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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Phillipa on February 26, 2007, at 12:04:17
What is the best treatment for agoraphobia. Are you allowed to stay home one day or do you have to force yourelf to go out daily as I was told? Thanks Phillipa
Posted by Quintal on February 26, 2007, at 12:04:17
In reply to Best Treatment For Agoraphobia, posted by Phillipa on February 25, 2007, at 15:23:52
Phillipa, when did you start to become agoraphobic?
Q
Posted by Declan on February 26, 2007, at 12:04:17
In reply to Re: Best Treatment For Agoraphobia, posted by Quintal on February 25, 2007, at 15:45:06
Since benzos are both the cause and the cure (not neccessarily in that order) of agoraphobia, what should you do, PJ?
I'd be very interested to know.
Posted by Larry Hoover on February 26, 2007, at 12:04:17
In reply to Best Treatment For Agoraphobia, posted by Phillipa on February 25, 2007, at 15:23:52
> What is the best treatment for agoraphobia. Are you allowed to stay home one day or do you have to force yourelf to go out daily as I was told? Thanks Phillipa
IMHO, the best treatment is desensitization, i.e. a gradual challenge of the threshold that induces the phobic reaction. That threshold is not fixed, but can be pushed back, until it no longer restricts normal functioning.
I think the key is in mindfulness. You need to know what you can handle, and always keep one foot in the comfort zone, as you extend the other into the challenging zone. Try to do more and more, but it's not like you're going to blow everything if you take a day of "rest". You can still walk in your yard, or go sit in your car. There are safe places outside the home.
Lar
Posted by Phillipa on February 26, 2007, at 12:04:18
In reply to Re: Best Treatment For Agoraphobia » Phillipa, posted by Larry Hoover on February 25, 2007, at 16:15:08
My agoraphobia is the type where I have to leave the house but not alone. And go some where there is people but not interract with them except for small talk. In the house I won't go upstairs don't know why afraid. And can't take a bath in the tub as when I met Greg he said too much water. I need to be with someone in the house afraid of being alone. This has been going on for the years my thyroid started when I stopped working. Afraid to volunteer fear being trapped. I need to be able to get out. Love Phillipa
Posted by bassman on February 26, 2007, at 12:04:18
In reply to Re: Best Treatment For Agoraphobia, posted by Phillipa on February 25, 2007, at 16:54:27
I was in the same place...I sometimes would have to summon all my courage to cross the room. I've found that desensitization, benzos alone, and CBT are pretty useless-the only thing that worked for me was an AD (you liked Paxil, too, I remember :>) with Xanax-and when it did work, all the fears went away-they just disappeared. So I'm a firm believer that it is the AD that runs the show in terms of being functional-at least, that is the way it is for me. Best of luck-agoraphobia is SO devastating in terms of what you can do and your self-confidence.
bassman
Posted by Phillipa on February 26, 2007, at 12:04:18
In reply to Re: Best Treatment For Agoraphobia, posted by bassman on February 25, 2007, at 19:40:13
Thanks bassman wish you'd babble me sometime. I do see my old pdoc this week may ask for low dose paxil again. Love Phillipa
Posted by FredPotter on February 26, 2007, at 12:04:18
In reply to Best Treatment For Agoraphobia, posted by Phillipa on February 25, 2007, at 15:23:52
Phillipa Although I was very dubious, I sent for PanicAway
and the basic trick, which could have been written in 2 pages, worked for me, to the extent that I travelled alone from New Zealand to LA, Montreal (where I presented a paper) and England and Wales, all unassisted by alcohol, although I had my Xanax with me just in case. The trick is a bit Claire Weekes-ish, but for situational anxiety it gave me a new lease of Life, to put it mildly. For other kinds of anxiety, of which there are many, it didn't work for me at all though.
I feel nervous about pasting the relevant chunk on the board. What do you think? Should I? I might have to reword it or he might sue me.
