One of the most frightening things you may find yourself experiencing is a panic attack and it is very difficult

to fully explain
how it feels unless you have experienced one. The very first panic attack often seems to come completely unexpectedly
and can even occur whilst you are doing something that you do every day like driving to work, shopping, walking the dog,
watching TV, cooking etc. Suddenly you are struck by a barrage of frightening and uncomfortable symptoms and you are
convinced that something terrible is going to happen to you there and then.
Courtesy erilyn !oss, ".#., $.%.C.S.&., The !oss Center for #nxiety and !elated 'isorders, %nc., &ashington, 'C.
#dapted from "athews et al. ()*(
If You Are having A Panic attack NOW
!emember that although your feelings and symptoms are very frightening they are not dangerous or harmful.
+nderstand that what you are experiencing is ,ust an exaggeration of your normal bodily reactions to stress.
'o not fight the feelings or try to wish them away. The more you are willing to face them, the less intense they will
become.
'o not add to your panic by thinking about what -might- happen. %f you find yourself asking -what if.- tell yourself
-so what/-.
Stay in the present. 0otice what is really happening to you as opposed to what you think might happen.
$abel your fear level from 1ero to ten and watch it go up and down. 0otice that it does not stay at a very high level
for more than a few seconds.
&hen you find yourself thinking about the fear, change your -what if- thinking. 2ocus on and carry out a simple and
manageable task such as counting backward from (33 by 45s or snapping arubber band on your wrist.
0otice that when you stop adding frightening thoughts to your fear, it begins to fade.
&hen the fear comes, expect and accept it. &ait and give it time to pass without running away from it.
6e proud of yourself for your progress thus far, and think about how good you will feel when you succeed this time.
General Information
7anic attacks can start for many reasons such as stress, overworking, bereavement, family, an accident, childbirth,
following surgery and so on but at the time panic strikes for the first time, you think you are doing fine and there seems to
be no apparent reason at all. %f you have subse8uent panic attacks, they too may seem to be unpredictable and random.
There is now emerging evidence that anxiety and panic may have a genetic link.
7eople that have never had a panic attack assume that that it is ,ust a feeling of nervousness or anxiety, but in reality the
attacks are far more frightening and overwhelming. %f nervousness is a 4 on a scale of (9(3, then a full blown panic attack is
((.
&hat often happens next is that you begin to associate the 7anic attack with the activity or place you were at the time so
you start to avoid that situation. This is where the problems begin as each time you are forced into the situation that caused
the attack, you automatically assume that it will happen again and start to re9live the feelings and this can lead to
agoraphobia and limiting of activities and leading a normal life.
7anic disorder can be frightening, disabling and frustrating, both to recover from and to live with someone suffering with it.
Often the sufferer will not go out as they say they 5know5 they are going to faint or 5have a heart attack5. See the -Symptoms-
section for explanations of these feelings and the reasons for them. 7lease read the -:elp yourself- section for some really
useful information on how to cope.
#s panic can strike very 8uickly, and often the trigger is not apparent, there is usually little warning that it is about to
happen. %t is not surprising therefore, that many sufferers avoid situations that they think or 5know5 might cause the panic
attacks to happen. This leads to fears of situations or places that last caused anxiety and so the sufferer avoids them at all
costs/ This is agoraphobia. The problem here is that it can take months, even years, to re9educate the individual that it is
their thoughts and assumptions that are to blame for these attacks and not the place at all but it still takes a long time to
return to such places.
;etting appropriate and 8uick medical help is not easy and the slide from anxiety to panic and then to agoraphobia can
progress 8uickly without intervention and support.
Talking from experience, % avoid public transport because of several incidents in taxis where % was terrified and therefore
starting associating any public transport with fear and panic. The problem then 5spread5 to include trains, buses and
eventually % was unable to get in the car with someone else driving. This is still a problem today. % do drive myself but the
problems do not stop there/
% was once told that if you 5sit out5 a panic attack to see how bad it can actually get, it will reach a point where it can5t get any
worse and you 5automatically5 start to calm down.
