Psychological Therapy For Agoraphobia: What Is It And How Does It Work?
Agoraphobia is an anxiety disorder characterized by anticipatory anxiety over the fear of having a panic attack in public. The person also fears being in a public place and not being able to “escape.” This is why psychological therapy for agoraphobia must be very focused on treating the cognitive variables that influence the perpetuation of the disorder
In this article, in addition to explaining the general characteristics of agoraphobia, we will learn what cognitive behavioral therapy for agoraphobia consists of (considered a first-choice treatment), how it works and what its six fundamental components are.
Agoraphobia is an anxiety disorder that involves fear of being in public places or situations where escape is difficult or embarrassing There is also a fear of being in places where it is difficult to get help in case of a panic attack or similar symptoms. That is to say, fear occurs in public places, and not so much open places, as is often thought.
Thus, due to this fear, situations that involve being in these places are avoided or resisted with great discomfort; In the event that they are confronted, the person with agoraphobia is usually accompanied. On the other hand, two characteristic components that the concept of agoraphobia usually includes are: multiphobia (having several phobias at the same time) and phobophobia (having “fear of fear”, or fear of one’s own anxiety).
Classification in manuals
Regarding its location in the different reference manuals, agoraphobia is a disorder that has undergone certain changes in the editions of the DSM (Diagnostic Manual of Mental Disorders). In this way, in the third edition of the same (DSM-III) and in the ICD-10 (International Classification of Diseases), agoraphobia was classified as an independent disorder, and may or may not be accompanied by panic disorder (generally in serious cases).
In the DSM-III-R and DSM-IV-TR, however, agoraphobia becomes part of a more global panic disorder Finally, in the current DSM-5, agoraphobia and panic disorder become independent of each other for the first time, and become two distinct disorders.
There are three treatments of choice to treat agoraphobia: in vivo exposure, cognitive behavioral therapy, and pharmacotherapy (use of Selective Serotonin Reuptake Inhibitors (SSRIs)). In this article we will focus on psychological therapy for agoraphobia from a cognitive-behavioral perspective, and that is why we will talk about the second treatment of choice mentioned: cognitive behavioral therapy.
This type of therapy is considered well established to treat agoraphobia, according to treatment effectiveness reference manuals; That is, the research results support it as an effective and safe therapy. Thus, it provides positive results to treat this disorder.
Components
Psychological therapy for agoraphobia from a cognitive-behavioral orientation usually includes a series of specific components. Let’s see what they are and what they consist of.
1. Psychoeducation
Psychoeducation consists of “educating” the patient in their pathology, that is, providing them with adequate information so that they can understand their disorder, its etiology, what factors are favoring its persistence, etc. Thus, in psychological therapy for agoraphobia, this education will mainly deal with anxiety and panic.
The objective is for the patient to have the necessary information so that they can understand why this happens, and so that they learn to differentiate some concepts that can sometimes be confusing. This information can help reduce his uncertainty and make him feel calmer.
2. Breathing techniques
Breathing is an essential factor in anxiety disorders, since learning to control it can greatly help reduce anxious symptoms. In agoraphobia this is especially important, since precisely what is feared is suffering a panic attack in places where it is difficult to receive help; These panic attacks are characterized by a large number of physical and neurophysiological symptoms related to anxiety.
That is why having strategies to breathe better, and to be able to exercise controlled breathing, can help the patient prevent the anxious symptoms characteristic not only of the panic attack, but also of agoraphobia itself, since agoraphobic patients begin to thinking that they will suffer a panic attack and that causes anxious symptoms.
Cognitive restructuring is another key element in psychological therapy for agoraphobia, since it helps modify the patient’s dysfunctional and unrealistic thoughts, given the belief that they may suffer a panic attack at any moment (or at the moment in which they occur). expose to a public place).
That is, cognitive restructuring will focus on modifying these thoughts and beliefs and also to correct the patient’s cognitive distortions (for example thinking “if I take the bus and I have a panic attack, I will die right there, because no one will be able to help me”, or “if I go to the party and I have a panic attack, I’m going to be very embarrassed, because I’ll also get overwhelmed and won’t be able to get out of there.”
The objective is for the patient to learn to develop more realistic alternative thoughts that help them face situations in a more adaptive way, and that contribute to reducing their anxiety or anticipatory discomfort.
4. Interoceptive exposure
Interoceptive exposure consists of exposing the patient to the anxious symptoms that cause a panic attack, but through other mechanisms (that is, artificially produced, simulating them). These symptoms are induced in the patient (in fact, they are usually induced by himself) through different strategies, such as spinning in a chair (to obtain the sensation of dizziness), performing cardiovascular exercises (to increase heart rate) , inhale carbon dioxide, hyperventilate, etc.
The objective of interoceptive exposure is to weaken the association between the patient’s specific body signals in relation to their body, and the panic reactions (panic symptoms) that they manifest. This type of exposure is based on the theoretical basis that considers that panic attacks are actually learned or conditioned alarms to certain physical signals.
5. Live self-exposure
Live self-exposure, the fifth component of psychological therapy for agoraphobia, It consists of exposing the patient to the real situation that generates fear or anxiety That is, go to public places where “it is difficult to escape”, and do it alone.
Furthermore, you should not flee from the situation (unless the anxiety you experience is exaggerated). The objective is, on the one hand, to empower the patient to resolve their disorder, and on the other, to “learn” that they can face these situations without experiencing any panic attacks. This type of exposure will also help the patient understand that the fact of being embarrassed by “running away” from a place is not so relevant, and that it can be put into perspective.
6. Records
Finally, the last component of psychological therapy for agoraphobia is the records; in them (self-registrations), The patient must write down different aspects depending on what the therapist asks and the technique used
Generally, these are daily records that aim to collect relevant information from the patient, in relation to the moments in which they experience anxiety (with their antecedents and consequences), the number of panic attacks experienced, dysfunctional thoughts, degree of discomfort associated with them. , alternative thoughts, etc. Records can be of different types, and are a very important monitoring tool.
Characteristics
Regarding the effectiveness of psychological therapy for agoraphobia, it may be affected and decreased if the time dedicated to the live exposure component is reduced.
On the other hand, an advantage of the cognitive behavioral therapy we are talking about, aimed at treating agoraphobia, is that tends to produce fewer dropouts and fewer relapses of panic attacks compared to live exposure
This is because in vivo exposure is a more “aggressive” type of therapy, where the patient is actually exposed to the situation (or situations) they fear; In psychological therapy, however, the operation is different and much less invasive or disturbing for the patient.