Fred
Posted by FredPotter on February 26, 2007, at 12:04:18
In reply to Re: Best Treatment For Agoraphobia, posted by Declan on February 25, 2007, at 15:50:44
Declan I don't understand how benzos are the cause of Agphobia
Posted by FredPotter on February 26, 2007, at 12:04:18
In reply to Re: Best Treatment For Agoraphobia, posted by Declan on February 25, 2007, at 15:50:44
Declan wrote >Since benzos are both the cause and the cure
Is it the way of it that what you've just uttered is the veriest gobshite (far from us be the Evil Thing!)? More specifically, do you mean we start with agoraphobia, then take Xanax, then "enjoy X so much" we look forward to our next attack so we can use it? I do not think its likes will be there again ( and other random Flann O'Brien quotes
Fred
Posted by valene on February 26, 2007, at 12:04:18
In reply to Re: Best Treatment For Agoraphobia, posted by Declan on February 25, 2007, at 15:50:44
Yes Declan, you are correct. Benzos can be the cure and ultimately the cause of agoraphobia. I know this from reading many many accounts of people who took benzos for years, became tolerant and went through tolerance w/d symptoms, which can manifest themselves as the very symptoms for which you first were prescribed a benzo in the first place!
I struggle with it sometimes myself and have been on a benzo for 25 years . I still have some difficulty with feeling more anxious in the mornings, not wanting to go out but do anyway. I never had this before I went on benzos. Yes I still take them at a reduced dosage but wish I never started on them to begin with as now I will be on a low dose possibly the rest of my life. Such is the problem for many people with long-term benzo use.
Val
Posted by gardenergirl on February 26, 2007, at 12:04:18
In reply to Best Treatment For Agoraphobia, posted by Phillipa on February 25, 2007, at 15:23:52
> What is the best treatment for agoraphobia. Are you allowed to stay home one day or do you have to force yourelf to go out daily as I was told? Thanks Phillipa
That sounds like part of the CBT treatment I think I've mentioned before. It would involve "in vivo exposure", which means facing that which you fear in real life situations; using relaxation and self-talk strategies to cope with the fear, and response prevention, which is essentially staying with the fear situation until the anxiety passes. Some therapists will do the in vivo practice with you, others will assign it to you to do outside of sessions. That's the behavioral part. The cognitive part involves working on the thoughts and beliefs you have that contribute to anxiety and then countering them.
During therapy sessions, you might work on imaginal exposure, where you construct an example of a fear situation with as much detail as possible, and then you visualize that, putting yourself into it as much as you can. When you begin to feel anxious, you stop and apply your relaxation and self-soothing skills until it passes. Then you continue. This is done in a graded way, starting with the easiest and working to the most fearful.
There are different intensities to this kind of work. Going slower can be helpful if a person is especially fearful, if there are safety issues involved (i.e. driving while having a panic attack), other issues such as dependent or other personality traits which contribute to the situation, etc. But, it takes a lot longer to go slow or to have fewer practice sessions. The other end is flooding, the most intensive approach. With flooding, you face the worst fear and just have to stay with it til you "survive" it, til the anxiety and fear pass. You would be prevented from fleeing or otherwise doing something to end the exposure prematurely. I suppose taking medication might also be a response that would be prevented. This often has dramatic and fast results, but it's really difficult. Most therapists would fall somewhere in between in how they treat this.
Daily outings are consistent with daily practice of skills you are trying to learn. If you were to take a day or more off, it interferes with progress. I think if the T said just to go out everyday, he or she is not giving you enough instruction and perhaps not putting much thought into applying this intervention. If you're not doing flooding, then you would need to construct a hierarchy of anxious events, from least to most anxiety provoking. You would start from the least and work your way up to the most. That might not seem as scary or burdensome to practice everyday, especially if you are experiencing progress as you tackle progressively harder situations.