%f you suffer from severe anxiety or panic attacks, but don5t know it, you can end up going to numerous doctors and
#ccident < =mergency departments with a variety of symptoms and self diagnoses, only to be told that there is nothing
medically wrong with you and you are not given any help, information or solutions. This leads you to the conclusion that you
may have some terrible mysterious condition that could kill you one day and that the doctors aren5t managing to find it. &ith
each test and subse8uent treatment that is performed and is deemed normal, your conclusion is strengthened and your
fears >and panic attacks? get worse. This can lead to house9bound agoraphobia.
'on5t give up/ !ead the other sections on this site to learn and understand what is happening and how to access the help
you need.
What is Panic Disorder?
# panic disorder is diagnosed when a person has four or more panic attacks in one month, or one panic attack followed by
a month of fear of having another attack. 7anic disorder is the next step up from panic attacks and it is generally recognised
that it takes longer to recover once you are diagnosed as having panic disorder rather than with isolated panic attacks.
&hat are the long9term effects of the condition. %f a panic disorder is not effectively treated, a person may not be able to
function at work or at home. This can have a negative effect on relationships, education and other important parts of a
person5s life.
Understanding the prolem
The body has a natural 5fight or flight5 response to danger. &hen a person perceives some threat or danger, the autonomic
nervous system is stimulated. This helps a person escape from danger. 'uring a panic attack, the body5s automatic
nervous system is triggered for no apparent reason 9 a false alarm, but it feels so real.
Once you5ve got the diagnosis that you are suffering from panic attacks or panic disorder 9 what next.
%t is essential that you understand the diagnosis and its implications. The good news is that it is not terminal and there is a
way to recovery, but it may be a long uphill struggle and it could take years to recover. Ok, so this is the worst case
scenario but a realistic one and it would be naive to suggest that you are likely to recover in a few weeks. @es, people do
recover within a few weeks but then there are sufferers that take years to overcome all effects of panic. % have been
suffering since ())4, so % know that it is hard work.
The biggest problem for most people is that they are embarrassed by the illness >like % am? and they see it as some kind of
mental of psychiatric disorder or weakness that is not something you want to be telling people about. %f you can learn to
accept that the disorder stems from malfunctioning of the central nervous system receptors then you are well on your way
to recovery.
The rewards are well worth the effort but you "+ST be prepared to work at the problem and accept help.
&hen caught in its early stages, further >more complicated? conditions can be avoided, including depression, alcohol abuse
and agoraphobia, so it is essential that you and your doctor recognise the condition early on and start treatment
immediately.
:indsight is a wonderful thing and % suffered from panic attacks for nearly a year before the doctor officially diagnosed it and
then % could begin treatment. % first went to the doctor and explained all my symptoms and % was told -to eat more brown
bread-/ This may sound funny but each time % went back % was ,ust fobbed off and went away thinking that something must
be wrong because it wasn5t normal to feel the way % did.
Once % was aware of what % had to deal with, % began treatment but it was too late to control the panic attacks and % did go
on to suffer from panic disorder and agoraphobia.
!teps for sufferers to take
ST=7 O0= :ave a complete medical examination to see if there is any physical condition that could be causing your
symptoms. =xplain the symptoms to your doctor and ask him if he would do full blood tests 9 this will rule out anything such
as diabetes, thyroid problems etc. ;et your eyes tested as well to make sure your sight is not causing those worrying di11y
spells and headaches. %f necessary, ask to be referred to an ear specialist to make sure the di11iness is not caused by an
ear infection or something similar.
@ou could ask for an =.C.;. to make sure the pounding heart is 8uite normal.
'o not go to your doctor and demand all these tests, however, be advised by what he suggests and accept that he will give
you all the test he deems necessary.
@ou will not be able to start your recovery if you are still convinced that there is something physically wrong, so this step is
very important. There may be many more visits to the doctors each time a new physical symptom appears but a general
health check will allay a lot of the fear.
