Because the sensations of panic have happened repeatedly 'out of the blue' the automatic bodily reaction occurs, i.e. normal protection response, when facing situations or places that are likely to trigger off a panic.??????? These attacks occur before the habit of avoidance begins which is the conditioning of a critical behavioural pattern. See Knowledge Notes 1. The first panic attack may have happened after a serious operation or physical experience - this does not mean that the agoraphobe is continually ill physically. Mental fatigue does come into this cycle, usually at the beginning when the sufferer is very confused, but when the body is at a low ebb, awareness of symptoms are more highly sensitised.

Agoraphobia is a state of SECONDARY FEAR AND TERROR.
Agoraphobia is made up of many fears - it is fear of open spaces as well as:
* FEAR OF FEAR
* FEAR OF LOSING CONTROL IN PUBLIC
* FEAR OF BEING TRAPPED (Especially a stay and wait situation)
* FEAR OF CLAUSTROPHOBIA
* FEAR OF PHYSICAL SYMPTOMS
* FEAR OF INSANITY
* FEAR AND ANXIETY OF WAITING FOR THE NEXT SIGN OF TERROR
* FEAR OF SET-BACKS
* FEAR OF FAILURE
* FEAR OF TRAVELLING
* LACK OF CONFIDENCE IN THE BODY
* LACK OF CONFIDENCE AND TRUST IN ANY ABILITY
Lack of trust in the body occurs because one day is successful and another day a failure; this brings more fear that finds expression in other thoughts as above, and a heightened awareness of the bodily functions. This is caused by confusion and bewilderment.

Any fear, agoraphobic panic or otherwise, is not easy to control and has nothing to do with will power. Any fear causes changes in the body.

SHATTERED SELF-CONFIDENCE IN YOUR BODY AND IN YOURSELF CAN BE REBUILT - IT IS A STEP BY STEP PROCESS YOU CAN UNCONDITION THESE RESPONSES WHICH HAVE BECOME FEAR ADDED ON FEAR
The experiment described in Knowledge Notes 1 of a child being savagely snapped at by a fierce dog, causing the child to become frightened, explains that the reaction was automatic and not chosen. To reduce the sensitised state of the child is to introduce it to a gentle friendly dog. This behaviour helps to reduce the conditioned fear.

Fear is not a sign of weakness but is needed to be a preservation of the body. FEAR IS MOST NECESSARY AND TO BE THANKFUL FOR. It is very useful to write fears down on paper, the healthy fears and the secondary Repressing fears is similar to avoidance and can lead to the conditioning of avoidance; owning up to them and airing them is like graded exposure i.e. actual field work in practise, looking at them and gradually rationalising the differences.

FEAR GROWS BUT WHEN EXPOSED, FEAR GOES. For recovery, the separation of the two is very necessary as the agoraphobe may expect complete total bliss and not the normal 'run of the mill' sensations e.g. like speaking to a public audience for the first time etc. All these have to be clarified as in "Accept the Physical Symptoms" ???????

RATIONALISATION BETWEEN NORMAL AND EXTREME INTENSITY IS A MUST

ANY FEAR OF ANY KIND IS AN AUTOMATIC REACTION TO PROTECT WILL POWER AND STRENGTH HAVE NOTHING TO DO WITH AN AUTOMATIC CONDITIONED REACTION e.g. A person standing relaxed leaning on a stationary car will jump when the horn is accidentally blown. This is a normal automatic reaction, as is avoidance, to protect oneself. Often the sufferer feels they are going insane or will act insane in public. This is the secondary fear that keeps the fear cycle rolling. (One would have to experience such terror to understand this). A although this rarely happens as the sufferer goes through torture just to prevent this. The thought of making a fool of themselves is added pressure and adds to mental fatigue. Feeling faint and strange is quite common and harmless though unpleasant.

ALL SYMPTOMS OF AGORAPHOBIA CAN HAPPEN AT HOME, ALONE OR IN COMPANY Agoraphobia is no respecter of persons, it can happen to anyone, anytime, confident or unconfident, dependent or independent, normal in every way, men and women with equal frequency, however it is more apt to persist in women.

