Exposure Therapy For Agoraphobia

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What is Exposure Therapy?

Exposure therapy is a technique used in treating anxiety disorders by exposing patients to feared situations or objects until the fear is extinguished.

What is Agoraphobia?

The literal meaning of the word is fear of the marketplace or open spaces but in the context of an anxiety disorder, this definition falls short.

Agoraphobia is a fear of experiencing a panic attack in places or situations from which escape might be difficult or socially embarrassing. (Stuck in traffic, driving over a bridge or through a tunnel, crowded theatre, etc.)

At their core, agoraphobics fear feeling trapped, helpless and/or exposed to public scrutiny.

Exposure therapy for agoraphobia is a little different from exposure therapy for PTSD or specific phobias. Since the root of the problem is essentially a fear of panic attacks, exposing the patient to feared situations will not work.

"The agoraphobic is afraid of the upsetting physical feelings he feels within himself when in certain situations. He must be taught to cope with these and not with a situation, otherwise he may manage one dreaded situation after another only to panic in a new one."

The above quote is taken from Dr. Claire Weekes' book Simple, Effective Treatment of Agoraphobia, published decades ago but in my mind the best and clearest explanation of what agoraphobia is and how to overcome it. That's not to say that it's easy. It's simple but difficult. You have to pass through panic. Not fight it or simply bear it until it passes. In Dr. Weekes' words, "[i]t is essential that the patient be taught how to cope with panic." The fear that fuels agoraphobia is the belief that you cannot cope when panic strikes.

Sensitized panic rarely vanishes by simply ceasing to come. It goes only when the panic is taken out of panic; that is, by the patient’s seeing panic through the right way so often, without adding second-fear, that eventually panic loses so much of its fire that the remainder no longer matters.

When I first read this book I couldn't believe that someone who had never experienced agoraphobia could write such a spot on book. I think it's fair to say that among agoraphobics, Dr. Weekes is regarded as a godsend for her clear and simple explanation of a bewildering anxiety disorder. 

I believe the book is out of print now and copies are not readily available. My local library had some of her other books, which are worth checking out, but didn't carry this particular one. I searched online and bought an old paperback from eBay, if memory serves. I haven't been able to find digital editions of it but physical copies are still available on Amazon. Shop around if money is an issue. There are some charging exorbitant prices, in my humble opinion. On Amazon.ca a paperback will run you about $8 CAD. 

These prices are beyond fucking ridiculous. I wouldn't pay this much for the first edition of Wuthering Heights. Ok, I probably would. But only because it's my all time favourite book.

At only 135 pages, the book is slim but packed with information. A second and possibly third reading is a must in order to process everything. At least for me. It's a lot of information to take in for a person suffering from panic attacks and agoraphobia. I once read a review where a reader stated that every time he read the book, he got something new out of it. 

In my next post, I'll talk about two key concepts--First Fear and Second Fear--that I found incredibly helpful and eye-opening. Concepts that I haven't come across in other more recent books.