Anxiety Disorders and Panic Attacks Self Help Program

Definition of agoraphobia
The term agoraphobia is made up of two Greek words f?ß?? (pron. fovos fear) and a???? (pron. agora marketplace). People who have any level of agoraphobia tend to feel anxious and fearful in situations like the marketplace - crowded places such as the Mall, or a football game, a concert, the movies, or even queuing up at the supermarket. Interestingly however, people who have agoraphobia can feel anything from mild uneasiness through to panic and terror, in places that are not crowded: someone with agoraphobia can also feel fear in wide open spaces. Whether in a crowded theatre or a wide open space the place has one element in common.

In all those places and situations, the person feels afraid and unsafe.

In all those places and situations, the person has had a panic attack and now fears that s/he will have another one.

The Panic Cycle
For one of the best, clearest and most precise explanations about how fear of another episode of panic can actually bring on the very thing feared, please visit Dr R Reid Wilson's excellent site: Anxieties.com On the home page of my website, and in my e-kit Calming Words, I recommend his book Facing Panic: Self-Help for People with Panic Attacks. Click here to order → Facing Panic from the Anxiety Disorder Association of America (ADAA) for only $15US. And no, I don't receive money for that recommendation, I make it because it is such a well-written and easy-to-follow book. If you can't afford that investment, please ask your local library to get it in for you - if they haven't already got a copy on their shelves. It will be part of your recovery to understand how your anticipatory anxiety (thinking and anticipating the next attack) works to guarantee that you'll have an episode of panic.

Agoraphobia is the end result of a person having such a strong fear of those situations and a fear of feeling so terrified, that they avoid places and situations in which they think it's likely that they'll panic.

How does agoraphobia develop?
Like any set of emotional responses, agoraphobia develops in a unique way in each person. However, there are some general characteristics of its development. First, is what we call the phobic trigger that is, the event or situation in which a person first feels overwhelming fear symptoms. In turn, those feelings of fear usually appear out-of-the-blue. That is, there is nothing intrinsic to the event or place that suggests it is to be feared.

As with any phobia, your day-to-day experience of agoraphobia may be what we could term mild. That is, you feel a little bit uneasy and you don't like feeling uneasy, but you can travel to and from school, University or work. If you're a full-time parent, you can get your children to and from any place they need to be and you feel generally quite relaxed in the groups in which you move. In each case, you might feel anxiety if you have to speak at a meeting at work, study or the local kindergarten. You might feel a little fluttering of fear but you can cope with it. For now.

Panic attack at the Mall
Let's illustrate by using an example. Lyn felt her first feelings of overwhelming fear when she was out shopping in the local Mall. She was with friends from High School with whom she regularly went to the Mall. In fact, it was something Lyn really enjoyed. On that particular occasion, she suddenly felt a bit queasy in the tummy, almost as if she was going to vomit. Then she realised that her pulse was racing and her heart seemed to be racing. She immediately felt quite faint and thought she might even pass out. Naturally, she felt threatened and very afraid of all those feelings. She didn't want to draw too much attention to herself but she had to tell Louise and Brandy her two closest friends that she felt somehow just plain 'weird'. They took her home and by the time she reached her front door, she felt so well that she didn't even want to tell her parents about it. All of those physical symptoms Lyn had felt at the Mall could be caused by a physical illness, so her mother took her to their wonderful GP who ran some tests and ordered other tests. The GP ruled out emphysema, heart problems and a brain tumour. Lyn and her family were relieved that the attack at the Mall was just one of those strange events but nothing to worry about.

Until the very next time Lyn went to the Mall.

She was barely out of the first shop when again she started feeling the same cavalcade of symptoms. The overriding one was fear. The second time it happened Lyn could much more readily focus on the fact that above all else, she simply felt too afraid to stay with her friends at the Mall. This time around however, she didn't want them to see that she was having what she called in her head 'an attack of the weirdness'. So, she pretended she'd forgotten an appointment, went to the car park and drove home.

Lyn noticed that as soon as she started to go towards her car which would take her home, her pulse seemed to slow down, the sweating eased and she felt less fear.

To make this long story short, Lyn stopped going to the Mall after a few more similar episodes. In fact, she started to anticipate feeling terrified in the Mall and guess what? That's how she felt as soon as the automatic doors at the Mall entrance opened.

Pretty soon, Lyn noticed that she felt a similar level and type of fear-filled symptoms if she went to the movies with friends and she had to sit in the middle of the row. She seemed OK if she could make sure that her seat was on the aisle. She felt even better if her aisle seat was near the EXIT.

Sometimes at the Mall she was less worried about the passing out than she was about other symptoms which sometimes accompanied her attacks if they got too intense. At those times, she could literally feel the terror stabbing her stomach area and pretty soon she'd developed one of the main symptoms of fear recorded among soldiers in World War 1 - nervous diarrhoea. Those poor men in the trenches had very good reason to feel such terror witnessing as they did the slaughter of their comrades. Poor Lyn couldn't figure out why she felt as she did, she just knew that at times she was so afraid that she developed diarrhoea. Naturally, she wanted to make sure that none of the symptoms caused by the fear were made manifest. It's interesting isn't it how we describe being afraid? We often talk about 'shitting myself' or 'I nearly filled my pants'. It's a perfectly normal physical reaction to too much adrenaline coursing through the system. Just that with Lyn, she had no good reason to feel such fear. Lyn made sure she knew where all the public bathrooms were in the Mall and in each shop within it, but even so, she still felt dreadfully afraid to the point where she simply stopped going to the Mall with friends. When she went on her own she felt a bit better. Then she felt she could leave without any embarrassing explanations.

