Facing the fear of Agoraphobia - 'Lucy's story'

Little did 'Lucy' know, four years ago, that she suffered from a little-researched personality disorder, listed in the DSM Guide as 'agoraphobia without panic'. Her 'wake-up call' was when someone independent to her observed, identified and externalised her sense of panic. It was a shock for her to be told that she 'looked terrified'. But in time, this observation helped her come to terms with her unknown internal struggle with panic and anxiety.

Lucy sought personal counselling and was offered time to explore her phobia and its origins. 'Finding self-awareness' during the counselling process, was a huge 'growing edge', as was working on her defence mechanisms. She frequently used her sense of humour to deflect her fear and relied on behaviours of avoidance.

Every month Lucy attended a residential training course, three hours away from home, her 'secure base'. She was determined to 'face the monster' of agoraphobia and this demanded that she would have to leave home without her 'safe attachment figure'. The worst part of the phobia at this time was the dread of what was to come. The week before her journey became a huge 'psyching-up' exercise' for Lucy, like a boxer preparing for a match. It became essential for her to plan journeys in detail. Coping requirements for the trip meant finding security in routine, the same sandwiches, books and checklists etc.

The train, its sight and sound, the squeak of the rails became a trigger symptomatic of the fear itself. Different coping-mechanisms were found to help. Texts from friends reassured her, listening to music became a welcome distraction, journaling helped her to understand herself. As with all suffering from agoraphobic symptoms, Lucy became extremely socially-conscious of herself and suddenly her surroundings seemed to really matter. Usual pleasurable activities such as reading were not possible, instead the words would dance crazily in front of her and she would be distracted by her inability to relax. Her heartbeat raced, her thoughts seemed to speed up, and an unusual and unexplainable 'cutting' fear radiated through her. 'Its an irrational fear' she explained to her counsellor. 'Is anything really irrational' her counsellor replied? Lucy began to realise that her symptoms were attached to traumatic memories, 'negative tapes' were playing in her head.

In those years she suffered from disassociation - removing herself from the intensity of the fear of the situation by 'floating up to the ceiling'. However the worse part of Lucy's 'residentials' was her frustrating sleeplessness. The hell of being too anxious to fall asleep was followed by the hell of coping with lethargy the next morning. Lucy learnt of the painful effects of the flight/fight panic system - the hyper-adrenaline response, producing an increase in urination and the heightening of arousal that caused her system to go into 'red alert'. The panic seemed to create more and more panic; the 'fear of the fear'. The fear didn't stop there. It seemed to attach itself to the experience. Even to smells; the lemon disinfectant and the brand of filter coffee used in the lecture room. In between training even seeing her colleagues on 'Facebook' was enough to rapidly bring the fear back and so fear started to invade her life. It did not obey her 'new thoughts' or the 'Socratic law'.

Lucy's breakthough came when she finally decided to embrace the fear. She thought to herself 'OK then, this is it in this moment, it may be terrible now but I will deal with it if it does happen in the future'. Eventually 'embracing the fear', rather than battling it finally provided her with a coping strategy that worked! However it wasn't 'in the bag'. Lucy like thousands of others in the UK are aware that it's all too easy to remain in a 'comfort zone'. That 'pushing oneself' needs to become part of life, in order to overcome and not to be held back and isolated. Empathising and understanding the enormity of trying to overcome this terrible anxiety disorder, is a key requirement for counsellors. It seems that people can learn to cope with agoraphobic symptoms but cannot 'rest on their laurels' for too long. Agoraphobia is a disorder that takes an extreme amount of courage to battle. But as experts believe 'facing the fear', learning to experience the fear, is the crucial element.

Therapy may involve taking clients on a 'desensitisation' experience within the counselling room. Here traumatic thoughts, feelings and somatic sensations are explored, before the more fearful practice of 'in vivo' exposure is slowly developed. This process is a useful way of understanding the particulars of client's fear; exploring painful or traumatic memories and developing coping mechanisms.

'In vivo exposure' is prepared for in advance. Behavioural goals timetables offer the clients a structured way to progress. Firstly a client may have the challenge of facing a little fear, by merely going outside for a minute or two. The exercise is gradually increased and goals are explored to find where the client wishes to progress, which creates an incentive. At the next counselling session experiences are discussed and new goals developed. Often the phobia is an experience in conjunction with other phobias such as separation anxiety and social phobia and PTSD.

Using CBT techniques one can target the distortions and roots of feeling inadequate or self-conscious thoughts and emotions. Creative methods such as 'drawing the fear' are also key. A client may choose to draw their 'guardian angel' and use this method to cope. Another may use a bible verse as 'a mantra'. Another clings to her phone for protection.

Psychoeducation, helps the sufferer understand the disorder - to take the power out of the negative experience. Agoraphobia is mainly experienced by women, and is a symptomatic of varying childhood patterns, such as relational dependency; an enmeshed attachment style; the experience of being a child of a single dependant parent. Agoraphobia is a disorder that sadly may in future may become more common and it is crucial that counsellors and psychotherapists become more aware of how to treat it.