Dealing with Agoraphobia : Know the right things to get treatment

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Agoraphobia- Closed spaces freak me out

What is Agoraphobia?
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Fear of closedAgoraphobia is a type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.

If you are an anxiety sufferer you might be dealing with agoraphobia as well. you fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line or being in a crowd.

The anxiety is caused by fear that there’s no easy way to escape or seek help if intense anxiety develops.

Most people who have agoraphobia develop it after
having one or more panic attacks, causing them to
fear another attack and avoid the place where it occurred.

Symptoms of agoraphobia

Typical agoraphobia symptoms include-

  • Fear of being alone in any situation
  • Fear of being in crowded places
  • Fear of losing control in public places
  • Fear of being in places where it may be hard to leave, such as an elevator or train
  • Inability to leave your home (housebound) or only able to leave it if someone else goes with you
  • Sense of helplessness
  • Overdependence on others

Fear of closed placesIn addition, you may have signs and symptoms of a panic attack, like-

  • Rapid heart rate
  • Excessive sweating
  • Trouble breathing
  • Feeling shaky, numb or tingling
  • Chest pain or pressure
  • Lightheadedness or dizziness
  • Sudden flushing or chills
  • Upset stomach or diarrhea
  • Feeling a loss of control
  • Fear of dying
  • The symptoms of this phobia can be classified into
    physical and psychological symptoms.

Physical symptoms:-

  • Hyperventilating or rapid/shallow breathing
  • Feeling of choking or difficulty swallowing
  • Sweating
  • Shaking and trembling
  • Nausea and other gastrointestinal distress
  • Dizziness or lightheadedness
  • Ringing or buzzing in the ears

Psychological symptoms 

  • Fear of losing control or going crazy
  • Fear of dying
  • Feeling ‘unreal’ or detached from oneself
  • Feelings of depression, dread or anxiety
  • Having low self-esteem or low confidence

Panic disorder and agoraphobia 

Some people have panic disorder with agoraphobia.

Panic disorder is a type of anxiety disorder in which you experience sudden attacks of extreme fear that reach a peak within a few minutes and trigger intense physical symptoms (panic attacks).

You might think that you’re totally losing control, having a heart attack or even dying.

Fear of another panic attack can lead to avoiding similar circumstances or the place where it occurred in an attempt to prevent future panic attacks.

When to see a doctor?

Agoraphobia can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands.

Don’t let agoraphobia make your world smaller. Call your health care provider if you have symptoms. Dealing with agoraphobia is extremely difficult without help of a therapist. 

Its Causes 

Having panic disorder or other phobias, or experiencing stressful life events, may play a major role in the development of agoraphobia.

Nevertheless, unhelpful emotions help maintain them. 

Risk factors 

Agoraphobia usually starts before age 35, but older adults also can develop it. Women are diagnosed with agoraphobia more often than men are.

Risk factors of agoraphobia include:

  • Having a tendency to be nervous or anxious
  • Experiencing stressful life events, such as abuse, the death of a parent or being attacked
  • Having a blood relative with agoraphobia

Preparing for your appointment 

To prepare for your appointment make a list of:

● Any symptoms you’ve been experiencing, and for how long.

● Your key personal information, especially any significant stress or life changes that you experienced around the time your symptoms first developed.

● Your medical information, including other physical or mental health conditions that you have. Also, write down the names and dosages of any medications and supplements you’re taking.

Ask a trusted family member or friend to go with you to your appointment, if possible, to help you remember information.

Prepare questions to ask your health care provider so that you can make the most of your appointment. For agoraphobia,

Some basic questions include:

» what do you believe is causing my symptoms?

» How long have you been dealing with agoraphobia and panic?

» How will you determine my diagnosis?

» Should I be tested for any underlying medical problems?

» Is my condition likely temporary or long term (chronic)?

» What type of treatment do you recommend?

» I have other health problems. How best can I manage these together with agoraphobia?

» What is the risk of side effects from the medication you’re recommending?

» Are there options other than taking medications?

» How soon do you expect my symptoms to improve?

» With treatment, will I eventually be comfortable in the situations that currently scare me?

» Does agoraphobia increase my risk of other mental health problems?

» Should I see a mental health specialist?

» Are there any printed materials that I can have?

» What websites do you recommend?

