Agoraphobia
Agoraphobia was thought to to involve fear of the “agora”- the Greek God of public places of assembly. Agoraphobics usually fear one or more form of travel, and commonly avoid cars, buses, airplanes and subway trains. Agoraphobia usually develops as a complication of having panic attacks (which can be terrifying) in one or more such situations. Agoraphobics are concerned that they may have a panic attack or get sick, they are anxious about being in places or situations from which escape would be physically difficult or psychologically embracing, or in which immediate help would be unavailable in the event that something bad happened(APA).
Panic disorder
DSM_IV defines a person must have experienced recurrent unexpected attacks and must have been persistently concerned about having another attack or worried about the consequences of having an attack for at least a month. There must be at least 4 of the thirteen prescribed symptoms present to qualify it as panic. Some of them are: shortness of breath, heart palpitation, sweating, dizziness, depersonalization, de-realization, fear of dying or going crazy etc.
Agoraphobia without Panic Disorder
Agoraphobia is a frequent complication of panic disorder, it can also occur in absence of panic disorder. Cases of Agoraphobia withut panic are extremely rare in clinical casesbut it not uncommon In epidemiological studies.
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Effective Treatments for Specific Phobia
Specific phobias are the only anxiety disorder for which psychological treatments are almost always considered to be the best approach to treatment. There are no controlled studies showing that medications are an effective treatment for specific phobias.
Psychological Treatments
• Exposure to Feared Situations – This technique, also called in vivo exposure , is the treatment of choice for specific phobias. Essentially, it involves confronting a feared situation repeatedly, until the situation no longer triggers fear. For example, someone with a fear of spiders might begin treatment by looking at pictures of spiders, or by standing 30 feet away from a spider in a sealed jar and gradually moving closer and closer to the spider (eventually even touching it). Someone with a fear of storms might be taught to stand near the window or on the front porch during a storm, instead of hiding in the basement. Someone with a fear of elevators would be taught to ride elevators repeatedly until the fear decreases. Exposure works best when it occurs frequently (e.g., several times per week), and lasts long enough for the fear to decrease (up to two hours). Exposure-based treatments for some specific phobias (e.g., animals, blood) have been shown to work in as little as one session.
• Applied Muscle Tension – This technique is used specifically to treat people with blood and needle phobias who have a history of fainting in the situation (see the “Did you know….” section below). It combines exposure to blood and needles with exercises that involve tensing all of the muscles of the body, which temporarily raises the person’s blood pressure and prevents fainting.
• Cognitive Therapy – Involves learning to identify one’s anxious thoughts and to replace them with more realistic thoughts. For example, an individual who is convinced that an airplane will crash might be encouraged to consider the evidence supporting that belief. In reality, the odds of a commercial flight crashing are about one in ten million, and the most dangerous part of any flight is the drive to the airport! Note that cognitive therapy alone is generally not considered an appropriate treatment for a specific phobia. However, some individuals may benefit from using cognitive strategies along with repeated exposure to feared situations.
Biological Treatments
There is very little research on the use of medications to treat specific phobias, and most experts believe that medications are not an appropriate form of treatment for this problem. Still, some individuals with specific phobias (especially those from the situational type, e.g., flying, driving) report some benefit from using either selective serotonin reuptake inhibitors, such as paroxetine (Paxil) and similar medications, or anti-anxiety medications such as diazepam (Valium) and related drugs. However, for long term improvement, medications are no substitute for behavioral treatments such as exposure. There is probably little benefit gained over the long term from combining medications with behavioral treatments for specific phobia.
Anxiety
Anxiety is a general feeling of apprehension about possible danger, was in Freud’s formulation a sign of an inner battle or conflict between some primitive desire (from the id) and prohibitions against its expression (from the ego and the superego). Sometimes this anxiety seem evident to him in clients who were obviously fearful and nervous. Today DSM has identified such cases within a group of disorders that share obvious symptoms and features of anxiety known as the anxiety disorders.
Panic
Panic is a basic emotion that occurs in many higher animals and humans iyt is usually associated with a distinctive facial expression and involves activation of the fight or flight response of the sympathetic nervous system. This allows us to respond rapidly when faced with a dangerous situation such as being threatened by a predator. In humans who are having a panic attack there is no external threat panic occurs because of some misfiring of this response system.
Phobia
Phobia is a persistent and disproportionate fear of some specific objects or situation that presents little or no actual danger to a person. When a person with a phobia encounters a feared object he or she will often experience the fight or flight response, which prepares a person to escape from the situation. Thus psychologically and behaviorally the phobic response is often identical to that which would in an encounter with an objectively terrifying situation.
In DSM IV there are three main categories of phobias
1) Specific phobia
2) Social phobia
3) Agora phobia.
Specific Phobia (simple phobias) may involve fears of other species or fear of various aspects of the environment (tunnels or bridges).
Social phobias involve fear of social situations in which a person is exposed to the scrutiny of others and is afraid of acting in a humiliating or embracing way. Social phobias may be circumscribed (as in fear of public speaking or generalized (as in fear of any social interaction).
Agora phobia was thought to involve, somewhat paradoxically a fear of both open and enclosed spaces. However it is now understood that agora phobia most often stems from anxiety about having panic attack in situation where escape might prove difficult embracing. The apparent paradox is resolved in this view because escape is difficult from both open and enclosed spaces.
Specific phobias
A person is diagnosed as having specific phobias if he or she shows strong and persistent fear triggered by the presence of or anticipation of an encounter with a specific object or situation. The level of fear must also be excessive or unreasonable relative to the actual danger posed by the object or situation. When individual with specific phobias encounter a phobic stimulus, they almost always show an immediate fear response that often resembles a panic attack except for the existence of a clear external trigger (American Psychiatric Assciation, 1994). The avoidance of the feared situation or the distress experienced in the feared situation must also interfere significantly wirth normal functioning or produce marked distress. In DSM-iv there are now five sub types of phobias listed
1. Animal subtypes_ snakes or spiders
2. Natural environment subtypes_ heights or waters
3. Blood injection- injury subtypes_
4. Situational subtype_ aero plane or elevators
5. Atypical subtype_ choking or vomiting
Some of these specific phobias involve exaggerated fear of things that many of us fear to some extent, such as darkness, fire, disease, spiders and snakes. Others, such as phobias of water or crowds, involve situation that do not elicit fear in most people. Many of us have a at least a few minor irrational fears, but in phobic disorders such fear are intense and often interfere significantly with everyday activities for example- claustrophobic persons may go to great lengths to avoid entering a small room or an elevator even if this means climbing many flights of stairs or tuning down jobs that might require them to take an elevator. This avoidance is a cardinal characteristic of phobias it occurs both because the phobic response itself is so unpleasant and because of phobic person’s irrational appraisal of the likelihood that something terrible will happen.
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