%f the doctor does find a physical condition that is causing the symptoms then you may find that once it is treated and
cleared up, the panic attacks will stop.
#bove all, if you are given a clean bill of health, you "+ST believe that panic attacks are not going to kill you and the
symptoms are ,ust temporary and will, in time and with some effort, recede and go away.
ST=7 T&O 0ot everyone develops panic attacks because they are stressed, tired, over9worked, anxious, worried, or even
after suffering traumatic life events. 7anic attacks have been known to run in families and can strike every walk of life.
Take a look at your personality to see if you have any high9anxiety personality traits that could be contributing to your
anxiety. @ou may need to seek the help of a therapist to work on these feelings.
% was once told that many sufferers of anxietyApanic tend to have low self9esteem and self9worth. &orking with a therapist to
increase the opinion they have of themselves can help reduce the panic and anxiety.
ST=7 T:!== Take a close look at your lifestyle and make changes that will help in the long9term. This could be something
as simple as watching your diet and trying to cut out different food groups to see if the symptoms are eased.
% stopped drinking tea, coffee and any soft drinks containing caffeine in September B333 and it has had a dramatic effect on
my panic attacks. % also tried cutting out all dairy products and found that this had no effect on the panic attacks so it was
reasonable to consider that they weren5t contributing in any way.
Seriously consider how much alcohol you are drinking. &rite down how many units you drink in a typical week and then
write down why you had a drink at a particular time. 'o you find that you are drinking to alleviate the symptoms of the panic
attacks. 'o you always reach for the bottle when you have had a bad day at work.
Take up exercise on a regular basis 9 walk up the stairs instead of taking the lift.
&hat about your ,ob. #re you bored, unhappy or so stressed at work that you are constantly running on adrenalin. &ould it
be so bad if you got a different ,ob that you en,oyed doing.
ST=7 2O+! $earn to live with the panic attacks but 0=V=! give in. %t could be a long struggle, but some people make
remarkably 8uick recoveries and never suffer attacks again. Others may suffer for years and never really make a full
recovery. #ccept that you are a panic attack sufferer and do everything you can to overcome it 9 do not allow it to rule you
life.
T#C= CO0T!O$ O2 @O+! $%2= TO'#@/
!pontaneous Panic " What is it? #o$ to deal $ith it?
Copyright 0otice
D !eproduced with kind permission of 50o 7anic5. 7lease do not copy this article without their prior permission
6y 7rofessor Cevin ;ournay, "7hil, 7h', C7sychol, #267sS
"ost people with anxiety states are simply more alert and aroused than the general population. The chemical processes
which underlie anxiety are complex but essentially lead to the body being put into an optimum state of preparedness. One
way of looking at anxiety is that the body goes into this state of preparedness without a rational external reason. 2or many
anxiety sufferers there is a simple cure which activates an attack. This may be the sight of a spider, the thought of going
shopping or talking to a large group of people. #ttacks of anxiety like this can be managed by the exposure based
approaches which have been shown to be so effective. Therefore gradually facing one5s fears and avoided situations in
graduated doses of difficulty, perhaps with some attempt to change how you think about such situations, will lead the body
eventually becoming used to those situations and no longer producing the state of arousal.
:owever, some sufferers seem to experience surges in arousal for no apparent reason. % have come across a very large
number of patients who have become physiologically very aroused and hence develop an anxiety state although there is no
particular source of anxiety in their lives. 7erhaps these people are more prone to produce adrenalin than some people and
for some reason their system becomes more prone to spontaneous panic attacks. The other group of people who are more
prone to spontaneous panic attacks are those who repeatedly encounter anxiety linked to a particular phobia or obsession.
%n these cases the repeated episodes of anxiety have a generalised effect and after a while the body seems to ,ust produce
surges of adrenalin for no apparent reason.
&hat then does one do about this.