{ Don’t hesitate to ask questions during your appointment }

What to expect from your doctor

Being ready to answer your health care provider’s questions may leave time to go over any points you want to talk about in-depth. Be prepared to answer the following questions from your provider:-

  • Have you recently had a spell or an attack when all of a sudden you felt frightened, anxious or very uneasy?
  • Have you recently been feeling nervous, anxious or on edge?
  • During these attacks of fear and anxiety, have you ever felt like you couldn’t breathe or like you were having a heart attack?
  • What other symptoms do you have?
  • When did you first notice these symptoms?
  • When are your symptoms most likely to occur?
  • Does anything seem to make your symptoms better or worse?
  • Do you avoid any situations or places because you fear they’ll trigger your symptoms?
  • What do you think is causing your symptoms?
  • How are your symptoms affecting your life and the people closest to you?
  • Have you been diagnosed with any medical conditions?
  • Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what treatment was most helpful?
  • Have you ever thought about harming yourself or others?
  • Do you drink alcohol or use illegal drugs? How often?

How do they Diagnose it

People who suffer from panic attacks should discuss the problem with a physician.

The doctor can diagnose the underlying panic or anxiety disorder and make sure the symptoms aren’t related to some other underlying medical condition.

The doctor makes the diagnosis of agoraphobia based primarily on the patient’s description of his or her symptoms.

The person with agoraphobia experiences anxiety in situations where escape is difficult or help is unavailable or in certain situations, such as being alone.

While many people are somewhat apprehensive in these situations, the hallmark of agoraphobia is that a person’s active avoidance of the feared situation impairs his or her ability to work, socialize, or otherwise function.

Treatments and drugs 

Agoraphobia treatment usually includes both psychotherapy and medication. It may take some time, but treatment can help you get better.

Psychotherapy 

Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms.

Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders, including agoraphobia.

Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to gradually return to the activities you’ve avoided because of anxiety.

Through this process, your symptoms improve as you build upon your initial success.

You can learn:

That your fears are unlikely to come true

● That your anxiety gradually decreases if you remain in public and you can manage those symptoms until they do

● What factors may trigger a panic attack or panic-like symptoms and what makes them worse

● How to cope with these symptoms

● How to change unwanted or unhealthy behaviors through desensitization, also called exposure therapy, to safely face the places and situations that cause fear and anxiety

If you have trouble leaving your home, you may wonder how you could possibly go to a therapist’s office. Therapists who treat agoraphobia will be well aware of this problem.

They may offer to see you first in your home, or they may meet you in what you consider a safe place (safe zones). They may also offer some sessions over the phone, through email, or using computer programs or other media.

Look for a therapist who can help you find alternatives to in-office appointments, at least in the early part of your treatment. You may also want to take a trusted relative or friend to your appointment who can offer comfort and help if needed.

The medications that are generally prescribed for panic and agoraphobia

Do not self medicate in anxiety

Antidepressant and anti-anxiety medications are often used to treat agoraphobia and panic symptoms that frequently accompany agoraphobia. You may have to try several different medications before you find one that works best for you.

Your doctor is likely to prescribe one or both of the following for your anxiety:

Antidepressants

Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil, Pexeva) and fluoxetine (Prozac), are used for the treatment of panic disorder with agoraphobia.

Other types of antidepressants, such as tricyclic antidepressants or monoamine oxidase inhibitors, may effectively treat agoraphobia, although they’re associated with more side effects than SSRIs.

Anti-anxiety medication

Also called benzodiazepines, anti-anxiety medications are sedatives that, in limited circumstances, your doctor may prescribe to relieve anxiety symptoms.

Drugs in this category that are used for the treatment of panic disorder with agoraphobia include alprazolam (Niravam, Xanax) and clonazepam (Klonopin).

Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis.

Because they can be habit-forming, these medications aren’t a good choice if you’ve had problems with alcohol or drug abuse.

Both starting and ending a course of antidepressants can cause side effects that seem like a panic attack.

For this reason, your health care provider likely will gradually increase your dose during treatment, and slowly decrease your dose when he or she feels you’re ready to stop taking medication.

Treatment for agoraphobia usually consists of both medication and psychotherapy

Usually, patients can benefit from certain antidepressants, such as amitriptyline (Elavil), or selective serotonin reuptake inhibitors, such as paroxetine (Paxil), fluoxetine (Prozac), or sertraline (Zoloft).

In addition, patients may manage panic attacks in progress with certain tranquilizers called benzodiazepines, such as alprazolam (Xanax) or clonazepam (Klonopin).

The mainstay of treatment for agoraphobia and other phobias is cognitive behavioral therapy

A specific technique that is often employed is called desensitization.

The patient is gradually exposed to the situation that usually triggers fear and avoidance, and, with the help of breathing or relaxation techniques, learns to cope with the situation.

This helps break the mental connection between the situation and the fear, anxiety, or panic.

Patients may also benefit from psychodynamically oriented psychotherapy, discussing underlying emotional conflicts with a therapist or support group.

Also see:

4 Clever Anxiety Hacks no one talks about

5 Ways To Avoid Extreme Anxiety and Achieve Balance

A Guide to 6-Step Anxiety Thought Record Worksheet to Curb your Anxiety

7 Anxiety Questions Answered By Dr. Helen Odessky

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