Agoraphobia Treatment in Cardiff

Agoraphobia treatment: Agoraphobia is an anxiety disorder and complex phobia in which the sufferer fears being in various situations that are considered difficult to leave. Having a panic attack in a situation and feeling trapped, embarrassed or isolated from help starts a sequence of fearful reactions that exacerbates the condition.

Agoraphobia can also develop when you have experienced a trauma usually away from your home. You now live in fear of experiencing another trauma when you leave your home.

With mild agoraphobia, you may be able to travel short distances to deal with “essential” matters. In the extreme progression of agoraphobia, you will struggle to leave your home.

Agoraphobia treatment: What situation does an agoraphobic fear?

Someone suffering with agoraphobia will fear returning to any situations where you have previously experienced a panic attack or a trauma, typically open spaces and public places. This can include:

• Being in open spaces where help may not be readily available such as in open fields and countryside, around and at the top of hilly and mountainous landscapes.
• Being away from home in extreme weather conditions.
• Travelling in vehicles or on public transport where you are unable to control the journey e.g. when travelling on a train, bus, coach, ship, underground tube, airplane and even a taxi. Or travelling in a car with unfamiliar people whom you fear would be unsupportive if you had a panic attack.
• Social situations or crowded locations where you cannot see your “exit” or where your help may not be able to find you easily.
• Being in confined spaces that are difficult to escape or where the location has limited access points such as in forests, on bridges, in tunnels, walking amongst tall buildings and being stuck in traffic jams. It can also include inaccessible situations at a relative height or altitude e.g. being in a lift at the top of a multi-storey building, parking at the top of a multi-storey car park or using a cable car to travel between locations.
• Visiting a large shop or supermarket that has: narrow aisles, is very crowded, has queues at the service tills, has electronically operated doors or where the shop is so enormous that you may not be able to vacate it easily.
• Being left alone and feeling isolated (either at home or away from home), particularly from those whom you trust or whom you believe can help you.
• Travelling over or being close to other potential areas of danger such as bridges, heights, deep water etc.

  

• Progressively being further away from your safe place, (this is usually your home) and being away from people who are important to you.
• Having driving anxiety (or fear of losing control and having a panic attack whilst driving) and endangering yourself, your passengers, other drivers, pedestrians and damaging the vehicle. This can be experienced in numerous situations detailed in this section. For example when driving over bridges (heights) and deep water. The feeling of anxiety is also intensified with certain road types such as motorways with increased speed, motion, shorter reaction time, relative open/closed spaces, exposure to sudden gusts of wind, distance away from home, being stranded if the vehicle broke down etc.
• Having experienced a previous trauma or near-trauma, you believe that you may experience an actual trauma or another trauma when you leave your home. Traumas can include being attacked, doing something that may cause extreme humiliation such as having a severe attack of IBS or being (re) infected by a serious illness. Fear of contracting a serious illness is also known as health anxiety.

You can appreciate from the above information that when you fear more situations, it increases the complexity of your agoraphobia with the likelihood that you could encounter any one of these “panic stricken” situations when you leave home.

Some locations will include several of these feared situations in one area and are likely to cause high anxiety if obligated to confront it without help e.g. when using the motorway to drive over a national boundary bridge (like the Severn bridge that spans the River Severn between England and Wales).

Agoraphobia treatment: What causes agoraphobia?

Agoraphobia is caused by a number of biological and psychological factors, more notably as a complication of panic disorder. Panic disorder is an anxiety disorder characterised by panic attacks that are assumed to be spontaneous and a possible symptom of a more serious condition e.g. a heart attack.

During the early development of panic attacks, you are in a state of high alert trying to look for causes of and solutions to your distress. You ignore the importance of your internal beliefs and the physiological meaning of these panic symptoms i.e. you are in a fearful state, but at this time, you just don’t know how you can end up feeling this way are why you feel this way.

You (mistakenly) focus externally on your situation, location or activity and (incorrectly) give excessive importance to when these symptoms are alleviated (i.e. when you escape the situation and arrive home). The situation you were in when you felt anxious becomes the “cause” of your distress and your rapid escape home becomes the solution.

Then, in order to control the frequency of panic attacks, you will avoid these situations in the future. The combination of your rapid retreat and avoidance convinces you that you are dealing with the situation in an effective way to minimise your immediate discomfort. However, these avoidant solutions are quick-fixes that make the long term situation worse as there are a diminishing number of situations in which you can feel safe from panic attacks.

In addition to this, your hasty escape becomes automated and a “necessary” method of coping even when you anticipate feeling anxious. Progressively, as the condition grips you, you feel high anxiety when you are at home just imagining confronting the outside situations.