To begin with, one must look at simple factors which pre9dispose sufferers to panic attacks. 6eing hungry or tired can often
be a factor and simply eating regularly and getting plenty of sleep is one remedy likewise, some people report that they are
more prone to these apparently spontaneous panic attacks after indulging in alcohol the day before. This association has
been known for some time but, it is becoming clearer that large numbers of anxiety sufferers can develop panic attacks in
response to alcohol. "ore recently % have seen a number of patients who have developed such spontaneous panic attacks
in the aftermath of taking illicit drugs such as "ari,uana or =cstasy. %n the latter cases % have seen a worrying number of
young people who have developed the severest states of panic disorder after even an isolated intake of this drug.
Sometimes, spontaneous panic attacks are not really spontaneous. There is a great deal of research which shows that
sometimes the arousal which occurs when one gets angry can be misinterpreted as anxiety and sometimes a panic attack
may actually be a feeling of anger which presents itself a little later after the original event which caused the problem.
Sometimes, there are other factors which may produce anxiety which are not so obvious. 2or example, one patient of mine
recently developed spontaneous panic after seemingly making a good recovery from her agoraphobia. % asked her to keep
a diary and eventually we isolated the cause of these -spontaneous- panics.
She had recently taken a new ,ob and the bus ,ourney to work which she was en,oying for the first time in many years
passed a funeral parlour on a daily basis. She therefore glanced at the funeral parlour on the way to work and this activated
a very long9standing fear of death, and cancer in particular >she had had four close family members die while she was a
teenager?. Thus, it became clear that this lady5s -spontaneous- panic was not really so spontaneous and she is in treatment
for her long standing fear.
:owever, some panics appear to be genuinely spontaneous. The first thing to do is to keep a diary and record these
panics, trying to also not what may have come before them so as to isolate a cause. Secondly, keep a note of what you eat
and drink. %n some cases, panic may be triggered by the intake of alcohol >as mentioned prior? or lots of strong black coffee.
%f a diary keeping exercise does not reveal a cause, think about ways of gradually reducing your base -level of arousal-.
#lthough things like relaxation training and @oga may be helpful, it is worth considering adding regular systematic exercise
to your routines. There is a great deal of evidence which shows that regular exercise, a minimum9of B3 minutes, 4 times a
week, can reduce states of high arousal. %t is also worth looking at your pattern of breathing and seeing whether you are
hyperventilating. %t may be that you are breathing rather rapidly from the top of your chest and, some tell9tale signs are
presence of pins and needles, yawning and sighing, feeling tired or having muscle cramps. The remedy for this malady is
slow, but not deep, diaphragmatic breathing. The 50o 7anic5 help9line will assist you, if re8uired, in learning some simple
breathing exercises.
2inally remember that panic can do you no real harm. Obviously, therefore one needs to look at how one thinks about such
panics and whether there is a pattern of catastrophic thinking. Therefore, if for example you think during a panic attack that
you might die of a heart attack or stroke, this needs to be treated as an irrational though and you should practice writing
down your irrational thoughts and countering them with rational responses. Thus, as you go along, you should record the
irrational though and think about every other reasonable way of considering the situation %n the cases of someone who5s
thoughts are of their heart stopping, one might respond by saying anxiety puts the body into an optimum state of
preparedness, one5s heart muscle is in a very healthy condition during increased arousal. Or one may say % have had these
panic attacks on numerous occasions and % have had the same though and % am still alive// Such simple self9help methods
can often be successful however, if spontaneous panic and catastrophic thinking is a problem which will not respond to self9
help strategies you should consider asking for a referral to a suitable cognitive behaviour therapist and, again, it may be
worthwhile asking the help9line for advice. %n some cases, medication can be useful but, although not a last resort, % would
certainly not consider medication until the person showed themselves to be resistant to self9help and professional cognitive
behavioural intervention. % would be very interested to hear from any of you who have developed your own strategies for
dealing with spontaneous panic.
