This is to explain a little about the greatly misunderstood subject - AGORAPHOBIA, and for those when on a programme that leads to independent living. It is hoped that it will impart some knowledge to help sufferers conquer the phobia which now has them sensitized through confusion, bewilderment, ignorance and a lack of understanding on the subject. Once understood, it will require motivation, effort and some help, depending on the degree of severity. Some of you may know the State Wide Agoraphobia Group (Australia) Incorporated, which supports agoraphobics and those who suffer panic attacks.

Firstly, it should be mentioned to the sufferer, that if you have not had a recent medical check - be sure to consult your local doctor or specialist to make it clear that there is nothing physically complicating the problem. It will be necessary to cover many aspects connected with Agoraphobia and realize that for some, it may be difficult to read, but it is important to convey to the non-agoraphobic person a broader picture of this condition. Ultimately you will benefit, not only from a knowledge imparted but people close to you will have a better understanding.

Everyone is familiar with every day scenes: Shopping - going to the beach - taking children to school - attending the theater or cinema - watching a football match at the grounds etc.. These are taken for granted, however for the agoraphobic some of these activities are impossible, with or without help. The dictionary defines, the Greek word agoraphobia as agora - meaning market or assembly place, and phobos - being terror and flight. This is an incomplete impression of this most common and intractable phobia; it has been very loosely described as ‘the fear of open spaces’. It is not in fact, and primarily a ‘fear of open spaces’ as such, neither is it a social phobia. When the phobia reaches a chronic state (house-bound) there have been many complications preceding this. It is definitely not a ‘house wife’ syndrome for many men suffer also and in a few cases, children. It is not a twentieth century condition, as it has been recorded as far back as Hypocrites. B.C.

* It should be impressed that agoraphobia is not connected with any mental disease of physical illness. It is a Classical Conditioned Emotional Reaction, and shows itself in the form of a panic attack (physically) which comes ‘out of the blue’’ for no apparent reason. Panic attacks create the first fear in agoraphobia. * It is no respecter of persons - it can happen to anyone- shy or confident, or from any socio-economic group. Well-meant advice of ‘pull yourself together’ is said in ignorance, as it has nothing to do with will-power. * A sufferer does not show many signs of this condition outwardly and go to great lengths to hide it and usually look quite healthy. This is confusing to themselves, also to their families. They are, on occasion, accused of not facing responsibilities - this of course is incorrect for they have learned to carry heavy responsibility and in a family crisis are usually the strong person others turn to for help. * Often sufferers do not know what they are suffering from, yet they do know something is wrong. The reason for this is, lack of knowledge in the past on the subject. * Panic attacks are experienced as inexplicable electrifying terror, and has been recorded as the most intense terror the human mind can endure. * The potential for this to occur is always present and can happen without warning. * Multiple panics program the body to become highly sensitized and from this state many fears grow. There is a constant feeling of fear and of their body letting them down, because it has done so in the past. The most common physical symptoms that occur during a panic attack are:- severe palpitations of the heart - so strong that the sufferer feels as though they are having a heart attack - blurred vision - dizziness - unreality - panting - over breathing - hyperventilation - an urgency to empty the bladder - the impression of undulating scenery - muscular weakness, etc..

A panic attack can happen in crowded places or at home, with the family or alone. These symptoms all happening at once, bring about confusion of thought and bewilderment, leaving the person with an overwhelming sense to run and hide. Because this occurs frequently having no sound reason or answer, the sufferer tends to hide it from their immediate family, relatives and friends. Some of the culminating events that could cause the beginning of agoraphobia are:- a minor operation - malnutrition - death of a loved one - road or other severe accident - and in some cased misdiagnosed illness or prolonged and delayed emotional shocks, also long term anxiety. Panic attacks usually occur when the body is at a low ebb.
There is no need to worry if an original cause cannot be found - an agoraphobe can still recover, regardless. Panic attacks and why they ‘come out of the blue’ have not been explained to the sufferer in the past, nor did they know how to explain it themselves. The panic attack is the first fear; ‘when’ and ‘what if?’ and the places associated with a panic is the second fear. This now has caused a ‘fear on fear cycle’ - to protect themselves from further panics, places are now avoided. It is important to remember that the sufferer can be de-sensitized out of this cycle and back to an independent lifestyle again, by understanding certain phases and steps and putting them into practice in there correct order, first with the help from others, then gradually alone. Many agoraphobics have wonderful qualities of patience, caring for others, determination and tremendous courage - many capable qualities in many fields. On the average they have a high IQ .