A cycle begins and a panic is anticipated constantly, the possibility of it happening again is always there, yet on the other hand it may not. THE MORE THE CONDITIONING - THE MORE THE FEAR GROWS! THE FEAR WILL RUN AWAY ITSELF WHEN FACED, AS ANY FEAR DOES AND WITH THIS SECONDARY FEAR IT WILL GO - GRADUALLY. VICTORY OVER FEAR DOES NOT COME BY ELIMINATING FEAR ALTOGETHER. Fear is not all bad, some are healthy fears and very necessary for our protection and survival. It is not to eliminate feat but put it back in it's right place. The fear and panic that the agoraphobe experiences is a secondary fear and nothing to be ashamed of but just to be recognised that it has protected us from overworking the emotions that are already highly sensitised. It has protected us from not knowing how to handle what we did not understand through lack of knowledge.

WITH NORMAL INTENSITY FEAR, the mind is completely absorbed in the obvious encounter or subject, causing the fear and is logically and automatically dealing with the answer e.g. fire, interview.

WITH EXTREME INTENSITY FEAR the mind is confused with nothing to solve for all reasons remain unknown and the thoughts turn into themselves creating confusion, adding mental fatigue, thus creating a non- stop fear cycle.

A correct attitude plays an important part in recovery of the agoraphobe. Learning to encourage oneself is vitally important. The agoraphobic does constantly criticise himself/herself. Feelings and emotions need to be changed, with a positive and correct attitude by being fed positive ideas and gradually a new opinion of worthiness will begin, without this, recovery is much slower.

PROCRASTINATION STRENGTHENS THE CONDITIONED AVOIDANCE. "PLAN THE WORK THEN WORK THE PLAN" THE NEW BEHAVIOURAL PATTERN OF LIFE SHOULD BE STARTED AS SOON AS POSSIBLE Step by step gradually - it is not the size of the step that counts but only making-the-step is important, no matter how small.

THE GOLDEN RULE FOR THE AGORAPHOBE-DON'T DO ANYTHING YOU CAN'T DO, BUT DO SOMETHING AND DO IT EVERY DAY. It has taken time to become agoraphobic and the new daily habits take time to see results, but on the average, fear is reduced - knowledge hastens this.

UNDERSTAND BOTH PHYSICALLY AND MENTALLY THE PROCESS OF SENSITISATION and DESENSITISATION WILL HELP BRING RELIEF IN YOURSELF THAT IS RIGHTFULLY YOURS.

Many people do not or may not realise the importance of a daily habit of practise. Practise reduces fear, builds confidence and ways to see how to rationalise. When trying something new or difficult, tranquillisers prescribed by a G.P. can help reduce the awareness of the physical feelings; most sufferers rely on tranquillisers for 'emergencies' when out, in fact the use of tranquillisers is very important until more confidence is gained. The help of a friend or trained assistant may be needed to help in the beginning also. The following is an example of planning a step at a time programme, including sub-goals - The goals should be set by the agoraphobe and no undue pressure added. The target is to drive alone to the nearest shopping centre. The day that the task is to be completed should not be decided upon untill sub-goals have been achieved. The example given is simple and not finely detailed, but enough to use as an example.

REMEMBER - GRADUALLY ONE STEP AT A TIME

It is only by practise that fear will be overcome; you will notice how the friend provides support for the appropriate performance in the situation, then gradually phased out of each situation. You will also note that anxiety is affected by seating arrangements in the car.

1. I sit in the passenger seat of my car while it is parked in the driveway. The engine is not running.
2. I sit in the driver's seat of the car while it is parked in the driveway. This time the engine is running.
3. I go for a short drive in my neighbourhood with my friend driving, to became familiar with the surroundings.
4.I drive my car down the driveway to the gate and back to the garage. My friend is sitting in the passenger seat.
5. I drive my car down the street and return home. My friend is watching me from my gate. - SUB-GOAL -
6.With my friend in the passenger seat of my car, I drive around the neighbourhood for 5-10 minutes.
7. With my friend following me in her car I drive around the neighborhood for 5-10 minutes. (prior to that my friend has been sitting in the back seat while I have driven previously on the same route).
8. I drive alone around the same route and my friend is waiting for me at my gate. - SUB-GOAL -
9. With my friend driving I go to the nearest shopping centre and back.
10. I drive to the shopping centre with my friend in the back seat of my car, and home again. - SUB-GOAL -
11. I drive to the shopping centre alone, my friend is following me in her car, and also follows me home.
12. I drive alone to the shopping centre, where my friend is parked waiting for me, she follows me home. - SUB-GOAL -
13. I drive alone to the shopping centre, where my friend is parked waiting, this time I drive home alone . She comes to my home allowing time for me to have already returned home.
14. I drive alone to the shopping centre and back home alone, my friend is waiting for me at home. - SUB-GOAL -
15. I ring my friend at her home and tell her I am driving to the shopping centre alone, she waits on the phone for my return.
16. I drive to the shopping centre and back alone.