What to Do if a %amil& 'emer #as an An(iet& Disorder
Copyright 0otice
D #dapted from Sally &inston, '.7sy., The #nxiety and Stress 'isorders %nstitute of "aryland, Towson, "', ())B
Sally &inston, '.7sy
(. 'on5t make assumptions about what the affected person needs 9 ask them.
B. 6e predictable 9 don5t surprise them.
4. $et the person with the disorder set the pace for recovery.
E. 2ind something positive in every experience. %f the affected person is only able to go partway to a particular goal,
such as a movie theater or party, consider that an achievement rather than a failure.
F. 'on5t enable avoidanceG negotiate with the person with panic disorder to take one step forward when he or she
wants to avoid something.
H. 'on5t sacrifice your own life and build resentments.
I. 'on5t panic when the person with the disorder panics.
*. !emember that it5s all right to be anxious yourself 9 it5s natural for you to be concerned and even worried about the
person with the disorder.
). 6e patient and accepting, but don5t settle for the affected person being permanently disabled.
(3. SayG -@ou can do it no matter how you feel. % am proud of you. Tell me what you need now. 6reathe slow and low.
Stay in the present. %t5s not the place what5s bothering you, it5s the thought. % know that what you are feeling is
painful, but it5s not dangerous. @ou are courageous.-
'on5t sayG -!elax. Calm down. 'on5t be anxious. $et5s see if you can do this >i.e., setting up a test for the affected person?.
@ou can fight this. &hat should we do next. 'on5t be ridiculous. @ou have to stay. 'on5t be a coward. 7ull yourself
together-.
Agoraphoia
$ast "odified B33)93)9(3 B(G(*G4(
0o "ore 7anic J #rticles J 7hobias J #goraphobia
#goraphobia affects about a third of all people with 7anic disorders. %n studies of agoraphobics it was found that the
ma,ority of sufferers also had 7anic attacks and the 7anic attacks always started before the agoraphobia. %n about IFK of
the cases studied, agoraphobic episodes began within a year of the initial 7anic attack. This can be attributable to the
sufferer not wanting the embarrassment of having a 7anic attack in public and so they remain at home where they feel safe.
#goraphobia is not, as many people believe, ,ust about open spaces. %t is really a fear of being in any place or situation
where the sufferer does not feel safe or where the sufferer feels trapped, and heAshe is driven by an uncontrollable urge to
escape to a place of safety which, in most cases, is hisAher own home.
'efined asG #nxiety about being in places from which escape might be difficult >or embarrassing? or in which help may not
be available in the event of having an unexpected or situationally predisposed 7anic #ttack or panic9like symptoms.
#goraphobic fears typically involve characteristic clusters of situations that include being outside the home aloneL being in a
crowd or standing in a lineL being on a bridgeL and travelling in a bus, train, or automobile.
Taking all these factors into account, it is thus not surprising that sufferers of agoraphobia do not venture very far from
home. Some agoraphobics find that they can get further from their place of safety if accompanied by a trusted relative or
friend. :owever, eventually the sufferer becomes totally dependent on their -carer- and thus finds that heAshe cannot go out
anywhere without their helper. %t is thus not surprising that sufferers try to avoid these awful sensations.
!egrettably by doing so they are only reinforcing their fears and so making recovery much harder. Once a phobia has set in
then the best way to overcome it is to slowly but surely face up to the fear. This is not easy as the sufferer has to
experience those feelings that for so long heAshe has sought to avoid.
7eople with agoraphobia can be seriously disabled by their condition. Severe agoraphobia often confines sufferers to their
homes for many years. Some are unable to work and rely heavily on friends and family to help them by doing simple things
like the shopping. =ven a necessary visit to the doctors can be impossible so the sufferer has to rely on an understanding
doctor who is prepared to visit them at home.
# person with severe agoraphobia will become totally dependant on family members for their help and this can in time put a
strain on the carers whose lives revolve around helping the sufferer.
Agoraphoia " )ause and *reatment
Copyright 0otice
D This article has been reproduced with kind permission of 0o 7anic. 7lease do not copy this article without permission.