Look at the first two points mentioned by using an illustration:- Imagine the reaction of a child, meeting a fierce dog for the first time. The child becomes frightened by the snapping, snarling and agressive behavior of the dog - the result is that the child usually becomes afraid of ALL dogs. (No one says “Pull yourself together” of “Snap out of it!”). It is an accepted behavior. Of course the parents would help the child by introducing him to a friendly dog; in time the frightened reaction would fade, however the natural instinct of caution would remain. The reaction of the child is fear - which is an automatic response, it is a natural instinct to protect and not made by choice- a reflex action! This illustration shows how the conditioning of fear and the avoidance of dogs could have began if the parents had not helped the child overcome the fright experienced. However the fear that the agoraphobe feels is much more intense and severe. Conditioned fear and conditioned avoidance is an inbuilt instinct of protection. It is known, all fear is not harmful and some are very necessary for survival.

Everyone at some time of another feels symptoms of fear and heightened anxiety and has a response to a situation - the following example show:- A car traveling against a red light is coming directly toward you, without thinking, your body reacts with a rush of automatic resources, the central part of the adrenalin gland, (commonly known as the fight/flight gland) responds to the situation, pumping out adrenalin -immediately you are ready to take protective action. Your foot would quickly slam on the brake pedal!
This example, although it may not be as immediate or as dramatic, the reactions are similar. You have an important job interview and as the time comes closer, you begin to feel sensations of increased adrenalin - your heart beat quickens - you breathe faster - your mouth becomes dry - your legs shake, etc.. These reactions can happen whether your thoughts are either positive or negative !
Normally when afraid, people accept these feelings because they know that when the cause or reason passes the reactions will also disappear - the mind works out a solution to the problem and what protective action to take. Remember this is common to everyone and ANY FEAR will cause changes in the body. Non-agoraphobics rarely realize just how INTENSE a panic attack is! For the agoraphobe the fear they feel is much more extreme than the average person feels. With normal intensity fear, the mind is completely absorbed in the obvious encounter or subject causing the fear and it is logical and automatically dealing with the answer, but with the extreme intensity of fear in agoraphobia, the mind is confused, as all reasons and unanswered. This of course perpetuates the condition until the mind has an answer and can then logically rationalize with the condition.

As mentioned before, THE FIRST FEAR for the agoraphobe is the panic attack WHICH COMES WITHOUT WARNING. These attacks occur before the pattern of avoidance begins. THE SECOND FEAR of ‘when’ and ‘what if ’and the association of places where a panic could happen, would not have developed into a chronic state, if the first panic or the first few panics had been explained. Because of this - it does become a FEAR OF FEAR ITSELF - A FEAR OF PANIC - A FEAR OF PHYSICAL SENSATIONS - OF THE BODY LETTING THE SUFFERER DOWN - OF BEING TRAPPED - especially in a stay and wait situation.- A FEAR OF BEING FAR FROM HOME - of familiar surroundings -OF BEING ALONE - OF TRAVELING - OF CLAUSTROPHOBIA - OF OPEN SPACES in as far as not being able to get help should the need arise.

