395: Overcoming Agoraphobia, Common Exposure Mistakes, Amygdala Reactivity, and More

Hello, friends!   In today’s episode, we tackle a profound listener question that may resonate with many of you.   A listener struggling with agoraphobia seeks guidance on overcoming their anxiety and finding motivation to pursue exposure exercises. They’ve been working with a therapist and taking anxiety medication but feel stuck. We explore the complexities of agoraphobia, the importance of prolonged exposure, and strategies for building motivation and support.   As always, you can send me questions to duffthepsych@gmail.com and find the full show notes for this episode at http://duffthepsych.com/episode395

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Question:

“Hi Dr duff,

I’ve written in before and you’ve been so helpful. I have a question about my agoraphobia. I’ve been agoraphobic for about 4 years now. I do not leave the house except for an infusion at the Dr every 4 weeks (I have MS) which lasts about 2 hours. I’ve been doing this for about 10 years (I’m 39) and able to do it. As far as leaving the house otherwise, I can ride in the car (don’t drive anymore, I get too anxious) and I can walk outside to get my mail alone. My question is… I’ve been working on this problem for the last 3 years. I’m in therapy, I’m on anxiety meds (been through many of them with no help) and I see a psychiatrist. I have tried to go into a store a few times but I panic and run out. My therapist wants me to get to the door, then leave. Then go a little further, maybe inside, then leave etc. But I am just too embarassed when people see me do this. I really thought my one med, xanax, would help me at least go for a walk or to my mom’s house or my primary dr for a visit. But I just can’t seem to do it. Is there anything else I can do? My therapist is great, it’s more me that’s the problem, not doing my “homework” or maybe not trying hard enough as I used to. I feel like I’ve become too comfortable with my agoraphobia.  Is that a thing? I’m embarassed to say that.  How can I get motivated again? I’ve been with my boyfriend for 13 years and he basically takes care of me, and doesn’t push me. But he does praise me when I get the mail or go for a car ride. I feel horrible that I’m this way, I was not this way before, I developed a lesion on my amigula?spelling? Or near it? And became anxious overnight and it has gotten horribly worse since it started and had an MRI. Is there any hope for my anxiety since it’s because of something physical? Do you think I can still get better- and if so, any advice would be appreciated. Thanks so much. Love your show!”

Response:

Overcoming Agoraphobia: A Path to Recovery
Agoraphobia, an anxiety disorder, involves fear of being in places or situations where escape might be difficult or embarrassing, or where help might not be available in the event of a panic attack. This can lead to avoidance of crowded or enclosed spaces, and even wide open spaces. Agoraphobia can develop for various reasons, including panic attacks, physical issues, or traumatic events.
Your Struggle with Agoraphobia
You’ve been experiencing agoraphobia for about four years, and it’s significantly impacted your life. You’re limited to leaving the house only for a monthly infusion for your MS treatment, getting the mail alone, or riding in a car with someone else. You’ve been working on this problem for three years, and despite therapy and anxiety medication, you’re struggling to make progress.
The Error in Your Current Approach
Your therapist’s approach, such as going to the door and touching it, then leaving, can actually make your anxiety worse. This is because you’re building up the anxiety in your mind, and then reinforcing the idea that there’s danger by leaving immediately. Exposure sessions for agoraphobia should be prolonged, around 30 minutes, to allow your body to work through the anxiety and prove to yourself that the danger isn’t real.
A Better Approach
  1. Start small: Identify a manageable goal, around a 6/10 in terms of discomfort, and gradually increase the duration and frequency of your exposure exercises.
  2. Prolonged exposure: Spend 20-30 minutes in the exposure exercise, allowing your body to go through the natural progression of anxiety.
  3. Frequency: Do the exposure exercise as often as possible, ideally every day, to make progress.
  4. Coping skills: Develop self-regulating strategies for your anxiety to endure a moderate amount of anxiety without fleeing.
  5. Medical aspect: Address the physical aspect of your condition, including relaxation techniques, meditation, physical activity, and neurofeedback to decrease the reactivity of your amygdala.
Motivation and Support
  • Don’t blame yourself for your agoraphobia; it’s a disorder that can be challenging to overcome.
  • Find a therapist who specializes in anxiety disorders like agoraphobia.
  • Share your plan with your boyfriend and ask for his support in encouraging you to pursue your exposure goals.
Remember
There is hope for overcoming agoraphobia. With a different approach and commitment, you can make progress and regain freedom in your life. Don’t give up!

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