6y 7rofessor Cevin ;ournay, "7hil, 7h', C7sychol, #267sS
#goraphobia was a term coined by the ;erman neurologist &estphal in (*I(. %n his original description, &estphal
described four patients >all men? who had attacks of anxiety in public places. %nterestingly, he described how several of
them used alcohol to reduce their fears. The term 5agoraphobia5 derives from the ;reek, the word 5agora5 meaning the
market place. This term, &estphal felt was appropriate because it described how people felt vulnerable in public places and
in particular where there was no obvious exit. #t the same time, another neurologist, 6enedikt, coined another term
>7lat1schwindel? which translated from the ;erman, means di11iness in public places. Over the years, this syndrome has
been called many things, one of the most convoluted terms being the -phobic anxiety depersonalisation syndrome/-
%n its fully developed form, agoraphobia probably affects between (AB and (K of the population, i.e. about ( (ABK million
people in the +nited Cingdom but, in a less severe form up to ( in * people, i.e. about I million, may be troubled by some
agoraphobic symptoms. "ore recently, the #merican classification system has defined agoraphobia as part of a more
general panic disorder and sees panic as being the central feature from which all fears stem. This is a concept which is
currently open to some dispute, but there is no doubt that panic attacks form a considerable component of agoraphobic
anxiety. &ith regard to incidence, it is probable that up to ( in 4 of us may have a panic attack during our lifetime and
certainly, at any one time, about 4K of the population may be experiencing panic attacks.
#goraphobia has its classic onset in early adult life, the peak ages being between (* and 43. %t is very rare for agoraphobia
to develop from its beginnings after the age of 43 although, some people appear in outpatients clinics in their 43s and E3s,
stating that this is the first episode. :owever, in many of these people, you can find a history of fear situations during school
life and transient episodes of anxiety in public places at other times in their life. %f, however, phobic symptoms truly start
without any history whatsoever in the E3s or F3s, it is likely that they are part of another syndrome, possibly a depressive
illness. #goraphobia is not a fear of open spaces although, some people with agoraphobia may be afraid in such situations,
it is principally a fear of situations in which escape is perceived as difficult andAor help is not perceived as being readily
available.
Therefore, people may often be able to travel long distances alone or go into crowded public places providing that they
know that help is at hand. ( have one particular patient of my recollection who was able to travel anywhere on his own
throughout the +nited Cingdom provided he had a mobile telephone with him, so that if he had a panic attack, he felt that he
could contact the emergency services >needless to say, he never needed to use it?. :owever, if for some reason he was
deprived of his mobile phone, he could not travel beyond a few hundred yards from his house. #s most of you know, people
with agoraphobia are extremely good at hiding their fears from the outside world and often people mask their symptoms
effectively for many years, or even a lifetime.
&ith regard to sex differences, men are much more likely to hide their fears than women and although we think that there
are probably almost as many male agoraphobics as women, the number of men who come to outpatient clinics is a (AE or
less of the number of women who attend. "en are certainly not as good at facing up to the fact that they have a fear and
this is probably a very strong socially conditioned response.
2or example, many men say 8uite openly that they see the admission of fear as being synonymous with being a wimp or
being week in some way.
% have carried out research in the field of agoraphobia since ()I) and this research has looked at both the nature of the
syndrome and the out9come of treatment. So, what do we know about this condition.
)ause
The cause of agoraphobia remains a mystery and it is probably more true to say that it is a matter of a number of causes
rather than one single cause. 7robably, most people with agoraphobia are biologically pre9programmed in the sense that
they produce adrenalin more readily than other people do. Secondly, we know that growing up among people who show
avoidance traits in their behaviour can lead to avoidance behaviour developing in offspring. &e know that separation
experiences during childhood can be 8uite important and a very large number of agoraphobics have been separated from
their mother or father.
