Anxiety, Fears, and Phobias

Panic Disorder With Agoraphobia

In some cases, panic disorder is linked to agoraphobia, the fear and avoidance of public places. The problem may start when a person has a panic attack in a certain place, or type of place. He or she may then become afraid of going to that place again in case the panic returns.

People who have panic disorder often develop fear of one or more of these situations:

• Going out alone
• Going in stores
• Eating in restaurants
• Using public transportation
• Being far from home
• Going to crowded places, like theaters and stadiums
• Waiting in lines
• Being in wide-open spaces

In recent years, therapists have developed successful methods of treatment involving exposure therapy. This type of therapy involves gradually getting the person used to a situation in order to overcome the fear it provokes. Some situations require only a few sessions of treatment. In other cases, treatment may take several weeks, or even months.

Exposure Therapy

Exposure therapy involves being exposed to the situation we are afraid of. That may sound alarming. But it is done gradually, so people need not feel threatened.

Exposure therapy helps get our natural defense system working the way it should.

When we are first in a dangerous situation, our senses are all keyed-up as we look for signals in our environment that mean something terrible is about to happen. This state is called hypervigilance.

If nothing terrible happens, most people experience less hypervigilance the next time, and even less the next. But people with panic disorder remain extra-sensitive.

Exposure therapy helps you get used to the fear-producing situation under controlled conditions. Once you are used to it, you may no longer respond as if it is a brand-new threat.

Therapists may use different approaches to the process of exposing you to your fears – or their source. Here’s one example of how exposure therapy can work:

• Laura panics in supermarkets. She and her therapist set up a schedule of gradual exposure.
• Twice a day, Laura went into the market when it wasn’t crowded. She spent three minutes there, and left without buying anything.
• Laura continued going in the store twice a day, still choosing a time when it wasn’t crowded. Each time when bought two items and picked a checkout line with only one person ahead of her.
• As she became more comfortable, she bought more items and picked longer lines.
• Laura was told that she must do the allotted task, even if her level of anxiety was high. She knew she could expect some feelings of panic, but was told to let those feelings “peak and pass.”
• It was up to her to decide when she was ready to move from one step to the next.

How Long Does Treatment Take?

In some cases, a course of gradual exposure to a situation may work quite fast. In others, treatment of agoraphobia may require months of regular exposure therapy and counseling.

In addition, it is quite common to have setbacks. After you think that you are better, you may start to feel fearful again. A “relapse” is especially likely to happen if you are under stress.

It is important not to let these setbacks get you down. They are quite common, and they don’t mean that you have failed in your course of treatment. You will have learned good techniques for dealing with your panic, so you will know how to help it go away.