positive reinforcements from the surrounding environment, this limit can also result in depressed feelings. She feels every day more useless, her self-esteem falls and her despair increases.
What is the underlying causes of Agoraphobia?
There are some explanatory factors that attempt to answer this question, although not necessarily all must occur because a case of agoraphobia occurs (with or without a previous anxiety crisis). Experts point out several factors that favor the occurrence of this disorder, here are some:
Attention focused on your feelings
There are people who have a special sensitivity to notice any bodily change: they are constantly aware, both consciously and unconsciously, of their body reactions and alterations, and take them as reference points to anticipate the dangers we have listed before.
When there is a symptom of a physical nature similar to those described above, subjects with this predisposition will notice it quickly, increasing their anxiety . This theory has a strong empirical basis, as demonstrated by Ehlers, Margraf, Roth et al. (1980), which noted that in anxiety disorder patients anxiety increased considerably when they noted that their stroke heart rate was accelerated.
Hyperventilation results in compensated respiratory alkalis (with almost normal blood PH), which means that the levels of carbon dioxide and bicarbonate in the blood are lower than the average. This lowering leads people to be more likely to suffer from anxiety crises and, therefore, to be suffering from agoraphobia.
Anxiety separation in childhood
Some authors, such as Silone, Manicavasagar, Curtis and Blaszczynski (1996), believe that agoraphobia may be related to the reactions of separation anxiety manifested during childhood. Separation anxiety can make the subject more vulnerable to falling into the escape behavior that develops during panic attacks, which lead him to suffer from agoraphobia.
A greater number of stress elements
There are some stressful environmental factors such as loss of employment, sentimental breakdown, or loss of one’s own dear, which can act as factors that favor the onset of a crisis.
If one of two monozygotic twins suffers from this disorder, it is likely that the other one is affection. Families of people with anxiety disorder have a probability ranging from 25 to 32% of having an anxiety disorder.
What is the treatment for agoraphobia?
Being a fear of our fear, or the fear of the symptoms that we have listed before, the treatment must be aimed at overcoming this fear and the ability to lead life with normality. This general objective includes other more specific objectives that the patient must progressively undertake during therapy.
Psychological treatment changes depending on whether it is “simple” agoraphobia or agoraphobia accompanied by stories of anxiety crisis, there are some common points. In this article we will deal with the treatment of agoraphobia. First, the patient needs to know what is happening and, to this end, use of psycho-education must be used . Psycho-education is not a true psychological technique, but it helps the subject to understand what is going on and normalize it.
It explains to the patient what its disturbance is , what are the causes, why it keeps it in time and what the treatment will be.
Once the patient knows his disorder and the options of treatment, one can begin the actual therapy. In this article we will focus on cognitive-behavioral therapy, as it is the one with the most consistent scientific basis. The treatment involves two distinct parts: a cognitive and behavioral one.
The goal is, on the one hand, that the person changes his misconceptions about his symptoms and the circumstances in which he must move, and on the other hand he is capable of exposing himself to these situations without resorting to security behaviors . The ultimate goal is therefore that anxiety is reduced and distorted thoughts change.
Cognitive restructuring is the “technique of choice” when we work with thoughts. It consists of asking the patient for questions to disassociate the negative and irrational thoughts that are part of the disorder.
In this way, the patient is forced to modify these ideas and replace them with others more connected to reality. For example, if the patient says he is afraid of predicting a heart attack, some of the questions we might ask him are “What data do you have in support of this thought?”, “How do you know that you will have a heart attack? “.
Behavioral experiments are another cognitive technique to be used. They are of a cognitive nature because the goal is to disassemble the patient’s thoughts . The subject must, along with his therapist, formulate hypotheses about a situation that he / she will have to expose in the future through experimentation. The patient records all that comes to his mind and then takes an active part in the experiment. After that, he reflects and observes that what has happened reflects his previous thoughts.
Although cognitive techniques are essential to helping the agoraphobic person to deal more calmly with situations that give him anxiety, behavioral techniques, maintained over time, will completely eliminate the disorder. When we talk of behavioral techniques in the context of agoraphobia, we refer to real and lively exposure to situations.
The patient, together with the therapist, has to elaborate a hierarchy of anxiety situations, from what causes him less anxiety than the one who gives him more. The assessment is done by Disadvantaged Disability Units (SUDs) ranging from 0 to 10. Some situations will include some security behaviors that must be progressively eliminated until the subject is able to deal with situations like any other healthy person.
In order for the exposure to the condition to take place properly, it is sufficient for the patient to learn about relaxation techniques . Two options are relaxation based on Jacobson’s breathing and relaxation. This will simplify the stage of exposure to experience.
It can be said that the patient has overcome a discomfort when he notices that his anxiety is shrinking considerably and that he can get alone. Only then can one go to the next situation, but never before; Otherwise, we may cause an awareness rather than an adaptation, which does not match the objective of the case.
If exposure is successful, the patient will be able to adapt. In this way, physiological causes and anxiety will decrease to normal levels; In addition, the subject will learn and interiorize the realistic idea that nothing of the terrible things that they have prefigured will succeed.
This is, in large measure, the general treatment for agoraphobia. However, depending on the case, other strategies can be encompassed, such as social skills training, treatment of depressive symptoms (if any), elimination of secondary reinforcements, and so on. In some more specific cases or longer courses, it may be advisable to combine psychotherapy with a pharmacological treatment.