How can you overcome street fear? What is the best treatment to deal with street anxiety? Agoraphobia or street fear is an unreasonable, irrational fear of public spaces. They avoid places or situations in which agoraphobics feel anxious in order to prevent a panic attack. Agoraphobia is often accompanied by panic attacks. Symptoms include: shortness of breath or choking – gasping for breath; palpitations, pounding heart, abnormally fast heartbeats chest pain.
Treatment of agoraphobia or fear of the street
- Seeking help for street anxiety
- Behavioral therapy for agoraphobia, street fear or agoraphobia
- An exposure treatment for agoraphobia, street fear or agoraphobia
- Cognitive therapy for agoraphobia, street fear or agoraphobia
- Relationship therapy for agoraphobia, street fear or agoraphobia
- A case
- Systemic therapy for agoraphobia, street fear or agoraphobia
Seeking help for street anxiety
Because agoraphobics increasingly avoid places and situations, this has drastic and far-reaching consequences for the social life, work and relationships of agoraphobics. Sooner or later, an agoraphobic will seek professional help to overcome his fear of the street. There are several options to treat agoraphobia. The most effective treatment is cognitive behavioral therapy. The different forms of therapy are treated separately.
Fear / Source: Istock.com/bahados
Behavioral therapy for agoraphobia, street fear or agoraphobia
Behavioral therapy is a form of treatment based on learning theory. The central idea is that all behavior is learned and can therefore be unlearned. Behavioral therapists aim to unlearn obstructive and undesirable behavior and to learn new behavior in its place, so that the agoraphobic can function in a desired manner. Fear and pleasant experiences and feelings are mutually exclusive. By now learning that pleasant experiences and moods can replace feelings of fear, one can get rid of a phobia.
Different types of interventions
Behavioral therapists use various methods. In the next paragraph I will discuss exposure treatment for agoraphobia, because the effectiveness of the treatment ‘exposure in vivo’ has been convincingly demonstrated. Exposure in vivo literally means: exposing yourself to the situation you are afraid of. It is the most proven method in the treatment of agoraphobia (Emmelkamp et al, 1989). This treatment is often combined with an antidepressant. However, other researchers believe that there is no evidence that there is a stand-alone treatment that is superior to other stand-alone interventions. Nevertheless, the combination of an antidepressant with exposure in vivo appears to be more effective than other standalone or combined treatments. In particular, it brings about a greater reduction in avoidance behavior.(*) Ideally, this treatment is combined with cognitive interventions (cognitive behavioral therapy), since thoughts determine our behavior.
An exposure treatment for agoraphobia, street fear or agoraphobia
This treatment starts after an inventory phase in which a so-called function analysis has been drawn up. This analysis gives the therapist insight into the possible cause of the complaints, but above all how the agoraphobic has dealt with them so far. This is often done using questionnaires. The procedure that is then followed has the following elements:
- explaining the method to the agoraphobic;
- establishing a fear hierarchy; and
- carrying out and discussing exposure assignments.
- The therapist explains the treatment to ensure maximum use of the agorabobicus. It will be emphasized that a lot will be expected of the agoraphobic and that his responsiveness and self-motivation largely determine the effect of the treatment. The agoraphobic will have to get to work. The therapist is a kind of coach.
2. Establishing a fear hierarchy . Here a list is drawn up of fearful situations ranging from little to very fearful. This list is the starting point of the treatment. The level of anxiety should only increase very gradually, because if the steps are too large, the therapy may fail.
3. Carrying out and discussing exposure assignments. The idea is that the agoraphobic spends one or two hours a day carrying out the assignment(s), so that the fear gradually fades away and new behavior can take its place. Through the exercises, the agoraphobic learns step by step to confront the situations he is afraid of. Whenever he has overcome his fear in a certain situation, a more difficult situation follows from the fear hierarchy. For example, someone who does not dare to travel independently by public transport will first be instructed to go to the station. The first time the therapist comes along and the next time the agoraphobic goes on his own. He continues to practice this until he experiences that nothing terrible happens when he is there. He is then assigned to travel a short distance by train and the assignments are increasingly extended until he can travel independently and without fear by public transport.