It causes not only lack of confidence in the body but also lack of trust in their abilities - this lack of trust in themselves comes because one day it is possible to do something, another day it is not possible to do the same thing. So it is easy to understand why further fears are gradually added. Sufferers should note that there are steps to take, also for every negative emotion that this condition brings, a positive action can be used to remedy this. All there fears sound impossible to overcome - but with knowledge and guidance they will slowly diminish.
It must be recognized that panic and avoidance has protected the agoraphobe from overworking the emotions- emotions that have become highly sensitized - it has protected them - not knowing how to handle what was not understood. Remember, it is a normal protective response mechanism in the body working at its extreme level of function, unfortunately this natural instinct actually strengthens the first and second stage fears. It has been written that the emotions and highly sensitized.

This should explain :- Sensitization is a state in which emotional and body sensory nerves react to delayed or prolonged emotional strain, with unusual intensity and with disturbing speed. Moderate awareness of surroundings and physical sensations become acute. Agoraphobics, because of the lack of knowledge previously, rarely understand what is happening - this adds to the heightened feelings and they become trapped in a ‘sensitized - confused - fearful - sensitization cycle’. An agoraphobe remembers vividly past panic attacks so it is of necessity to change the approach and the attitude to these memories, and replace it with the correct approach and attitude. They need to understand sensitization and de-sensitization. It is possible that this alone can reduce the already heightened nervous system. Without added confusion, sensitization heals itself - understanding this process will help restore trust and belief in themselves again, which is part of recovery. Brain illustration Understanding is the only way to begin to break the conditioning of agoraphobia.

Agoraphobia drains off mental energy, which causes fatigue. Many may find that preparing a meal, reading a newspaper or book or just watching television impossible to do at times, when agoraphobia is chronic. Mental fatigue is difficult to identify in a confused state - people, when mentally fatigued, recognize it - a student will have a break from study to allow the mind to rest. For an agoraphobic, the mind rarely has time to rest, because there has been no answer forthcoming - also because of this total pro- occupation with the problem, they are sometimes accused of being selfish - this often can give others such an impression but this is not the case. Their thoughts have turned inwards and they are absorbed in trying to find a way to break out of the cycle. Agoraphobia is unrelated to any other psychological pattern, it contradicts the theories of behavioral patterns, because the conditioned reaction does not fade away ! A conditioned reaction as this is, would go away if one kept going out , but the natural reaction to a situation of personal threat is to avoid, to protect one’s self. The strengthened avoidance pattern keeps the cycle going.

Sufferers have become conditioned in many ways, it must be noted, not by their own choice, but by circumstances and situations - conditioned negative thinking - negative emotions - negative attitudes and memories of fast experiences and failures. When one is so entrenched in this crippling fear cycle it is virtually impossible for them to believe that they will ever be free. It is important for them to realize that they cannot change what has happened but it is equally important to realize that they can change how they react to what has happened. The conditioned fear NOW IS THE MAIN CONCERN - KNOWLEDGE REDUCES FEAR ! CONDITIONING CAN BE UNCONDITIONED !
Another example, to show how knowledge reduces fear:- A person enters a darkened unfamiliar house. The first thoughts that come to mind are “I can’t see anything, where are the lights, what if there is something dangerous in here, maybe I’ll fall over something and hurt myself!” The person finds the switch and turns on the light. All is clear and no danger is there. Knowledge makes things clear. Knowledge about agoraphobia will reduce the fear, the sufferer has been living with and like the illustration ‘they have been kept in the dark!’ Let us go through the cycle again - A sudden or gradual stress can increase the flow of adrenalin which in turn heightens the awareness of the body’s functions, emotional responses and surroundings. This sets the stage for the first panic attack, unaware to the person. After a fruitless search for answers to the panic, confusion and bewilderment take over. This again increases the sensitized state with fear and panic at the focal point. The cycle grows - tension and agitation increases, bringing with it the avoidance pattern - further confusion brings mental fatigue, also emotional a muscular fatigue - depression and guilt enter the scene and sometimes in certain cases, obsessions.

