Agoraphobia is a psychological disorder strongly linked to panic attacks, although agoraphobia can exist without a history of panic disorder or anxiety, the most common is that the two go hand in hand, so it is necessary to define the two concepts and place ourselves in a more complete conceptual framework, in this way the reader will better understand what agoraphobia is.
Anxiety attacks, also known in the scientific literature as panic attacks or anxiety attacks, involve the sudden, isolated and temporary appearance of intense fear or discomfort, which is usually accompanied by certain characteristic symptoms, both physiological (palpitations or heartbeat, sweating, tremors, shortness of breath or choking, chest tightness, nausea or abdominal discomfort, dizziness) and cognitive (feeling of unreality, also called derealization, impaired self-perception or depersonalization, believing that you are losing control , who is going to die).
- Obviously.
- When you suddenly feel all these physiological manifestations.
- Your thinking pattern takes on an alarmist tone and you feel an even higher dose of fear.
- So these early symptoms of anxiety are on the rise.
The person will interpret these symptoms so that they truly believe that they will die or lose control of the situation and eventually strengthen them further.
Thus, the vicious circle forms and increases anxiety to the point that the person ends up asking for help or concerns those around him, who end up acting for him. Other behaviors characteristic of this type of anxiety are related to avoiding perceived places as possible. sources of anxiety, fleeing the person’s place, taking a certain type of anxiolytic, etc.
These types of behaviors are called safe behaviors and aim to avoid potential disasters that the patient imagines in his mind What is the problem of safe behavior?They only work in the short term.
That is, if the person, when he perceives these symptoms, takes an anxiolytic, drinks water or flees the situation, he will notice that these unpleasant sensations decrease, so the escape will be a negative reinforcement that will lead that person to do the same in the future. In fact, it will eventually be further limited because this escape will not allow you to realize that nothing really terrible is going to happen. You won’t die, you won’t lose control or you won’t go crazy.
Running doesn’t allow you to notice. All you can do is give yourself a reason, believing that through your escape from the situation or the possibility of acting on your safety behaviors, you are safe and sound.
In fact, the patient makes a sesathed interpretation, mistakenly believes that these symptoms can kill him, because in fact they are partly similar to the symptoms of a heart attack or psychosis, but it should be clear that the fact that it seems so does. doesn’t mean they really are.
The truth is that these are symptoms of anxiety, which probably appear after the person has suffered many adversities in their life history, as if it were a pressure cooker that eventually explodes, sending the message that you have to stop a little and regain balance and inner balance. Peace.
Agoraphobia occurs when the person who has suffered these anxiety attacks repeatedly acquires the horrible fear of manifesting himself in specific situations, this fear is motivated by the idea that this attack can be repeated and that it will be very difficult to get help.
The person presents what is called “fear of fear”, and this fear of one’s fear, metaphorically, could be compared to the child who fears his own shadow and tries to escape. This leads the person to try to avoid everything. situations where the attack occurred and even those in which it never happened.
For example, if your panic attacks occurred in a supermarket, they are likely to occur over time in places like cinemas, shopping malls, and even public transportation.
Finally, this limitation can even lead to depressive feelings, as the patient no longer receives positive reinforcements from their environment, feels increasingly disabled, with low self-esteem and increases despair.
Some explanatory factors attempt to answer this question, although not all symptoms should necessarily be present to set up a case of agoraphobia (with or without panic attacks), some authors talk about the following factors as facilitators of the disease:
Some people have a particular sensitivity to detect any body change, are people who are constantly aware, consciously or unconsciously, of their body’s reactions and changes and use them as a reference to anticipate the dangers we have detailed above.
Thus, when a physical symptom appears, such as those described above, patients with this predisposition will notice it quickly, thus increasing their anxiety. This theory has a great empirical livelihood, as evidenced by Ehlers’s study, Margraf, Roth et al (1980), in which patients with panic syndrome significantly increased their anxiety when they noticed that their heart rate was increasing.
Compensated respiratory alkalosis (with almost normal blood pH) occurs with hyperventilation, that is, the levels of carbon dioxide and bicarbonate in the blood are slightly lower than normal, making people more likely to suffer anxiety attacks and, therefore, to suffer agoraphobia.
