Today, I'm talking about agoraphobia and the best treatment methods for agoraphobia. Hi, I'm Paige Pradko. Welcome to Therapy for a Better Life.

My inspiration for doing these videos came from a client who had agoraphobia and panic disorder. And he used to ask me to please do some videos to help support him and others with agoraphobia. In order to have a Diagnosis of agoraphobia, a few different criteria have to be met including two or more of the following: the person must have intense fear and anxiety when using public transportation, or they have intense fear when being in an open area or an intense fear and anxiety when being in a closed in area or fear of being in a crowd or waiting in line, or they have intense fear and anxiety being alone or being outside of their house or safe place. If one meets two from that list, then they do meet the criteria for having agoraphobia. The fear must be out of proportion to the actual possibility of danger. And it is a persistent fear that has been there for longer than six months, and it causes the person a lot of distress.

What are the causes of agoraphobia? Well, there are several possibilities. The first is genetics, just biological factors. The second is a traumatic event, possibly an illness or loss, or even an accident. And the third is having intense fears, intense fears of possibly something terrible happening, a crime or terrorism or an accident. And the fourth is a complication of panic disorder where a person begins to avoid different situations and activities and events because they fear that they will panic.

Now, how do we treat a person with Agoraphobia? As I mentioned earlier, I use a combined approach and it really depends on if the person has panic disorder or not, and the severity of their symptoms. I'm going to review a six-prong approach to treatment.

Number one is practicing a lifestyle that reduces the fear of their fear center of their brain called the amygdala. And the way we do that is by researched, proven methods to calm that fear area of the brain. These techniques should be practiced daily as an overall lifestyle for stress management and not in response to anxiety in the moment. I've detailed these stress reducing methods in a series that I call The Calm Series for Anxiety: C is for Calm the Body. You can find the entire CALM Series for Anxiety on my playlist, but I will also leave you a link so that you can review the techniques to calm down that fear center of the brain and reduce your anxiety. What I really want you to pay attention to are two techniques. The first is called square breathing, and the second is called breath focused meditation. Both of them are excellent techniques to practice every single day to keep your anxiety low. I also encourage my clients to just practice a healthy lifestyle, good nutrition, good sleeping habits, exercise daily, if they can. And there's just a little suggestion that I give to clients with anxiety and that is that people with anxiety cannot have C.A.T.S. (caffeine, alcohol, tobacco, and sweetener). Those things have been shown to influence your level of anxiety.

Now the second mode of treatment is called interceptive exposure therapy. I use interceptive exposure therapy for my clients who have panic disorder that is triggered by a body sensation. For example, their panic may be triggered by a rapid heartbeat, hyperventilating or quick breaths, maybe swolleness in their throat area, possibly dizziness or nausea or derealization. There can be several different body sensations that trigger people's panic attacks. Interceptive exposure is how we treat that. I have a link that details what to do to practice interceptive exposure therapy. I'll leave a link in the description so that you can watch that video.

I like people to know that is constant research on what works best in treating people with panic and agoraphobia. In 2011 in the British journal of Clinical Psychology Volume 36, and the neuroscientist and researcher Michelle Craske and colleagues found that interceptive exposure therapy is much more effective at treating panic disorder than cognitive behavioral therapy CBT techniques like cognitive restructuring. Interceptive exposure therapy is highly effective. I use it with most all my clients with the agoraphobia.

My next method number three is teaching clients what to do during a panic attack. I use a method that I came up with called the MEWS method. M.E.W.S. is an acronym that stands for M: moving the body to burn up our adrenaline and cortisol. E: is to keep an external focus. We focus outside of our body and all our attention goes into what we're looking at or what we are doing instead of focusing inside of our body. W: is for welcoming the panic or anxiety. We stay nonreactive and just let it wash right over us. Claire Weeks used to call in “Floating” through it. Welcoming anxiety and panic are a strategic approach. It's also a paradoxical treatment approach. It's one of my favorite techniques as it gives a message to the brain that you are not concerned, and you are safe. You can learn more about it in my video on Strategic Exposure Therapy. S is for square breathing. I do not like to recommend breathing techniques for panic and we only do this technique afterwards, to calm down after the panic. Generally, I prefer for people to be as nonreactive to panic as possible so that you are not sending alarming messages to the brain that keep you in fight or flight.

If a person with agoraphobia does not suffer from panic, they can move on to the next method called exposure therapy and that is treatment number four. I like people to start off using imagining exposures, however, if they can tolerate a situational exposure, that is always preferred to imaginal ones. Real life, situational exposures are called In Vivo exposures. People will typically work their way up to do all different variations of situational exposures. Often people want to begin exposures with safety people, but eventually we remove the safety people, and they learn that they can do exposures on their own. Now it's important with exposure therapy to have a lot of variety, all different places, all different times a day, for different lengths of time of the exposure. We want to mix it up as much as we can so that we increase the effectiveness of every exposure.

Now, the fifth mode is of treatment for agoraphobia is practicing mindfulness and acceptance. I also have a video on this technique. we want to eliminate any avoidance behaviors. We want to fully welcome the feeling of anxiety and fear. We don't want to resist it. We want to welcome it and accept it and notice it. I like my clients to know that there is no safe place. There is no safe person because they are their own safe place, and they are their own safe person.

Now, the final mode of treating a person with agoraphobia number six is medications. Not all my clients use medications, but if someone is interesting in using medications like SSRI’s, I do have them consult their physician. I do recommend antidepressants for agoraphobia and panic disorder, but I do not recommend benzodiazepines. Although they are very highly prescribed to people with the agoraphobia. There's actually evidence that benzodiazepines make agoraphobia worse. If you're on one of these medications, I do advise you to work with your physician to slowly go off because they are difficult to wean off in a safe way. So, you will want to work with your physician to do that. I do have a video that describes a little bit more research on why I advise my clients to work with their physician to go off those medications.

And finally, I like people to be aware of safety behaviors and begin to eliminate their safety behaviors. Almost everyone that I know that has agoraphobia has certain safety behaviors. We identify them and they become part of exposure treatment to gradually let them go. They include things like having your cell phone right there, having medication in your pocket, having a safety person there, knowing the location of the nearest hospital.

I want to leave you today with just a message that there is hope. Agoraphobia is a very complicated condition, but there is 100% hope in complete recovery. I've witnessed people fully recovering from agoraphobia many times in my life. People that were completely house bound and are now engaging fully in their life, even traveling. So, I leave you with that gift of hope and possibilities for your full recovery. I would love to hear your comments or your questions about this video. I hope that you learned some new information today, and I want to remind you if you liked the video to go ahead and like it, and to subscribe to the channel if you'd like or more information like this. So until next time take care, I will see you in session. Bye-Bye.