online conference transcript
Our guest, Paul Foxman, Ph.D., talks about the definition of agoraphobia, the three ingredients in most cases of agoraphobia, and treatment for agoraphobia (anxiety control skills, exposure therapy, visualization, anti-anxiety medications). We also discussed the different levels of fear that agoraphobics experience, from a moderate pattern of avoidance, like avoiding air travel, to a housebound agoraphobic with a severe case of anxiety and an extreme need to be in control.
Audience members shared their agoraphobic experiences and had questions about anxiety disorder relapses, anxiety and depression, how to overcome anxiety, facing phobic situations, and anxiety associated with a medical condition. Some also expressed concern that they had tried various treatment methods to no avail and were worried that they might never recover from agoraphobia.
David Roberts: HealthyPlace.com moderator.
The people in blue are audience members.
David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Help For Agoraphobia." Our guest is Paul Foxman, Ph.D., Director of the "Center for Anxiety" in Vermont. He is a psychologist, in practice for 19 years, who specializes in the treatment of anxiety disorders and trains other therapists on how to treat anxiety disorders. Dr. Foxman is also the author of "Dancing with Fear," a popular book which offers help for anxiety.
Just so everyone knows, Agoraphobia means a fear of open spaces. Here is a more detailed definition of Agoraphobia.
Good evening, Dr. Foxman, and welcome to HealthyPlace.com. Many agoraphobics are afraid to even step out of their homes. They want help. They call the doctor and the doctor says "you need to come to my office." If that's the case, how is the individual supposed to get treatment for agoraphobia?
Dr. Foxman: First, I would like to clarify my definition of agoraphobia. The condition to me means a pattern of avoidant behavior designed to protect oneself from experiencing anxiety. There are many situations people avoid, including, of course, going out into the public. In those cases, getting to a health care professional can be a problem but there are some alternatives. I use a home-based self help program called "CHAANGE" for those who are truly housebound, with telephone consultations. If we have time, I would be happy to say more about the CHAANGE program.
David: You mentioned those agoraphobics who are housebound. Are their different levels of fear when it comes to agoraphobia?
Dr. Foxman: In my opinion, the housebound agoraphobic is usually a severe case of anxiety because a pattern of avoidance has developed and the person's life is severely limited.
David: So what would be some other "less severe" instances of agoraphobia? What would that look like?
Dr. Foxman: Many "agoraphobics" function in what appears to be a normal way, such as ability to work outside the home, hold responsible positions at work, etc. However, internally, they are anxious and uncomfortable. Typically, there is a still a pattern of avoidance of some kind, such as meetings, travel, etc. There is also a need to be in control, and anxiety is highest when control is not feasible.
David: How does a person develop agoraphobia?
Dr. Foxman: In my view, agoraphobia is a learned condition that develops over time, usually resulting from having an anxiety experience in a particular situation. Thereafter, that and similar situations are associated with anxiety and avoided.
There are three ingredients in most cases of agoraphobia. First is "biological sensitivity": a tendency to react strongly to stimuli outside as well as body sensations. Second is a particular personality type that I discuss in my book. Third is stress overload. It is usually stress overload that determines when a person becomes symptomatic.
David: You mentioned "personality type" as being one of the precursors. Can you explain that in more detail, please?
Dr. Foxman: Yes. The "anxiety personality," as I call it, consists of personality traits, such as perfectionism, difficulty relaxing, desire to please others and obtain approval, frequent worry, and high need to be in control. These traits are both assets and liabilities, depending on whether you are in control of those traits or whether they are controlling you.
The anxiety personality sets a person up for increased stress and anxiety symptoms.
David: We have a lot of audience questions, Dr. Foxman. Let's get to a few of those and then I want to address treatment issues. Here's the first question:
Zoey42: But what causes that first inital anxiety attack for no apparent reason?
Dr. Foxman: Although it seems that the first anxiety attack occurs "out of the blue," it is usually preceded by a period of high stress when other coping mechanisms are strained. Take a look at the 6-12 month period preceding the first attack and see if your stress level and other changes occurred.