You can find out more about this type of treatment, which is considered to be the "best practice" for agoraphobia in "The Agoraphobia Workbook: A Comprehensive Program to End Your Fear of Symptom Attacks".
I really encourage you to give this a shot, Phillipa. I've seen it work, and there's a lot of empirical support for this approach.
namaste
gg
Posted by Phillipa on February 26, 2007, at 12:19:27
In reply to Best Treatment For Agoraphobia, posted by Phillipa on February 25, 2007, at 15:23:52
Thanks gg this is psychology right? Love Phillipa
Posted by Phillipa on February 26, 2007, at 12:22:06
In reply to Re: Best Treatment For Agoraphobia » Phillipa, posted by Phillipa on February 26, 2007, at 12:19:27
Help I'm scared as I've built a tolerance to benzos too and can't find a pdoc here Two referrals failed already. Any suggestions please? Love Phillipa
Posted by scentedgarden on February 26, 2007, at 13:26:07
In reply to Re: Best Treatment For Agoraphobia, posted by Phillipa on February 26, 2007, at 12:22:06
sori to appear dumbo here, but plz , whats pdoc?
ive seen this word so much on bable boards and have not heard of it in the uk... what is it plz?
thanks anyone who ansa's me!! ive been meaning to ask on here for ages now...
regards
scented garden
Posted by FredPotter on February 26, 2007, at 14:32:10
In reply to Re: Best Treatment For Agoraphobia » Phillipa, posted by scentedgarden on February 26, 2007, at 13:26:07
Psychiatrist - but what's "plz" and "ansa"?
Posted by Phillipa on February 26, 2007, at 14:47:44
In reply to Re: Best Treatment For Agoraphobia » Phillipa, posted by scentedgarden on February 26, 2007, at 13:26:07
Think plz is please and ansa strange but guessing answer? Love Phillipa
Posted by Declan on February 26, 2007, at 18:46:05
In reply to Re: Best Treatment For Agoraphobia » Declan, posted by valene on February 26, 2007, at 9:04:51
I speak from experience.
I sure as hell don't have a fixed position or anything.There have been studies.
Benzo dependant agoraphobes generally lose their agoraphobia when the benzo is successfully withdrawn.
Needless to say this isn't easy or pleasant.I don't want to spark another of these benzo wars.
Posted by Declan on February 26, 2007, at 18:51:37
In reply to Re: Best Treatment For Agoraphobia » Declan, posted by FredPotter on February 26, 2007, at 5:51:45
No Fred, what I meant was this.
That in at least a percentage of people, long term benzo use seems to aggravate fears relating to interaction with others.
At the same time benzos clearly are useful in relieving those fears.It's called being between a rock and a hard place.
I'm not against benzo use at all, but I wouldn't recommend them to someone who hasn't tried them.
I wouldn't recommend western medicine at all, not for what I had.
Posted by Phillipa on February 26, 2007, at 19:41:16
In reply to Re: Best Treatment For Agoraphobia » Phillipa, posted by scentedgarden on February 26, 2007, at 13:26:07
Sorry I misunderstood your question pdoc is psychiatrist. Love Phillipa
Posted by canadagirl on February 27, 2007, at 17:04:57
In reply to Best Treatment For Agoraphobia, posted by Phillipa on February 25, 2007, at 15:23:52
I think it can be a very difficult challenge to have. I know several people who have had it and they have done quite well over time. I think the key is, taking it one step at a time and doing a little at a time. My friend's mother was literally in the house for many years, this year she got out and actually got baptized in a church, in the water and everything. Really amazing and wonderful progress. Don't give up.
Posted by FredPotter on February 28, 2007, at 21:08:43
In reply to Thankyou » valene, posted by Declan on February 26, 2007, at 18:46:05
when I was in hospital a nurse who didn't know anything explained to me about paradoxical anxiety when taking benzos. I protested but they took me off Xanax immediately, with valium for about a day. I ended up having a seizure, although I was drying out as well at the time
This is the end of the thread.
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