Experiencing panic attacks in your “safe place” causes confusion as your remedial escape plan is now meaningless. Effectively, you are running away from your “own mind” and have exhausted your options to comfort it. At this advanced stage of the agoraphobia, you are probably housebound and experiencing a higher frequency of panic attacks.

Other causes of agoraphobia can include:

• Experiencing trauma (e.g. violence) whilst away from your home. You live in fear of experiencing another similar trauma if you were to leave your home.
• Suffering major lifestyle traumas like bereavement, divorce and unemployment. These external events can cause a significant loss of confidence, feelings of guilt, worthlessness, embarrassment and shame. Some people feel vulnerable and exposed to judgement from others when you go through a major lifestyle event and are exposed to social situations.
• Having other anxiety disorders and phobias such as depression, generalised anxiety disorder, obsessive compulsive disorder (OCD), social phobia and claustrophobia.
• Suffering a history of abuse and control.
• Conditioned responses from a family background of agoraphobia. In some cases the background can include a “dependency culture” that stifles self-confidence.
• Problems with substance abuse.

  

• You have certain medical conditions such as suffering problems with balance (vertigo) and spatial awareness distortion issues. This affects how you perceive the proximity of people and objects. You feel disoriented and vertiginous when environmental features “look busy”, are too close, too far away or have a “descending” perspective when viewed from a height.

Click this link for more information on the general causes of a phobia.

Agoraphobia treatment: What are the symptoms of agoraphobia?

Physical symptoms: Since avoidance is the common strategy to minimise discomfort, the agoraphobic will rarely confront those situations that cause distress. When it is necessary to confront those situations however, the anxiety symptoms experienced are common to those when having a panic attack. Symptoms will include hyperventilation, rapid heartbeat, nausea, excessive sweating etc.

Cognitive symptoms: The cognitive symptoms reflect the underlying belief system. For example, the agoraphobic with health anxiety will be convinced that your physical symptoms are connected to a serious illness. Whereas the agoraphobic with social anxiety will be believe that appearing out of control with a panic attack will draw attention and will feel humiliating. In addition to this, the agoraphobic with claustrophobia will judge that you will not be able to escape the situation particularly when experiencing a panic attack.

Behavioural symptoms: The behavioural symptoms have been detailed in the section above entitled “Agoraphobia treatment: What situation does an agoraphobic fear?” and includes being in open spaces where help may not be readily available.

How is agoraphobia diagnosed?

Agoraphobia is usually diagnosed by your doctor who will ask questions about your signs and symptoms, and your medical and family history. It is common to do some blood tests to dismiss any physical causes for your condition e.g. hyperthyroidism.

How is agoraphobia treated?

Agoraphobia treatment can involve a specific or a combination of different interventions including:

• Self help techniques that help you understand agoraphobia and panic attacks. When you learn about these conditions, it may help you have more control over your symptoms. Lifestyle changes such as taking up regular exercise (initially performed in your home) can help you reduce symptoms of everyday-anxiety.
• Prescribed medication from your doctor such as SSRI’s (selective serotonin reuptake inhibitors), antidepressants or anti-anxiety medications can relieve some of your agoraphobia or panic attack symptoms.
• Therapy such as psychotherapy, Cognitive Behavioural Therapy (CBT), and Exposure therapy can be used to discuss your fears, change your thoughts and progressively challenge your behavioural symptoms.

How can hypnotherapy treat your agoraphobia?

Agoraphobia is considered to be a complex phobia since it can integrate various anxiety disorders e.g. panic disorder, and a number of advanced individual fears and phobias that now dominate the sufferer’s self-limiting experience. Unless the symptoms are being caused by a specific issue, agoraphobia treatment is rarely a quick-fix since many of the symptoms have developed over an extended period of time. But when the agoraphobia treatment allows for a structured approach, it can be invaluable in returning the sufferer to emotional wellbeing and lifestyle confidence.

Is hypnotherapy a viable treatment for agoraphobia then? There is some case study research to demonstrate hypnotherapy’s effectiveness. For example, hypnotherapy has been used when treating IBS-induced agoraphobia and in another case study where the application of hypnotherapy was psychodynamic in its approach. Hypnotherapy has the advantage over other treatment modes since it can utilise the subconscious mind with some impressive outcomes.

Furthermore, studies from Stanford University state that phobia sufferers “tend to score high on hypnotic susceptibility scales and… respond favourably to hypnotic intervention.” You can assess your level of suggestibility using this hypnosis test.