Authors such as Silone, Manicavasagar, Curtis and Blaszczynski (1996) consider agoraphobia to be similar to separation anxiety reactions that occur in childhood; Separation anxiety can make a person more vulnerable to preventive behaviors that develop during panic attacks and, as a result, suffer from agoraphobia.
Some stressful environmental factors, such as job loss, separation, or loss of a loved one, can also act as factors that facilitate the emergence of a crisis.
In single siblings, if one has the disorder, the other is much more likely to suffer from the same problem. Relatives of people with panic disorder have a 25 to 32% chance of developing an anxiety disorder.
Because it is a fear of our own fear, treatment relies on overcoming that fear in order to lead a normal life, this overall goal should include other more specific goals that the patient will meet during treatment.
Although psychological treatment is not exactly the same when it comes to panic attacks with or without agoraphobia or simply agoraphobia without panic attacks, they share some points in common, in this article we will stick to the treatment of agoraphobia, the first thing that the patient needs to know what is happening to him, and for this we must use psychoeducation (this is a psychosocial strategy of great importance because it allows a process of knowledge and awareness of the disease). Psychoeducation is not a psychological technique per se, but it helps a person understands what is going on and controls panic attacks.
It is necessary to explain to the patient what their disorder is, what the causes may be, why the recurrence and what their treatment will be like.
Once the patient knows about their disorder and what the treatment options are, we can start therapy. For our part, we will focus on cognitive behavioral therapy because it has received the greatest empirical support. Treatment will consist of two distinct parts: a cognitive part. and a behavioral part.
The goal is, on the one hand, for the person to change their beliefs and misconceptions about their symptoms and situations that facilitate seizures; on the other hand, be able to expose yourself to these same situations without safety behaviors, in order to reduce anxiety and modify your distorted thoughts.
Cognitive restructuring is the technique of choice for working with thoughts and involves asking questions to patients to put an end to the negative and irrational thoughts that are part of maintaining the disorder.
In this way, the patient is forced to modify these ideas and replace them with others more adapted to reality, for example, if the patient says that he is afraid because he anticipates that he is very likely to have a heart attack, you may ask yourself some questions : “What data do you have in mind for this thought?” How do you know you are going to have a heart attack?
Behavioral experiments are another cognitive technique that we can use, they have a cognitive character, because the goal is to dismantle the thoughts of the patient, the patient and his therapist choose a situation for him to expose himself and understand his reactions.
The patient writes down everything he thinks can happen and performs the experiment, then observes and ponders whether what actually happened has something to do with what he thought was happening.
While cognitive techniques are critical to helping the agoraphobic person more easily cope with anxiety-generating situations, behavioral techniques, maintained over time, are the ones that really help eliminate the disease altogether. When we talk about behavioral techniques in the context of agoraphobia, we are talking about exposure to real situations.
The patient, along with his therapist, must develop a hierarchy of anxious situations: from those that cause less anxiety to those that cause the most anxiety, are evaluated based on subjective units of anxiety (USAS), ranging from 0 to 10. Some situations involve safety behaviors, but they should be phased out, until the person is able to deal with situations like anyone else who does not have the disorder.
To perform exposure correctly, it is important that the patient learns relaxation techniques. Some relaxation options are based on Jacobson’s breathing or relaxation. This will facilitate exposure to stressful situations.
The situation will be overcome when the patient notices that their anxiety has decreased significantly and can develop on its own. Only then can we move on to the next situation, never before. Otherwise, we can raise awareness rather than familiarization, which is not our goal.
If the exposure is successful, the patient will be able to get used to it and their anxiety will be on a normal level, and will also learn and internalize the realistic idea that nothing as terrible as he imagined would happen.
Generally speaking this is the most common treatment for agoraphobia, however, depending on the case to be treated, we may include other strategies, such as training in social skills, treating depressive symptoms if necessary, eliminating secondary gains, etc. specific or longer-lasting cases, it may be advisable to combine psychotherapy with medications.