Agoraphobia Counseling & Treatment in Tulsa and Broken Arrow

Agoraphobia Counseling in Broken Arrow for Tulsa Area Residents

By Alina Morrow, LPC-S, CAMS II, GC, CCTP

Disclaimer: The article below is for informational purposes only and should not be considered as direct advice, a personal diagnosis, or as an individual treatment plan. Always consult with a mental health professional or medical doctor if you have concerns.

Introduction and Overview

Agoraphobia is an anxiety disorder characterized by an intense fear "...about being in places or situations from which a possible escape might be difficult or embarrassing, or in which help may not be available in case of a panic attack or panic-like symptoms" (DSM).

The term agoraphobia is often misunderstood and confused with its literal definition (fear of "open spaces"). However, agoraphobia is not limited to a fear of open spaces, but rather fear of situations, locations, or activities associated with anxiety and/or panic-like symptoms.

Agoraphobia

Panic-like symptoms include at least one of the panic attack symptoms (palpitations, pounding heart, accelerated heart rate, sweating, chills or hot flashes, trembling or shaking, sensation of shortness of breath, sensation of choking, chest pain or discomfort, nausea or abdominal discomfort, dizziness or lightheadedness, tingling sensations) or symptoms that can be embarrassing or incapacitating (such as a sudden attack of dizziness, a sudden attack of diarrhea, loss of bladder control, vomiting in public).

The high anxiety situation can include:

(1) being alone outside the home or being home alone,

(2) being in a crowd of people,

(3) traveling in an automobile, bus, or airplane, or

(4) being on a bridge or elevator.

In most of the cases, agoraphobics develop a pervasive avoidance behavior, which in time can lead to an impaired ability to live a healthy, meaningful life. They become trapped in their house (sometimes the only place they feel safe) and become unable to travel, work, or carry out homemaking responsibilities. Often these feared situations can be confronted by the agoraphobic when he or she is accompanied by a companion. In some cases, the agoraphobic will struggle to function normal and confront the feared situations alone but with considerable dread and great difficulty.

Agoraphobia has an insidious evolution. It usually begins after a first seemingly "out of the blue" panic attack. This first episode is usually followed by a visit to the emergency room with the concern a heart attack has occurred. If the medical investigation reveals no health related causes, the person starts associating the panic attack with the initial situation it occurred in, which might be avoided in the future. The avoidance behavior increases when the panic attacks repeat in similar or different situations. The fear and worry of experiencing similar episodes troubles the person which they will eventually avoid or fear to face alone other situations where possible panic attacks can occur. In time and without a proper treatment, the avoidance behavior will expend over a wide range of situations, locations, and activities.

It is estimated that approximately 5 to 12 percent of Americans are affected by agoraphobia at some point within their life. About 3.2 million Americans age 18 to 54 are living with agoraphobia. Agoraphobia is twice as common among women than men, and its average onset age is between 15 and 35.

Symptoms

The essential features of agoraphobia is anxiety about being in places or situations where a possible escape might be difficult (or embarrassing), or the possibility to receive help in situations of a panic attack is reduced.

One of the main symptoms of agoraphobia is the fear:

of being alone.
of being in crowded places (shopping malls, sport events).
of losing control in public places.
of being in places where escape is difficult (elevator, bridge).

Other agoraphobia symptoms include:

Inability to leave the house (to work, travel, or house chores).
Sense of helplessness.
Sense of impending doom.
Social isolation.
Over-dependence on others.
Panic attacks.
Anxiety.
Avoidance behavior.

Some of the agoraphobia symptoms can be confused with symptoms of other anxiety disorders. Anxiety and the avoidance behaviors in agoraphobia are triggered by fear of an impossible escape or receiving help in case of a panic attack or an episode of panic-like symptoms.

