DE-SENSITIZATION AND GRADED EXPOSURE STEPS PART I

ANSWER each question (before looking at the answer) by acknowledging a,b,c or d. Any answered not 'correct' read that section again.
1 WHAT IS AGORAPHOBIA? (a) An agoraphobic is someone who has a fear of going far from home, a fear of being alone or far from help, and a fear of crowded public places, like streets, shops, buses and so on .

Most people like this also have an additional fear that they will loose control over their own reactions, that their fear will get completely our of control, and lead to a panic attack or worse.

Because of this fear, they tend to avoid places that could trigger it off, and this avoidance tends to become a habit. Often they feel better with someone they know well, and so can be dependent on having someone with them when they go out. Once a person regularly avoids going out alone or avoids many different places for this reason they are said to have 'agoraphobia'.

Agoraphobia is quite a common problem - about one in 100 people suffer from it.

QUESTION-Someone with agoraphobia is likely to be afraid of: a) Open spaces in the country. b) Losing control in crowded public places. c) Staying at home with someone. d) Being with other people.

It is caused in the first place by the body reacting to everyday situations as if they were dangerous and frightening, in the second place by the worry caused by these strange feelings, and in the third place by the fact that agoraphobics tend to avoid places connected with these feelings.

To understand this, think about the way your body reacts at a time of real danger - say a near miss in what could have been a fatal accident. Your heart may beat hard and fast, your stomach may churn, or you may sweat and tremble, and so on. The exact reaction varies from person to person, but it is usually quite strong enough to cause 'shock' after an accident.

In agoraphobia it seems that this bodily reaction has become oversensitive for a while, and tends to be automatically triggered by quite ordinary everyday situations.

QUESTION-Agoraphobic panic is different from ordinary fear or shock because: a) It can't be controlled very easily. b) It causes bodily changes such as your heart beating faster. c) It is an automatic bodily reaction. d) It is the same as fear without any real danger.

Whatever the cause, once it has happened a few times, it starts to happen more frequently in certain places.

The reason for this is a special kind of learning called 'conditioning'. To understand this , think of the reaction of a child when it meets a dog for the first time. If by bad luck the dog barks loudly and frightens the child then the next time he sees a dog he may feel nervous and even run away.

Conditioning is the name given to the way the particular reactions - including emotions like fear, come to be associated or connected with particular things or places. This association is learned in a completely automatic way - it happens whether you want it or not.

QUESTION-'Conditioning' means: a) Association of a reaction with a situation. b) Learning to be afraid. c) An oversensitive state following an illness. d) Learning that two things always go together.

In the case of agoraphobia, panic reactions get attached to particular situations (and ideas) by the same process of conditioning, even after the 'oversensitive' state which caused the fear reactions in the first place has died away, the conditioned fear keeps on. Since this fear results in avoidance of places associated with these reactions, there is no reason for the phobia to get better.

QUESTION-If a child was frightened by a large, fierce dog, would it be best to: a) Keep him away from dogs for a while. b) Tell him to be braver next time. c) Give him a sweet to cheer him up. c) Introduce him to a more gentle dog.

QUESTION-AGORAPHOBIA IS: a) A mental disease like schizophrenia. b) Due to physical illness. c) A learned emotional reaction. d) Caused by a lack of will-power.

The main reason is that the natural reaction to feelings of panic you cannot understand is to avoid the places where they happen. Unfortunately this seems to have the effect of actually strengthening the conditioned fear - the longer the avoidance goes on the stronger it can become.

People often feel that they can help by getting things for an agoraphobic so that they don't have to go out. This only makes the habit of avoidance stronger.

It is very common to find that people with agoraphobia depend a lot for getting out on other people close to them. This is because a familiar, reassuring person can make frightening situations seem safer. The trouble is that depending on other people tends to become a habit, in the same way as avoiding places.

QUESTION-If you avoid a shop where you had a panic attack. a) You will find it more and more difficult to go back. c) You should wait until you are will before going back. d) You should get someone else to go into the shop for you.

Some people feel dizzy, or breathless, some get a feeling of weakness in their legs, or their legs, or their heart pounds, and some feel that everything seems unreal, like a dream and so on . Worrying about these feelings tends to get them more firmly fixed, like a habit. It is only too easy to get into the vicious circle of worrying and being afraid of the feelings of fear themselves. Some people think that they might make a fool of themselves in public, faint or be sick, perhaps physically collapse or injure themselves, or even lose control permanently and become insane.

In actual fact, agoraphobics run no more risk of any of these things than anyone else does.

QUESTION-Agoraphobic symptoms often include: a) Acting insanely. b) Feeling faint or strange. c) Collapse through physical overstrain. d) No special feelings.

Most important is to stop avoiding the feared places - it is only by gradual practice in these places that the fear will be overcome. Because the fear has been developing for a long time, it will need a long time to get rid of it. This means practice in facing the feared situations over and over again until confidence returns. In other words, a person with agoraphobia must get into the daily habit of shops, travelling on buses, or facing whatever the feared things are. Of course, you can't expect all of these things to be done at once - each situation has to be practised in stages, one step at a time. Confidence is built up by doing the easier things first and then gradually doing more and more difficult ones.

QUESTION-If you succeed in going to a particular place that you have avoided for some time: a) It won't give you any more trouble. b) It will be even more difficult next time. c) It won't have made any difference one way or the other. d) It will probably be slightly easier next time.

When doing something difficult for the first time, it sometimes helps to take a tranquilliser (if one has been prescribed) just beforehand. The idea is not to rely on them, or take them regularly, but to use them occasionally the first time you tackle something that you have been avoiding.

It is not a good idea to rely on 'help' from others, if this means them doing things for you, which leads to your depending on them or when it implies well-meaning sympathy, which just encourages dwelling on your problems - instead of doing something about them.

QUESTION-It may be useful to take tranquillisers at first just before practising something new and difficult because: a) they will get rid of all the feelings of fear. b) People become dependent on them for going out. c) They build confidence for practise without tranquillisers. d) They give people something to rely on in an emergency.

SUMMARY OF TREATMENT PLAN
1) Practice in facing the feared situations every day. 2) Plan progress from easier to difficult situations/ 3) Expect to experience some fear when practising - the point of the exercise is to cope with the feelings instead of over-reacting to them. 4) Use tranquillisers when necessary to help with new or difficult things. 5) Avoid relying on others, or dwelling on your own problems and symptoms. Concentrate on help with leads to doing things for yourself.

QUESTION-Which would be the wrong thing to recommend for someone with agoraphobia? a) Doing things one step at a time. b) Taking tranquillisers before some practice sessions. c) Practice is going out every day. d) Having help from others with things like shopping.

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