COURSES ARTICLE - THERAPYTOOLS.US

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1 COURSES ARTICLE - THERAPYTOOLS.US Individual Planning: A Treatment Plan Overview for Individuals with Agoraphobia Phobia Problems. Individual Planning: A Treatment Plan Overview for Individuals Suffering Agoraphobia Phobia Problems. Spend at least one hour developing different treatment plans. Agoraphobia (from Greek aã à ñÜ, "marketplace"; and à üà à ò/à à à ßÃ, -phobia) is an anxiety disorder. Agoraphobia was traditionally thought to involve a fear of public places and open spaces. However, it is now believed that agoraphobia develops as a complication of panic attacks But there is evidence that the implied one-way causal relationship between spontaneous panic attacks and agoraphobia in DSM-IV appears incorrect. Agoraphobia may arise by the fear of having a panic attack in a setting from which there is no easy means of escape. Alternately social anxiety problems may also be an underlying cause. As a result, sufferers of agoraphobia avoid public and/or unfamiliar places, especially large, open, spaces such as shopping malls or airports where there are few 'places to hide'. In severe cases, the sufferer may become confined to his or her home, experiencing difficulty traveling from this "safe place." Definition: Agoraphobia is a condition where the sufferer becomes anxious in environments that are unfamiliar or where he or she perceives that they have little control. Triggers for this anxiety may include wide open spaces, crowds (social anxiety), or traveling (even short distances). Agoraphobia is often, but not always, compounded by a fear of social embarrassment, as the agoraphobic fears the onset of a panic attack and appearing distraught in public. This is also sometimes called 'Social Agoraphobia' which may be a type of social anxiety disorder also sometimes called social phobia. Not all agoraphobia is social in nature, however. Some agoraphobics have a fear of open spaces. Agoraphobia is also a defined as "a fear, sometimes terrifying, by those who have experienced one or more panic attacks." In these cases, the sufferer is fearful of a particular place because they have experienced a panic attack at the same location in a previous time. Fearing the onset of another panic attack, the sufferer is fearful or even avoids the location. The sufferer is now considered to suffer from Agoraphobia. The sufferer can sometimes go to great lengths to avoid the locations where they have experienced the onset of a panic attack. Agoraphobia, as described in this manner, is actually a symptom professionals check for when making a diagnosis of panic disorder. Other syndromes like obsessive compulsive disorder or post traumatic stress disorder can also cause agoraphobia, basically any irrational fear that keeps one from going outside can cause the syndrome. Gender differences: Agoraphobia occurs about twice as commonly among women as it does in men. The gender difference may be attributable to social-cultural factors that encourage, or permit, the greater

2 expression of avoidant coping strategies by women. Other theories include the ideas that women are more likely to seek help and therefore be diagnosed, that men are more likely to abuse alcohol as a reaction to anxiety and be diagnosed as an alcoholic, and that traditional female sex roles encourage women to react to anxiety by engaging in dependent and helpless behaviors. Research results have not yet produced a single clear explanation as to the gender difference in agoraphobia. Causes and contributing factors: The causes of agoraphobia are currently unknown. It has been linked however to the presence of other anxiety disorders, a stressful environment or substance abuse. Chronic use of tranquilizers and sleeping pills such as benzodiazepines has been linked to causing agoraphobia. When benzodiazepine dependence has been treated and after a period of abstinence, agoraphobia symptoms gradually abate. Research has uncovered a linkage between agoraphobia and difficulties with spatial orientation. Individuals without agoraphobia are able to maintain balance by combining information from their vestibular system, their visual system and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse as in wide open spaces or overwhelming as in crowds. Likewise, they may be confused by sloping or irregular surfaces. Compared to controls, in virtual reality studies, agoraphobics on average show impaired processing of changing audiovisual data. Some scholars have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base. Recent empirical research has also linked attachment and spatial theories of agoraphobia. Spatial theory: In the social sciences there is a perceived clinical bias in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. One such approach links the development of agoraphobia with modernity. Diagnosis: Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder (American Psychiatric Association, 1998). Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur. In rare cases where agoraphobics do not meet the criteria used to diagnose Panic Disorder, the formal diagnosis of Agoraphobia Without History of Panic Disorder is used (Primary Agoraphobia). DSM-IV-TR diagnostic criteria: A) Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd, or standing in a line; being on a bridge; and traveling in a bus, train, or automobile. B) The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a panic attack or panic-like symptoms, or require the presence of a companion.