To be successful in agoraphobia treatment however, hypnotherapy still needs to incorporate other tried and tested methods. My agoraphobia treatment approach includes various treatment strategies using these tried and tested methods.

This is how you can benefit from hypnotherapy:

Your core issues will be identified and treated

When you live inside your agoraphobia symptoms, you will be responding to a negative programme that is now established and automated. Your behavioural reactions are not the problem, but act as a further symptom of your condition. In the early stages of your treatment your agoraphobia “map” will be traced to identify core issues that may have been forgotten and repressed. In many cases an issue like a height phobia is not being confronted, yet is still playing an active part in the avoidance programme. When these issues have been identified, either through discussion or using hypnotic techniques, your treatment goal will become clearer and can be broken down into progressive stages.

Hypnotherapy will help reduce your anxiety

Advanced anxiety states benefit from an interruption from the pathways that maintain it. By introducing relaxation into these pathways, it allows you to see out of the habitual patterns of avoidance and prepare to accept new patterns. My hypnotherapy incorporates anxiety reduction as part of the induction, a process that may not be included in other therapies. This is helpful in your goal to overcome your agoraphobia, but it is not the complete treatment. The post-hypnotic suggestions that are targeting aspects of your agoraphobia are the main part of the treatment and will accelerate you towards therapeutic change.

Hypnotherapy can help you control your panic attacks

The ability to use breathing techniques to control your anxiety is an essential part of feeling in control of your internal state. You may have previously tried breathing techniques, struggled to benefit from them and then dismissed them as being helpful following another panic attack. Your treatment will revise these techniques and anchor them in hypnosis so that they become a natural effective intervention in your anxiety management.

Hypnotherapy suggestions can target your agoraphobia symptoms

In a hypnotic state, you are more receptive to positive suggestions. Hypnotic suggestions can target your physical, cognitive and behavioural symptoms interrupting the current pathways that are overwhelming you. When you have intense positive visualisations without conscious interference, it can transform your current negative state into your desired state. The suggested visualisations act as positive rehearsals for your practises enabling you to confront the situations that you are avoiding. As you embrace these new patterns of behaviour, essential feature that maintains your agoraphobia like your automated “escape” reaction will be modified.

Hypnotherapy can reframe your past emotional traumas

Regression techniques often get a slating from solution focused hypnotherapists and other therapies that consider “revisiting the past” as a waste of time. Painstakingly combing through every part of your life is the common misconception with age regression techniques, but this is not necessary unless treating deeper issues like extensive abuse. With agoraphobia, reframing the negative emotional learning from past events can be completed in a relatively short period of time. By examining the (i) origin (also known as the “cause” of your condition), (ii) the most emotionally significant past event, and/or (iii) the most recent event is, in many cases, sufficient for emotional release. Regression hypnotherapy adopts the view that it’s your state of mind when you learned your agoraphobia that is continuing to cause you problems, not the reactions that have ensued.

Hypnotherapy can assist your desensitisation programme

Doing the “in vivo” exposure or “mind work” to treat the emotional blocks connected to your agoraphobia in the clinic is an important part of the treatment process. It will prepare you for the “in vitro” or behavioural exposure to confront the “outside of clinic” situations that you are currently avoiding. As you systematically achieve the objectives in stages, it completes the circle of belief that you are building confidence and can overcome your condition.

Can hypnotherapy be combined with desensitisation (or graduated exposure) techniques effectively? Hypnotherapy can be mistakenly identified as a “one trick pony” in which you are “made” to change in one session or the treatment has failed. Would you seek this same expectation from a cognitive behavioural therapy programme? Probably not; you would expect a course of therapy particularly if it includes systematic desensitisation. In the treatment of phobias, research has shown that hypnotherapy can be effective in the application of desensitisation therapy where the treatment is tailor-made to the individual. Hypnotherapy can offer a “rapid and cost-effective form of treatment for these conditions” (p. 107).

Follow this link for more information on general phobia hypnotherapy treatment.

Hypnotherapy: how can you access your agoraphobia treatment?

Agoraphobia treatment at the clinic: If your agoraphobia severity is low to moderate and you can travel short distances or travel accompanied to the practice, then your hypnotherapy treatment can take place at the clinic.

If your agoraphobia is moderate to high then consider:

Agoraphobia treatment at home: Initially, you can be treated in the safety of your own home with hypnotherapy home visit treatments to get your therapy moving. (N.B. an additional travel fee applies.) Or…

Agoraphobia treatment online: You can access your agoraphobia treatment using online hypnotherapy without the need for travel or additional travel fees.

For more information on agoraphobia treatment & hypnotherapy in Cardiff, contact Richard J D’Souza Hypnotherapy Cardiff