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Agoraphobia

This page uploaded 31 July 2009
By Lyn English (PADA - South Australia )

What is it? If you look at the literal definition it suggests it is a fear of 'open spaces'. This is somewhat misleading and not completely accurate; consequently the term agoraphobia has been misunderstood. People with agoraphobia are not necessarily afraid of open spaces, they are afraid of having a panic attack. When an acutely anxious person refuses, or is too fearful to leave their home, they are referred to as agoraphobic. In extreme cases, sufferers can confine themselves to a room which they consider to be 'safe'.

Agoraphobia is about avoidance and is a severe anxiety condition which develops with a pattern of avoidance behaviour. This avoidance may be a public place such as a supermarket or going somewhere crowded, driving the car, travelling on a bus, attending meetings, social gatherings, the list is endless. It is not significant where or what the person attempts to avoid, when avoidance begins, so does a vicious cycle: anxious feeling - fear response - physical avoidance - more fear. A pattern of behaviour commences.

Let's look at the pattern and how easily it develops and the restricted and narrow existence sufferers create by a 'perceived threat to their safety'.

Someone feels anxious or 'panicky' about a particular situation or event and they relate the situation or event as something to fear. If the anxiety develops into a panic attack, this reinforces the person's feelings that this situation, place or event is to be feared. The worry and fear of the panic attack causes the person to avoid so they won't become 'panicky'. The avoidance behaviour becomes a repetitious cycle which escalates very quickly and increases the level of anxiety.

A pattern is established when the internal anxiety becomes intense and a person becomes fearful of going anywhere or doing anything or seeing anybody where these 'panicky' feelings have occurred, particularly if they've occurred repeatedly. They do this without any evidence or rationale to support their heightened fear.

Here's one that stumps a lot of us. Collecting the mail. What will happen when I venture out to that dreaded object at the front of the house or unit? What is it about the mailbox that is so scary? Yes, I know that sometimes little spiders or creepy crawlies make their homes in our warm, dark letter boxes. But, we can prepare ourselves with a can of insect repellent, a small brush or big stick to deal with these unwelcome critters and can easily sweep away the cobwebs if we must.

Of course there may be an electricity account, water, telephone or any number of bills that we all receive. What a pain! Yes, they can be a drain on often difficult financial situations, but won't jump out of their window envelopes and grab us by the throat. Another difficulty is also the problem that we could run into a neighbour that we feel obliged to speak to. What a hassle!

But, is the 'trip' to the mailbox or the box itself really going to hurt you? Ask yourself, what is it about going to get the mail that can or will threaten me or my safety? It is not the bill, the spider, the neighbour or the mailbox. You may feel 'awful', 'strange', 'queer', 'weird', 'shaky', heart pounding, difficulty in getting your breath. This is about fear and your body has a mechanism to respond by 'fight or flight'. You are scared of these feelings and your body responds to your fearful thoughts with uncomfortable, but non-threatening symptoms.

Back to the collection of the mail, or picking up the local paper thrown onto the garden or front verandah. Routine, mundane, simple tasks to some, become events which are bigger than Ben Hur for people with anxiety who have started to lock themselves inside.

This simple task can impact so much on people, have them worrying about the thought of doing it, the stress builds up to unrealistic proportions. We limit our own lives by catastrophising and giving day to day tasks far more importance than they deserve. We allow them to have us worrying in advance unnecessarily about the 'hows' of doing easy, basic chores and letting them impact on our feelings to the extent that we restrict our living dramatically.

Consider my need to go shopping, go to the bank or queue somewhere for service. In preparation, way ahead of time, I began to think about these tasks and worry, and to anticipate the worst-case scenario. These worries were distorted, unrealistic and not based on fact. Round and round in my head went thoughts like "I know I'll feel weird, funny, queer, strange, and want to run. I must be going crazy". I got myself so worked up and worried excessively, going over and over these thoughts. I

concerned myself needlessly of how it might be, what might happen, what physical effects I might feel. Unhelpful thinking. This fuelled my anxiety and contributed to my panic. BUT, it was my thinking that created it, the distorted perceptions, NOT FACT. Feelings are not fact.

Because I had become fearful about going to the shops, queuing at the bank or post office, I started planning how to avoid having to do these things. Why? Because the last time I attempted these things I felt unwell, shaky, sick or whatever 'peculiar' symptoms that fed my doubts and fears.

Now I am developing a new problem. Another pattern of behaviour that is unhelpful, unhealthy and counter-productive. Plotting and planning to get things done like the shopping, banking or the bills paid. Worrying about how to complete basic tasks and do necessities without leaving my 'comfort zone' (it was far from comfortable).

There were days I did not want to leave my bedroom. Times I struggled to leave the house, never wanted to be alone, and definitely would not do anything on my own. But, when I did leave the house, nothing happened. I felt frightened, dreadful and very angry and frustrated. Of course, I didn't want anybody to know what was happening, because they wouldn't understand and may really think I was losing it. No, I wasn't losing it. I wasn't going crazy. I just felt damned awful: this was panic disorder.

The way to break the cycle of avoidance and reduce the panic and anxiety was TO STOP AVOIDING. Was it difficult? Absolutely! Did it take time? Yes. And commitment. Did I need to go through this process in order to get well? Definitely. I constantly challenged the unfounded, illogical, irrational and fearful thoughts.

It was necessary to put as much effort into challenging my thinking, as I put into 'control' strategies that I adopted to keep me 'safe'. Life then was like a living hell.

Today, life is very different and pretty good. I don't avoid. I do practice what I preach!



Check out PADA's website at: http://www.panicanxietydisorder.org.au/

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