Can you imagine being afraid to go out on the street alone? Do you constantly worry and fear the possibility of suffering from an anxiety attack? Can’t take the bus to work or go to a mall to buy a gift for your child?
Well, that’s how a person with agoraphobia can be every day.
What is agoraphobia?
Agoraphobia, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), is the appearance of anxiety in places or situations where it is very difficult to escape, Or when you can’t get help with an anxiety attack.
The situations in which this intense fear or anxiety appears may be:
- Public transport.
- Open spaces.
- Closed places.
- Line up or be in the middle of a crowd.
- Being alone away from home.
The psychologist from Malaga Ana Claudia Alda, From the firm Psychologists Málaga PsicoAbreu, emphasizes that the fear that appears in agoraphobia is not a specific fear of situations, but it is a question of fear. In other words, it is the fear of experiencing the symptomatology of anxiety and its possible consequences.
Therefore, the fear and anxiety that appear is disproportionate and excessive to the real danger these situations pose.
Agoraphobia can appear in the following ways:
- Anxiety disorder with agoraphobia. The person has experienced anxiety attacks on several occasions and is also concerned about the occurrence of a new attack and its possible consequences.
- Agoraphobia with no history of anxiety disorder. An anxiety attack has never happened, but agoraphobia appears out of fear of developing symptoms that resemble an anxiety attack.
What are the characteristic symptoms?
The most common symptoms of agoraphobia are as follows.
At the physiological level. changes appear such as:
- Feeling of suffocation.
- Chest pain.
At the cognitive level, There are anticipations related to the possible occurrence of an anxiety attack, as well as concerns about its possible physical (heart attack, inability to breathe, etc.), mental (loss of control, going crazy, etc.) consequences. .) and social (that others think the person is crazy).
At the behavioral level, The person tends to avoid situations that they fear or face, but with high emotional distress. It is common to find safety behaviors that help cope with the discomfort, such as walking, taking medication, or always carrying water with you.
Vulnerability and maintenance factors
There are different variables related to the development and maintenance of agoraphobia that make it easier to understand this phenomenon.
- Genetics and temperament. Neuroticism or the predisposition to feel unpleasant emotions in the face of stressful stimuli appears to be the trait most associated with the development of anxiety problems.
- Sensitivity to anxiety. It refers to the belief that anxiety and its symptoms can have negative consequences on the physical, psychological and social levels. This function determines the onset of the fear mentioned above.
- interoceptive awareness. People with agoraphobia problems have a great awareness of their own physical sensations, as well as a good ability to detect them.
- Onset of anxiety attack. When agoraphobia is accompanied by anxiety attacks, agoraphobia usually appears as a result of the fear experienced during the attacks. The worry of not knowing whether it will reappear or whether it can cope with it, leads the person to the development of agoraphobia.
interoceptive conditioning. Due to previous experience, the person experiences any physiological changes such as the onset of an anxiety attack. In this way, physical sensations that may resemble anxiety (sexual arousal, exercise, etc.) elicit an autonomously activating emotional response that facilitates the onset of another attack.
Catastrophic interpretation of bodily sensations. The person interprets any somatic sensation as a symptom of the onset of a seizure. Thus, the belief that anxiety will have negative consequences (sensitivity to anxiety) favors this catastrophic interpretation.
Do you have treatment? What is the most appropriate intervention?
Cognitive-behavioral psychological treatment was very effective, Become the main line of intervention.
There are two intervention programs in the cognitive-behavioral stream that have had excellent results. They both use very similar cognitive and behavioral techniques, but differ in their conceptualization of the problem.
1. Clark’s Anxiety Disorder Cognitive Therapy Program
This program it is mainly based on the idea that the main factor supporting the problem is the catastrophic interpretation bodily sensations. All of the techniques used in this program aim to restructure the catastrophic beliefs that exist about physical sensations.
2. Barlow’s Panic Treatment Program
In this case, priority is given to habituation to interoceptive sensations to eliminate interoceptive conditioning. existing through exhibitions. Like the previous one, it also works on the restructuring of catastrophic beliefs from the achievements made.
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington DC: American Psychiatric Association.
- Barlow, DH and Cerny, JA (1988). Psychological treatment of panic. New York: Guilford Press.
- Barlow, DH and Craske, MG (1989). Control your anxiety and panic. Albany, New York: Graywind Publications.
- Barlow, DH and Craske, MG (2007). Controlling Your Anxiety and Panic (Workbook) 4th Edition. United States: Oxford University Press.
- Clark, DM (1989). States of anxiety: panic and generalized anxiety. In K. Hawton, PM Salkovskis, J. Kirk and DM Clark (Eds), Cognitive Therapy for Psychiatric Problems: A Practical Guide. Oxford: Oxford University Press.
- Salkovskis, PM and Clark, DM (1991). Cognitive therapy for panic disorder. Journal of Cognitive Psychotherapy, 5, 215-226.
- Vallejo, MA (2016). Handbook of Behavioral Therapy. Madrid: Dykinson.