In social phobia, anxiety and avoidance behavior is limited to social or performance situations in which the person fears humiliation or embarrassment. In specific phobia, the person avoids only specific feared objects or situations (like elevators, heights, bugs, snakes). In obsessive-compulsive disorder, the avoidance behavior is triggered by the fear of contamination. In post-traumatic stress disorder, the person avoids stimuli associated with a severe stressor, while in separation anxiety disorder, children avoid situations that take them away from home or close relatives.

When agoraphobia is accompanied by panic attacks, some of its additional symptoms include:

Rapid heart rate
Trouble breathing
Lightheadedness
Dizziness
Excessive sweating
Flushing
Nausea and vomiting
Upset stomach or diarrhea
Trouble swallowing
Chest pain
Feeling of losing control
Jitters
Fatigue
Intense fear of dying
Intense fear of going crazy
Agoraphobia Causes and Risk Factors

Causes

The etiology of agoraphobia (cause) is not fully understood and identified, but the likelihood of developing this disorder involves a combination of genetic, social, and psychological factors.

Genetic Factors: The genetic causes of agoraphobia are complex and not completely understood. However, a study conducted in 2001 by a Yale geneticists team discovered a genetic locus on the human chromosome 3 that governs the person's risk of developing agoraphobia.

Psychological Factors: The research points out the possibility of an inborn temperament that makes a person more vulnerable to anxiety related situations. However, agoraphobia develops when a psychologically prone individual experiences high anxiety events.

Approximately 42 percent of those diagnosed with agoraphobia report a life history of real or feared separation from their parents or significant people in their childhood stage (caretakers). Based on these facts, researchers believe that adult agoraphobia can be attributed to an unresolved childhood separation anxiety. This hypothesis is also based on the observation that most agoraphobics feel safe in going out when they have company.

Social Factors:The social factors seem to be related to the gender differences. According to statistics, agoraphobia is more common among women. A plausible hypothesis that can partially explained the gender prevalence of agoraphobia is the gender role socialization. This hypothesis is based on the fact that girls, more than boys, are thought to be fearful and timid about venturing out in public.

Another hypothesis that may explain the gender differences on agoraphobia prevalence is based on the mother-daughter relationship. According to this perspective, mothers seem to give mixed messages to their daughters about becoming separate individuals. This might lead to a more fragile sense of self and a weak sense of internal psychological boundaries in girls, which tend to stay more within the physical boundaries of their home where they are safe.

Counseling & Treatment

Agoraphobia can be treated with psychotherapy and doctor prescribed medication.

Psychotherapy: Individuals with agoraphobia seems to benefit mostly from psychotherapy. There are three types of psychotherapies used to treat agoraphobia:

behavioral therapy,
cognitive therapy, and
cognitive-behavioral therapy.

1. Behavioral Therapy:
Behavioral therapy is an effective treatment because individuals with agoraphobia learn to modify and gain control over unwanted behaviors, and to cope with challenging situations. During the initial phases of behavioral therapy, the person identifies those situations where the avoidance behavior occurs. The unwanted and unhealthy behaviors are changed through systematic desensitization (also called exposure therapy). The first step is learning relaxation skills that allows the person to cope and control the fear and anxiety. The second step is gradual exposure (first in imagination and than in reality) to feared stimulus.

2. Cognitive Therapy:
Cognitive therapy is another therapy that can bring relief in those with agoraphobia. It can serve as an alternative if the behavioral therapy failes. Cognitive therapy focuses on re-training the way the person thinks. The benefit of this type of therapy is that (1) the person gains information regarding their condition and what it causes, (2) learns relaxations techniques that help him control the fear, anxiety, and panic attack symptoms, (3) gains control over the dysfunctional thoughts by realistically evaluating and modifying the thinking patterns that trigger the agoraphobic symptoms, and (4) faces the feared situation by applying the new skills achieved.

