Agoraphobia – the difficult phobia which is shown in the form of fear of open spaces, big congestions of people, crossing of wide streets and the areas, stay in places which cannot be left quickly and imperceptibly for people around etc. Results from the fears connected with people and the emotional injuries got in the course of personal or social contacts. It can be shown by sharp weakness, orientation loss, feeling of instability, heartbeat, perspiration, a shiver, increase of breath and fear of death. The main method of treatment of an agoraphobia – cognitive and behavioural therapy, sometimes against the background of medicamentous support. In some cases the long psychotherapy is required.
Agoraphobia – steady inexplicable fear of stay in crowd, on open space and in other places which cannot be left imperceptibly at development of the panic attack, manifestation of the helplessness or "loss of the person" which is allegedly confirming inexcusable weakness of the patient or his discrepancy to standards of behavior on public. It can be observed at the panic attacks, panic frustration, generalized disturbing frustration, sociophobia, other mental diseases, neurotic and boundary frustration.
The patients having an agoraphobia cannot use public transport, cannot reach the place of work, and in hard cases cannot leave the house at all. It seriously limits their professional and social opportunities, and also their personal relations with other people. The agoraphobia is one of the heaviest phobias and quite often leads to an invalidization. Treatment of an agoraphobia is performed by experts in the field of psychology, psychotherapy and psychiatry.
Reasons of development of an agoraphobia
From the point of view of patients their fears are inexplicable, direct link between an agoraphobia and a sharp or chronic emotional trauma often is not traced. Some patients note that for the first time the fear appeared in the circumstances connected with feeling sick or adverse psychological a state, for example, at overfatigue, an acute respiratory disease, a lowering of arterial pressure in heat and closeness, at nervousness before examination or a heavy personal conversation, etc.
Actually, development of an agoraphobia is caused by a combination of several physical and psychological factors which importance can significantly differ. Usually the low level of basic safety is the cornerstone (feeling of level of safety of the world which is put in the childhood and exerts impact on all subsequent human life). For some reason at children's age at patients the steady image of as vulnerable, defenseless, helpless, incapable to cope with circumstances, and an image of the world as obviously dangerous, menacing space not forgiving weaknesses and misses was created.
Along with features of education features of character of patients matter. The agoraphobia develops at the sensitive, impressionable, disturbing patients inclined to hide the experiences more often, "to save in itself" negative emotions. Sometimes the agoraphobia arises after the sharp injuring events: a serious illness, physical or sexual abuse, the death of the loved one, natural disaster, loss of work or stay in the territory of military operations.
According to researches, at some patients with an agoraphobia communication of a vestibular mechanism with propriotseptivny and visual systems of perception is broken. Usually people without effort maintain balance, being guided by three types of signals: propriotseptivny, tactile and visual. If balance is maintained only or mainly at the expense of visual and tactile signals, the disorientation at stay in moving crowd, hit on inclined surfaces and big open spaces with a minimum of reference points is possible.
Communication of an agoraphobia with hereditarily the caused change of level of some hormones in a brain is noted. At patients with an agoraphobia vegeto-vascular dystonia and neurocirculator dystonia is often observed. Experts also note that in the presence of the corresponding premorbidny background the agoraphobia can develop as a result of abuse of alcoholic drinks, stimulators (including – caffeine), benzodiazepines and narcotic medicines.
Agoraphobia traditionally call fear of open spaces, however today the interpretation of this term significantly extended. Understand fear of the situations located outside a zone of comfort of the patient as an agoraphobia. Patients with an agoraphobia can feel fear at movements outdoors, stay on open spaces, in crowded public places and in places which cannot be left imperceptibly (public transport during the movement, the hairdresser's chair during a hairstyle). The fear to publicly show the helplessness, to be dishonored before people around at loss of control and development of an attack of panic becomes the reason of alarm.
Usually the level of alarm decreases if nearby there is a person to whom the patient trusts. Expressiveness of symptoms of an agoraphobia and the list of the disturbing situations can strongly vary. At one alarm arises only at stay on squares or in public transport, others cannot go on foot without attendant, but freely move on the car, the third do not leave the house at all, and sometimes cannot even stay at home alone. A characteristic symptom of an agoraphobia is avoiding of unsafe situations. Patients will organize the life so that not to appear in the environment or circumstances causing alarm.
At hit in the disturbing circumstances tachycardia, the speeded-up superficial breath, the strengthened sweating, dizziness, a preunconscious state, a shiver, nausea, unpleasant feelings in a stomach and intestines and swallowing difficulty are possible. Physical symptoms are followed by fear to find the panic before people around, to go crazy or die. Out of the disturbing circumstances the fear of expectation usually is observed (the patient begins to be anxious in advance, knowing that after a while he should leave a comfort zone).
Patients with an agoraphobia suffer from uncertainty in themselves and a low self-assessment. They feel helpless, are afraid that they will not be able to survive without the aid of other people, feel that they lose control over the life. At patients with an agoraphobia depressions often develop. A certain recurrence of a disease at which the patient "wins" some space from a disease and expands a safety zone can be observed, loses it (usually losses happen at emergence of some additional injuring circumstances).
Treatment of an agoraphobia
The most effective method of treatment of an agoraphobia is cognitive and behavioural therapy. It is short-term psychotherapy at which the doctor together with the patient reveal the thoughts and beliefs provoking development of alarm at visit of unsafe places. Then the patient begins to plunge gradually into frightening situations, in the beginning – with assistance of the expert, and then and independently. There is a psychological desensitization, the patient gets used to frightening situations, and the level of his alarm decreases.
In the presence of the accompanying depression, panic frustration and other similar diseases psychotherapeutic treatment is carried out against the background of medicamentous therapy with use of antidepressants and tranquilizers. It is necessary to consider that substances, the oppressing TsNS, can interfere with performing cognitive and behavioural therapy therefore during treatment it is necessary to exclude alcohol intake, and to accept tranquilizers strictly on doctor's orders (usually these medicines are appointed to short term to facilitate a condition of the patient prior to effect of antidepressants).
In the presence of severe psychological injuries and the internal conflicts the long psychotherapy with use of gestalt therapy, psychoanalytic therapy, the psychodrama, existential therapy and other methods can be required. All listed techniques set as the purpose not disposal of an agoraphobia, but elimination of mental sets, ideas of themselves and features of perception which promote emergence and preservation of fears – without work with these psychological mechanisms after performing cognitive and behavioural therapy the agoraphobia can return or be transformed to other phobia after a while.
The forecast at an agoraphobia depends on depth and weight of the psychological problems causing development of a disease, features of the identity of the patient, existence of the accompanying mental and somatic pathology. Chances of treatment increase with accurate motivation, conscious cooperation with the psychologist, the psychotherapist or the psychiatrist and exact implementation of all recommendations of the expert.