3 C) The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of fear of embarrassment), Specific Phobia (e.g., avoidance limited to a single situation like elevators), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives). Association with panic attacks: Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed. During a panic attack, is released in large amounts, triggering the body's natural fight-or-flight response. A panic attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes. Symptoms of a panic attack include palpitations, a rapid heartbeat, sweating, trembling, vomiting, dizziness, tightness in the throat and shortness of breath. Many patients report a fear of dying or of losing control of emotions and/or behavior. Treatments: Treatment options for agoraphobia and panic disorder are similar. Cognitive behavioral treatments: Exposure treatment can provide lasting relief to the majority of patients with panic disorder and agoraphobia. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.[23] Similarly, Systematic desensitization may also be used. Cognitive restructuring has also proved useful in treating agoraphobia. This treatment uses thought replacing with the goal of replacing one's irrational, counter-factual beliefs with more accurate and beneficial ones. Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic. Psychopharmaceutical treatments: Anti-depressant medications most commonly used to treat anxiety disorders are mainly in the SSRI (selective serotonin reuptake inhibitor) class and include sertraline, paroxetine and fluoxetine. Benzodiazepine tranquilizers, MAO inhibitors and tricyclic antidepressants are also commonly prescribed for treatment of agoraphobia. Alternative treatments: Eye movement desensitization and reprogramming (EMDR) has been studied as a possible treatment for agoraphobia, with poor results. As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma. Many people with anxiety disorders benefit from joining a self-help or support group (telephone conference call support groups or online support groups being of particular help for completely housebound individuals). Sharing problems and achievements with others as well as sharing various self-help tools are common activities in these groups. In particular stress management techniques and various kinds of meditation practices as well as visualization techniques can help people with anxiety disorders calm themselves and may enhance the effects of therapy. So can service to others which can distract from the self-absorption that tends to go with anxiety problems. There is also preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.

4 Behavioral Definitions for Individuals with Panic-Phobia or Agoraphobia Problems: Irrational fear of a particular object or situation that causes avoidance behaviors because it incites an anxiety response. Incapacitating panic symptoms causing concern about having additional attacks or behavioral modification to avoid attacks. Fear of being in an setting that client believes may cause strong anxiety symptoms, client avoids such locations. Avoids certain locations due to overwhelming anxiety or fear. Unrelenting fear despite awareness that the fear is irrational. Unable to travel due to overwhelming anxiety or fear. Panic symptoms that occur when presented with a specific stimulus. Uncomfortable on public places. Unable to leave home due to overwhelming stress Unable to complete normal routines due to fear or anxiety problem. Long Term Goals for Individuals with Panic-Phobia or Agoraphobia Problems: Decrease fear so that client can easily leave home and be comfortable in public environments. Be able to travel away from home through enclosed transportation. Decrease fear of the particular stimulus or situation that formerly caused immediate anxiety. Reduce intrusion in normal routines and eliminate distress from feared object or situation. Eliminate panic symptoms and the fear that they will recur. Short Term Goals for Individuals with Panic-Phobia or Agoraphobia Problems: Express phobic fear and focus on recounting the precise stimuli for it. Develop examples of circumstances that cause anxiety. Become capable in relaxation and breathing exercises. Recognize a non threatening, pleasant setting that can sponsor relaxation using guided imagery. Collaborate with systematic desensitization to the anxiety-activating stimulus. Experience in vivo desensitization to the stimulus. Come across the phobic stim ulus and omit feel ings of control, calmness, and comfort. Recognize symbolic signifi cance that the phobic stim ulus may have as a basis for fear. Express the separate realities of the irrationally feared object or situation and the emotionally painful experience from the past that has been evoked by the phobic stimulus. Share the feelings associ ated with past emotionally painful situation that is connected to the phobia. Acknowledge the cognitive beliefs and messages that mediate the anxiety re sponse. Express positive, healthy, and rational self-talk that Decreases fear and allows the behavioral encounter with avoided stimuli. Use behavioral and cog nitive strategies that Decrease or eliminate irrational anxi ety. Cooperate with an evalua tion by a physician for or ganic causes of symptoms and for psychotropic medi cation. Responsibly take prescribed psychotropic medication to alleviate phobic anxiety. Describe the history and nature of the panic symp toms. Recognize any secondary gain that accrues due to modifi cation of life related to panic. Express acknowledgement that panic symptoms do not bring on mental illness, loss of control over self, or heart attack. Rehearse positive self talk that comforts self of the aptitude to endure anxiety symptoms without grave consequences.

5 Use deep muscle relax ation and breathing exercises to stop panic symptoms. Strategies or Interventions for Individuals with Panic-Phobia or Agoraphobia Problems: Talk about and evaluate the pho bic anxiety, its intensity, and the triggering stimuli. Run a fear survey to further measure the extent and extensiveness of phobic responses. Guide and aid in developing a hierarchy of anxiety producing circumstances linked with the phobic response. Educate in progressive relaxation methods. Use biofeedback systems to assist relaxation skills. Coach in guided imagery for anxiety relief. Guide systematic desensitization procedures to lessen phobic response. Appoint and or escort client in a vivo desensitization contact with phobic stimulus. Evaluate and verbally support advancement toward overcoming anxiety. Clarify possible symbolic meaning of the phobia stimulus. Explain and distinguish between the irrational fear and past emotional pain. Strengthen insights into past emotional pain and present anxiety. Recognize the erroneous schemes and related automatic thoughts that set off anxiety response. Teach in modifying core schemes using cognitive reformation techniques. Copyright 2011 THERAPYTOOLS.US All rights reserved