FEAR FINDS MANY EXPRESSIONS WHICH BRING ABOUT A FEELING THAT THE WHOLE PERSONALITY IS DIS-INTERGRATING AND CAUSE A RADICAL CHANGE IN THE LIFESTYLE

On the whole agoraphobic people are not nervous or depressed but usually this can be a product of this state. It does not mean that the person is continually physically ill. It should be kept in mind that this condition is NOT A MENTAL DISEASE NOR A PHYSICAL ILLNESS. Illustration cycle Although this is written to give “An Insight Into Agoraphobia” this section in particular is directed to the agoraphobe. Recognize the phobia, and its physical side effect; this is of the utmost importance and should not be overlooked.

Understanding reduces much confusion and fear. Emotionally, you may think that the initial start may be too much for you - REMEMBER this thought is based on lack of confidence in your body - you will be surprised that you can rely on your body to function properly when you work with it and not against it, through the knowledge gained. Many sufferers believer that it is impossible to think while having a panic attack - but you do think - your thoughts are “I’m getting out of here!”. Thoughts can be changed around to work for you. Every one finds it easy to think about the difficulties and negative things of life and the mind has a tendency to dwell on the negative. Every one has to train their minds to see with equal facility the positive and good things in any circumstances. This is a good thing to remember because a positive attitude is so much closer to the truth than a cautious negative one, and a positive attitude is a stronger force.

Illustration Think of a small trickle of water flowing across the sand into the sea. If you wish to change the direction of the water, you would dig, little by little a small trench to divert the flow. Gradually the water would follow the new path that had been dug, until the water flowed in a new direction. In the same way new behavioral patterns can be channeled in another direction, until they become permanent and show through expression, and over-ride the negative which would no longer remain. It is realized that you have tried so many different ways to get help and that you undoubtably believe that nothing will work - you must trust advice given as you are probably unable to trust yourself at this point. Trust in yourself will be re-established. Agoraphobia is nothing to be ashamed of - do confide in a competent person with your fears and feelings - it does emotional harm to bottle up problems.

Do not expect to notice a dramatic change over-night. You will not be aware on a day to day basis of the natural healing that is also taking place as you begin new behavioral patterns. Suppose your leg was broken you would give the leg all the possible support available to help the leg, while the natural healing process is taking place and so too with agoraphobia, try all the supports available to you - some will suit you better than others - this support could be in the form of any of the following: A professional person - groups - tapes- self-help manuals - prescribed tranquilizer- support persons - emergency phone counseling service - I.D. cards etc.. Use the support that is available to you at the time.

A sufferer must understand and recognize the panic for what it is and realize it is only the physical symptoms that make you lose confidence. The body is kept alert and ready to act to defend itself by running and fighting - try to surrender these actions. You cannot physically fight a programmed memory of past panics ! Concentrate on building trust in your body, step by sep you can use a program that is constructive. Creative and positive as well as rewarding - and as mentioned previously, to be done in the CORRECT ORDER to help you lead to independant living.

You are someone special - accept this fact. You are not inferior to anyone. Different - yes - wonderfully different. Wouldn’t it be dull if we were all alike?

There are various degrees of agoraphobia and numerous differences in the individual situations - some can drive alone in the car, other only if accompanied and some cannot even do these. No matter what the degree, its severity of symptoms are all the same to each.

There are new behavioral patterns to learn, a few are :- * How to breathe correctly - this controls the physical effects by keeping the correct amount of carbon dioxide in the body that is required. * How to relax against tension - this reduces stress signals. * How to think correctly - so reducing confusion. * Have the correct attitude -which will allow you to make the right decisions as you - * Begin graded-exposure at your own pace. * During all of this you will begin to rationalize your situation and your body’s reactions and differentiate between over - sensitivitiy and normal - sensitivity.
Everything that has been written here does relate to the agoraphobic person, whether they be male or female, housebound, part or full-time worker, student, business man or woman, old or young. It is hoped that what has been written has given a further INSIGHT INTO AGORAPHOBIA. It is also hoped that once again the agoraphobic person can be free to choose their own lifestyle an express their own personality.

MAKE OPPORTUNITIES WHERE NONE EXISTED BEFORE-MAKE YOURSELF READY FOR OPPORTUNITIES

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