Cognitive therapy for agoraphobia, street fear or agoraphobia
It is not the situation that gets people into trouble, but the way we interpret it. Thoughts drive our behavior. Because the agoraphobic interprets the physical symptoms he experiences in a particular situation, the fear of losing control, going crazy or having a heart attack and the possible accompanying panic attack are triggered. It starts with the agoraphobic perceiving a certain situation as threatening, which provokes fear. The fear he feels causes him to overbreathe, causing the CO2 level in the blood to drop and the pH value to rise. The acidity drops and as a result all kinds of physical symptoms occur that the agoraphobic interprets as dangerous and catastrophic. He panics and the circle is closed when the panic again triggers physical fear reactions, which are again misinterpreted.
Irrational thoughts change
By replacing these incorrect, catastrophic and irrational thoughts with rational thoughts, the behavior of the agoraphobic will change accordingly. Cognitive therapy teaches the agoraphobic to change thoughts that underlie his anxiety, panic attacks and avoidance behavior into rational thoughts that enable him to function normally. It begins with him learning that the physical sensations he perceives do not indicate a dangerous illness or other catastrophe but are harmless and that his feeling of panic is entirely the result of an incorrect interpretation of the physical symptoms associated with the panic attacks .
Learning rational thoughts
The main goal of cognitive treatment is to teach non-catastrophic thoughts or cognitions. The point is that the agoraphobic will interpret the triggers of his anxiety and possible panic attacks differently. Keeping a diary can be a tool in identifying irrational thoughts and reinterpreting them. In therapy, irrational thoughts are challenged by the therapist and the agoraphobic is taught to counter them with correct thoughts.
Relationship therapy for agoraphobia, street fear or agoraphobia
In a large number of agoraphobics, it appears that other treatments must follow the above therapy, in which the agoraphobia is tackled with or without panic. It often happens that agoraphobics are recommended to undergo therapy together with their partner, when the way of interacting with each other maintains the phobia and is even functional as a form of behavior for the relationship. The problems that the agoraphobic faces because of his phobia are seen as one of the pillars on which the relationship rests. If these problems become less or disappear because the agoraphobic has entered therapy, then one of the pillars of support will also disappear and the relationship will literally become crooked. Both the agoraphobic and his partner will then have to make an effort to restore balance in the relationship and that will probably mean that another problem will replace the phobia, which we can call symptom behavior. It often happens that when one person’s difficulties diminish, the other person starts to have problems and is even able to undermine and oppose the therapy he initially supported.
breeding ground
Relationship therapy will mainly focus on the way in which both partners interact. We will look for the benefit that the phobia provides for both partners in the relationship. They can unwittingly maintain a system that is the breeding ground for a phobia. They will have to change certain relational aspects of their relationship in order for the phobia to disappear permanently.
A case
Giving an example. Jealousy and dependency can play a role in a relationship where, for example, the woman has agoraphobia. On the one hand, it suits her, because because of her dependent behavior, not being able to go shopping, not being able to go out, not being able to take initiatives, she, in this example, binds her partner to her. He can’t let her down, because she has that disease; she can’t do anything about that either. On the other hand, it suits him that she does not have the opportunity to come into contact with other people, because she would then be able to give him less time and attention. He will receive all the attention there is to give.
When this woman goes into therapy alone and slowly learns to accept her fear and go out into the street, it is quite possible that her untreated partner will become jealous and resist the therapy in order to get the same amount of attention. For example, he may have problems himself or become ill, making it clear that he needs her and she no longer has time to socialize outside the home. If both partners were to enter couples therapy, their jealousy, based on uncertainty about each other’s feelings, would be addressed and a different, more direct way to deal with those feelings could be learned.
Systemic therapy for agoraphobia, street fear or agoraphobia
An entire family can be recommended to undergo therapy together if all members of the family cooperate in maintaining the phobia of one of the family members, which has thus become the carrier of the family problem.
Note:
(*) Bakker, A.: Recent developments in the treatment of panic disorder and agoraphobia; journal of psychiatry 43 (2001) 6, 385-394.
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