3. Cognitive-Behavioral Therapy:
Cognitive-behavioral therapy is considered the most effective psychotherapy that can treat agoraphobia. This type of therapy considers that our thoughts and not the external situations, people or events, trigger the behavior and feelings. This form of therapy combines methods from behavioral and cognitive therapies for a better outcome. Cognitive-behavioral therapy retrains the way a person thinks and reacts to different stimulus. This is possible if following several steps:

Education, a step where the therapist explains the cognitive, emotional, and behavioral processes involved in anxiety, panic attacks or panic-like-symptoms.

Monitoring, a step where the person monitors the frequency, severity, and length of panic attacks or panic-like symptoms, and identifies the situations when panic attacks or panic-like symptoms occur.

Physical control strategies, a step where the person learns relaxation techniques which decrease the physical symptoms (heavy breathing, fast heart beat, trembling, etc.) that maintains the fear and anxiety.

Psychological control strategies, a step where the person is taught to realistically evaluate and modify thinking patterns that trigger and help maintain the fear and anxiety.

Behavioral strategies, a step where the person is encouraged to face the feared situations that cause anxiety by applying their newly learned skills.

Individuals with agoraphobia seems to mostly benefit from exposure therapy, when the person eliminates the association originally formed between panic symptoms and feared situations, and cognitive restructuring, when the person identifies those thoughts associated with the feared situations, and replace them with realistic, functional thoughts.

Frequently Asked Questions

Q. How much does it cost per session?
A. My price is $150 for a 50-minute session.

Q. Who can come to counseling?
A. Anyone who wants guidance to improve their quality of life.

Q. What are the office hours?
A. Monday thru Friday from 10 am to 4 pm.

Q. How soon can you see us/me?
A. I can usually schedule you the week that you call.

Q. What do I need to do to make an appointment?
A. You can call, text or email me with the day and time you prefer, and we can go from there. PLEASE NOTE: A debit or credit card is required to reserve an appointment. The card has to be provided at the time you schedule your first appointment.

Q. What office policies do I need to be aware of prior to making an appointment?
A. All the clients that schedule appointments with me will be informed about the Making/Cancelling or Rescheduling Appointments Policy. This policy is included in the first appointment forms and is discussed with every client at the beginning of our work together. This policy states that each client will receive a text reminder 2 days (48 hours) prior to their scheduled appointment. The client is required to respond back by confirming, cancelling or rescheduling the appointment the lastet by 8pm the day I send the reminder. If the client fails to respond back, it will be assumed they cancelled the appointment without further notice and they become financially responsible for the booked appointment. Please know that at 8pm the appointment becomes available to other clients, and it is no longer yours.

Q. What is the role of the Making/Cancelling and Rescheduling Appointments Policy?
A. This policy helps me provide equal access to services to all clients (existent or new clients). Each time a client makes an appointment the allocated time is dedicated just to them; therefore, no one else has access to that appointment. This allows me to keep my schedule organized and coordinate the care of each client I have, as well as allocating the rest of the scheduling hours to others that are in need of services. When a client does not respond to my reminder, they directly affect several people. My schedule is affected, and other clients are prevented from having access to appointments. Please understand that mental health services also involve emergency or highly critical situations where clients need to receive services as soon as possible. If you (the client) do not respond to let me know the status of your appointment, I am not able to coordinate the care for other clients and attend to their needs. Clients that need services but cannot be scheduled are put on a waiting list. This is the reason I ask a confirmation by 8pm the day I send the reminder. After 8pm, the clients on the waiting list are contacted and the available appointments are offered to them. Usually the time span between the moment I send the appointment reminder and the latest time I accept confirmations or cancellation is usually 10 to 12 hours. I send the reminders in the first part of the morning (between 8 and 10 am). By not responding to my reminder in that time frame, you (the client) keep an appointment blocked and others will not have access to services. Therefore, you (the client) become financially responsible for making an appointment and not taking responsibility for it or disregarding the needs of others. Please understand that I cannot discriminate against clients. Since this is a policy all the clients abide by when they start counseling with me, I cannot differentiate between clients and make exceptions.