IF THE PROGRESS COMES TO A HALT-ONE HAS CHOSEN TOO HARD A GOAL -

IMPORTANT Before starting out think about doing the sub-goals- visualise yourself achieving it - combine this with practising the quick isometric relaxation and correct breathing. THESE NEW ACTIONS ARE IMPORTANT, FOR NEW ACHENVEMENTS WILL GRING GOOD MEMORIES AND REPROGRAMME THE MIND.

Even on the 'off' days do something - the work of parctising is hardest when it's a bad day but it's more valuable then to do it.

Even if there is a time when practise cannot be done, the ground that has been prepared will not be lost!

REALISE THIS Once the conditioning of avoidance starts and the fear of the sensations one feels begins, the negative self-talk e.g. "What if's " are constantly plaguing the thoughts. Self-talk such as " Don't be silly, I've got to preserver" is not long lasting or affective for long.

With the knowledge of recovery steps THE MIND DOES HELP IN THE BEHAVIOURAL PATTERN IN A LARGE WAY -

POSITIVE RATIONALISATION OF CORRECT ATTITUDES IS ESSENTIAL Once the second fear has set in your mind, it has become programmed to tell yourself "What if ?" because of the constant attacks coming 'out of the blue' ----- This is a natural way to think as one day seems free of sensations and another day full of sensations -------- WITH KNOWLEDGE, SELF-TALK CAN BE AN ASSET but WITHOUT KNOWLEDGE TO GO WITH SELF-TALK excuses would still be made; trying to cope would still be a problem.

" What if ?" and " but" and "I can't go because "........become words that are no longer used by the agoraphobe. Confident, self praise 'self-talk' proves to yourself how capable you really are and many securities in yourself are once again re-inforced.

When a sub-goal or goal is achieved, it shouf become earier and easier if the daily practice is lept up, if however some time has elapsed it is unusual that the grounf covered is lost. Set-backs are to be expecteda, be prepared for them learn from the mistakes and build on them, evern with ups and downs,fear is reduced and progress is made as we develope in attituces, the thought of a set-bakd can actually be turned to an advantage, the more negative thoughts are siphoned out the sooner "rightness in thinking" takes it's place. * Learn to encourage yourself * See things in perspective * Learn to praise youself *get to know yourself * Recognise you own feelings * Remind yourself of your rights as a human being (remember no one is perfect) * Do something you enjoy regularly.
CONSULT ALL THE RECOVERY MATERIAL AS MUCH AS YOU POSSIBLY CAN.

SUMMARY
1. PRACTISE DAILY (NO MATTER HOW SMALL THE GOAL)
2. PLAN YOUR GOAL, THEN BREAK IT DOWN INTO SUB-GOALS (choose pleasant goals, not mundane ones)
3. EXPECT 'UPS AND DOWNS'
4. ONLY PLAN WHAT YOU ARE 70% -80% SURE OF SUCCEEDING
5. THE AIM OF A NEW BEHAVIOURAL LIFESTYLE IS TO REDUCE FEAR AND REGAIN TRUST AND CONFIDENCE. IN YOURSELF, BOTH MENTALLY AND PHYSICALLY
6. ASK A TRUSTED HELPER. IF NECESSARY. USE TRANQUILLISERS PRESCRIBED IF REQUIRED
7.ONLY ONE STEP AT A TIME
8 DIARY FOR REPORTS - IMMEDIATELY (NOT 2 HOURS LATER)
9 CHART AND UNDERLINE YOUR SUCCESSES NO MATTER HOW SMALL
10. PLAN TO RATIONALISE YOUR THINKING

THE HEART IS A VERY STRONG MUSCLE AND CAN COPE WITH THIS - ONE CANNOT DIE OF A PALPITATING HEART AND NO ONE HAS EVER DIED OF A PANIC ATTACK - A PERSON CANNOT HAVE A HEART ATTACK THROUGH A PANIC - THAT IS NOT ONE OF THE CAUSES.

There is no need to be afraid of high blood pressure as there is successful treatment for this, but fear of it will keep one sensitised. Symptoms thought to be due to this are usually caused by tension. High blood pressure does not worsen the symptoms of panic.

THE BODY HAS INCREDIBLE RESOURCES TO RESTORE, HEAL AND ENERGISE - TO CORRECT PHYSICALLY, MENTALLY AND EMOTIONALLY IT'S NATURAL BALANCE. Stories of amazing strength, courage, bravery or dedication in crises have been known. Often this source has never been tapped.

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