The Mall and the movie theatre were the start of a growing list of places in which Lyn felt so incredibly uncomfortable that she thought she would just pass out with terror. Those situations began to include things like going to lectures at College. Lyn and her friends had just started College and being extremely bright and conscientious, Lyn had managed to secure a place at Harvard where she would study Medicine. One semester into her course, she wanted to quit. Not because the subjects were too demanding: far from it. She wanted to leave because sitting in a crowded lecture theatre was a form of torture for her. If she felt uneasy or anxious or downright terrified during a lecture, she couldn't just get up and leave without everyone wondering why she was doing so.

All the places and situations had one thing in common. They seemed threatening to Lyn. They were places from which it was difficult to make a quick exit. Not impossible, but difficult in the sense of socially embarrassing and in the sense of having to admit to others that she was feeling terrified. Each was a place in which fear seemed to lurk to bring on the symptoms of panic and anxiety that Lyn first felt in the Mall. Allied to feeling as if there was something threatening about them, the places were not somewhere Lyn felt safe.

The good news for this scenario which I composed as an example from my extensive counselling experience is that Lyn did go back to her GP to talk about her symptoms. You see, the other key element is that Lyn did realise that there was nothing to fear in the lecture room or movie theatre. Therefore, she felt even more silly and weird that she was having such inappropriate feelings. Yes, initially she felt that her attacks were of a physical nature but once the extensive tests came back she understood and accepted that the racing pulse, dry mouth, nausea, diarrhoea were symptoms of unknown origin. Fortunately for Lyn, her GP was well-versed in emotional issues and she referred Lyn to a great counsellor. Also, the student counsellor at Harvard was a fantastic help.

Panic attacks versus agoraphobia
Just to be clear about the very thin line between having panic attacks and having agoraphobia, Lyn started to avoid the places in which she'd panicked. That's the key difference if you must draw a distinction between what is a fairly fluid descriptive labels of people's everchanging emotional reactions and behaviours. People who experience attacks or episodes of panic but who go on putting up with that do not then develop agoraphobia. They don't feel a phobic response to the event, place or situation. Hence they don't avoid it. I am not too concerned with clients about deciding whether or not they have agoraphobia at an early and mild level or whether they are merely experiencing panic attacks. For me, it is more important to focus on solutions to any feeling or behaviour that is limiting your joy in life than it is to label your feelings.

At one end of having agoraphobia a person might avoid going to concerts or s/he might not travel on crowded trains. That avoidant behaviour - making sure that you only travel in off-peak times, or that you only go to a concert when you can sit near the door and on the aisle - that behaviour is part of how many people cope with their agoraphobia. It remains at that almost manageable phase but it's always there in the background as a worry. At the other end of agoraphobia, a person might find every encounter outside the safe haven of her/his home to be a terrifying experience. In that instance, people avoid everything or almost everything in life.

Most of all, they avoid panic attacks. As a coping mechanism staying at home or having a highly restricted life can be an effective strategy against feeling terrified. It's simply not a great way to live and to enjoy life as the imaginative, creative, intelligent person that most people with agoraphobia are.

What is panic disorder?
I don't like the terms panic disorder or anxiety disorder. Each term implies a pathological and clinical malfunction when in both situations, they are inappropriate emotional responses to one's environment, not illnesses. People who feel intense anxiety or panic when no real and present danger exists can readily be taught to acknowledge the inappropriateness of their hyper-anxious response. My experience is that they can also easily be shown how to re-write those inappropriately anxious responses without being categorised as having an illness or dis-order. One of the other reasons I'm not keen on such labels is that they rarely describe accurately the way each individual feels and how they then react to those feelings. Quite often, people can move themselves quickly out of anxiety states but once labelled they almost become part of a self-fulfilling prophesy: "Oh, I have anxiety disorder, or generalised anxiety disorder, these are (or will be) my symptoms and this is how I will react." If they'd been treated as individuals they may have developed their own solutions much earlier.

Of course I acknowledge that people do need and want solutions to behaviours and emotional responses that are spoiling their lives. It's important to face the reality that 'anxiety' is not an illness like pneumonia which can be 'cured' in the sense of eliminated. A life without anxiety would not only be extremely boring, it would be downright dangerous. Anxiety is part of the emotion fear which in turn, is as legitimate a part of our human responses as any other emotion. Anxiety makes us study for exams, motivates us to get out of the way of oncoming cars and allows us to make sage decisions about how far out we should swim in heavy surf. Given that most of us experience at least a couple of episodes of an over-anxious response in our lives, especially when our adolescent children take up driving. It's much more useful to work towards solutions for each person rather than categorical and largely unhelpful labels about dis-orders.