&e also know that agoraphobia may be associated with stressful life events and that people who suffer repeated stresses
can often develop phobic symptoms. Sometimes, people develop agoraphobia following frightening experiences and the
best examples of this is to be found in people who perhaps have been trapped in a fire, a lift or a motor car involved in an
accident. These people often develop agoraphobic symptoms. :owever, it is interesting to note that there are many people
trapped in such situations who do not go on to develop phobic symptoms and, thus, one really has to consider the
possibility that there is a predisposition both biological and psychological to this syndrome.
*reatment
6efore behaviour therapy, the treatment outlook for people with agoraphobia was not good. 7sychoanalytic psychotherapy
was often used on people but the outcomes with this approach were very poor. Similarly, the drug treatments which were
used many years ago often led to ma,or problems.
The first behavioural attempts to treat agoraphobia were those of systematic desensitisation, i.e. teaching people to relax in
association with imagining various phobic situations. :owever, BF years ago exposure in real life was developed as a
central treatment for agoraphobia and this involved a therapist taking the patient into the phobic situations and keeping
them there for long enough so that their symptoms reduced. These exposure exercises often lasted for B94 hours at a
minimum.
&hile exposure in real life has remained the mainstay of treatment, therapist aided exposure is much less used today.
7rofessor lsaac "arks at the %nstitute of 7sychiatry, the world5s leading expert in this area, argues that exposure treatments
can be as effective using self9help material, computer programmes or therapist instruction and he has a great deal of
research evidence to support this proposition. %n recent years, cognitive therapy has developed and all over the world,
psychologists and psychiatrists are applying cognitive therapy principles to agoraphobia and panic attacks. &hile there is
some evidence that cognitive therapy is useful in the treatment of panic attacks, there is as yet little evidence that cognitive
therapy adds much to the outcome of exposure treatments. This controversial area is continuing to be sub,ected to
research en8uiry and % am sure that over the years we will see new emerging approaches. :owever, % am sure that
exposure will remain an absolute prere8uisite.
The results of exposure on its own are very good and probably I3K of people who complete programmes will achieve I3K
or more recovery. :owever, many people drop out of treatment or fail to complete an ade8uate trial. Some of my research
indicated that some people have difficulty tolerating exposure treatment and for this group of people, cognitive therapy may
be helpful as a preparation. :owever, as most of @ou know, there is no way round the central truth that, in order to combat
a fear, one needs, eventually, to face up to it//
Self9help groups such as -0o 7anic- provide a mainstay for the population of people with phobic anxiety in this country, as
treatment resources are still desperately short. +nfortunately, although we have many skilled and very competent nurses,
doctors and psychologists who have received the proper training in behaviour therapy, there are by no means sufficient
numbers to treat the phobic population that exists. #s mentioned above, self9help approaches can be very effective and,
providing the correct ingredients of treatment are used, i.e. central emphasis on exposure and how it is applied, there is no
doubt that the 50o 7anic5 volunteers can achieve outcomes which compare favourably with health professionals.
*he main principles of e(posure are+
=xposure must be prolonged. @ou must stay in the situation until your fear starts to go. This may take a long time 9
often several hours
Short periods of exposure without experiencing a reduction in symptoms can be harmful
=xposure should be regular
Try and involve the family as co9therapists
6uy some self9help literature
#void the use of alcohol at all costs
%f you are taking medication, this must be discussed with someone who has expertise both in behaviour therapy
and in the area of pharmacology. % believe the research evidence is that very few people with agoraphobia should
be prescribed medication as a first line of treatment and that medication may achieve some short term gains but, in
the long term, there is still a 8uestion mark over its usefulness
%f self9help is not working and you feel that you would benefit from professional treatment go to your ;7 and
re8uest a referral to a suitably 8ualified therapist. %nsist on receiving behavioural therapy for your phobic condition.
This is a universally recognised treatment and in my view it is your right to be referred. +nder the new funding
arrangements in the 0:S, your ;7 should have access to referral to a specialist resource outside your immediate
area if, local treatment facilities do not exist