Medication was not a regular part of my recovery program. However, I did take Xanax on a limited basis.

I often carried two .25mg pills in my pocket to get me through a particularly panicky time. But I did not take Xanax every day.

My philosophy about medication is that pills are helpful when used on a temporary basis and combined with cognitive-behavioral methods. Medication can provide a window of opportunity to practice overcoming fear with the confidence that your anxiety won’t get too far out of control.

The danger lies in attributing too much of your progress to medication. People who attribute their progress to medication are less likely to make a complete and lasting recovery from agoraphobia than people who attribute their progress to developing skills.

Ultimately, skills not pills will set you free from agoraphobia.

But don’t be afraid to use medication temporarily, and under the supervision of a doctor, if it is part of a larger recovery plan.

I was asked a great question recently,

“If certain situations trigger panic, then why do we sometimes panic in a situation, and then are sometimes able to stay calm in that same situation?”

The reason why we react differently in the same situation s because panic attacks are not a purely automatic response. If I have written somewhere that situations trigger panic, this should not be taken as an absolute rule.

We may react differently in the same  situation because there are two sides of the brain at work when it comes to panic attacks.

Sure - panic attacks are partially triggered by emotional memories or associations formed in the right brain through experience. But your thoughts, which come from the left side of the brain, also play a role in determining whether or not you panic. Your thoughts can override a panic attack.

That’s why I recommend self-help techniques for agoraphobia that work on both sides of the brain:

1) Relaxation, visualization, and reconditioning to replace associations on the right side.

2) Learning to detect and replace panic-producing thoughts on the left side.

Of course, many other factors influence a panic attack, such as being tired. But these are the two major influences, associations and thoughts.

For most people with agoraphobia, the safe zone is either their home or a certain distance from their home. Much literature on agoraphobia recovery is written with this assumption.

Recently, I was emailed a very good question that challenges this assumption:

“Why did I have a panic attack when I went shopping just two streets away, but on another day I traveled 1400 kilometers without having a panic attack?”

The answer to this question lies in understanding how the safe zone develops. The safe zone is not always defined as a certain distance from one’s home in all  directions.

Phobias like agoraphobia develop through associations formed in the brain through experiences that are recorded as emotional memories. In other words, safe places are places in which someone with agoraphobia learns to associate safety through pleasant emotional experiences. Unsafe places are places in which a person learns to associate fear or danger through experiencing panic attacks.

In most cases, a person with agoraphobia experiences panic attacks in so many places away from home that the fear generalizes - and most places outside the home become regarded as unsafe. In other cases, the fear does not generalize and certain places are recorded in the brain as unsafe due to panic experiences, while other places remain perfectly safe.

In summary, panic attacks are most likely to occur in places where the brain has recorded a memory of panic, regardless of the distance from home. If the fear does not generalize, places in which a person has not experienced a panic attack are less likely to trigger one.

This is a common question for parents with agoraphobia, especially if they have young children. If have agoraphobia, it’s natural to feel concerned about your children developing anxious or phobic behaviors from watching you.

The best information and advice for people in this situation is written in a book called “How to Help Your Loved One Recover From Agoraphobia” by Karen Williams (in Chapter 5 “How Agoraphobia Affects the Family”)

Here is a summary of what the chapter says:

There is some evidence that phobias, including agoraphobia, are passed on both genetically and by modeling (though experts disagree on the strength of each influence). So trying to hide agoraphobia from your children, or not talking about it won’t really protect them.

According to Dr. Arthur Hardy, who spent his life treating agoraphobics including Karen Williams (the author), “it helps children to be allowed to take part in the recovery process.” Dr. Hardy believes that this helps keep children from becoming phobic themselves. If you have agoraphobia, he suggests that you allow your children, if they are old enough, to help you in positive ways such as goal setting and practicing facing your fears.

But even if your children are not old enough to help in the recovery process, the best thing is to model recovery from agoraphobia and not avoidance behavior.

Also:

- Make sure your children know they are not to blame for your anxiety and panic attacks, that you are not mad at them, and they had nothing to do with the cause of your problem. Children have a tendency to blame themselves or feel guilty when a parent has a problem like agoraphobia that they don’t fully understand.

- Make sure your children have permission to be angry at the way agoraphobia makes you act sometimes, and give them a chance to talk about it.

- If agoraphobia is keeping you from paying the amount of attention to your children that you feel they need, communicate the reasons why the best you can and arrange for your child(ren) to receive attention from another source, such as a close relative or trusted friend. This will help keep your chidren’s self-esteem healthy, and keep them from feeling rejected.

Of course, the level of communication you can have with your children about agoraphobia will increase with their age, but “with a little attention and sensitivity on the part of the parent, children will come through this crisis better than most parents think they will” (quote from the author).

“Can agoraphobia be cured?”

“Will I ever be able to get completely over it?”

“Will I ever live a normal life again?”

Though it exists in many forms, this is the number one question I have received from visitors to the Agoraphobia Help website. And the answer to this question is yes!

Agoraphobia CAN be completely cured and you CAN get completely over it. I am living proof of this.

Agoraphobia is highly treatable because it is not a mental illness. Anxiety disorders and phobias, of which agoraphobia is both, consist of learned thoughts and behaviors. The good thing about learnd thoughts and behaviors is that you can unlearn them.

I am not saying that it’s easy to unlearn panic or irrational fear, but it can be done if you do the right things consistently over time.

If you have agoraphobia can lead a normal life again. In fact, research says that about 90% of people who practice cognitive-beavioral therapy (CBT) on a consistent basis either recover from agoraphobia completely or have a significant reduction in symptoms.

Today, I emailed a survey to everyone on my list asking this question:

“What is Your Biggest Question About Agoraphobia?”

I had about 45 responses within one hour, and the questions keep coming in. I want to answer as many or all of the questions that I can - and here are the ways I am going to do it:

1. Through the weekly Voice of Hope Messages (sent each Friday people on my mailing lists).

2. In the monthly Agoraphobia Report Newsletters.

3. Through regular posts on this blog.

4. During upcoming telephone seminars.

I am going to be offering telephone seminars very soon, to give you a chance to get on the phone with me and ask questions. These teleseminars will also give me the chance to go deeper and share specific, step-by-step details about agoraphobia recovery for those who sign up.

If you sign up for the Agoraphobia Report Newsletter, you will be notified of all the above. Also, if you have a question about agoraphobia click on “Questions?” and submit it. I will do my best to respond.

I care about your recovery from agoraphobia.

Did you know that 4 out of every 5 people diagnosed with agoraphobia are female?

That doesn’t necessarily mean that more women than men actually HAVE agoraphobia, but women are 4 times more likely to be diagnosed.

Researchers have explored some possible explanations for this phenomenon and I just posted an article that discusses them.

To read more about why more women are diagnosed with agoraphobia, look in the articles section of this website under “Causes and Development.”

My article is called “Is Agoraphobia a Women’s Disease?”

In my last post, I wrote about the value of facing your fears out of order instead of creating the tradiitonal a “Fear Heirarchy” and working on overcoming your fears from least to greatest.

Now I am going to pass on another agoraphobia recovery tip from anxiety disorder expert, Dr. Reid Wilson - change the conditions under which you practice desensitization.

If you usually practice in the morning when it is light outside, try practicing at night after dark.

If you usually plan your practice sessions far in advance, try practicing spontaneously.

Try practicing in both cold and warm weather. Practice with people sometimes, and at other times, alone.

You get the idea, the more you mix up your desensitization practice, the more your practice will model real life, and the more likely you will be to prepare yourself for unexpected challenges that come your way.

Desensitization therapy for agoraphobia may be more effective if it is not so systematic - or so an article I just read by Dr. Reid Wilson suggests.

Dr. Wilson is a professor at the University of North Carolina and an internationally recognized specialist in the treatment of panic and anxiety disorders. His book, “Don’t Panic,” helped me tremendously in my own recovery from agoraphobia.

In a recent article called “How to Keep the Fear from Returning,” Dr. Wilson challenges a traditional assumption of systematic desensitization, which is considered to be the most research-proven treatment for agoraphobia today.

The traditional systematic desensitization method is to face your fears in sequential order, from least to greatest. The logic is that you will gain confidence for overcoming larger fears by first conquering smaller ones.

Dr. Wilson suggests that you try just the opposite, to face feared situations randomly. Instead of working all the way through a lesser fear before working on a greater one, work on all of your fears at the same time. Choose randomly which fear you will face on a given day.

Dr. Wilson says that doing “random and variable practice” will send yourself the message that you are capable of handling a variety of situations and “add into memory a larger number of cues” to associate with positive learning. In other words, if you mix up the order in which you face different fears, you will better generalize your success to different situations.

Many of you have already read and commented on the July edition of the Agoraphobia Report - “Beat Agoraphobia with Your Eyes Closed.”

In no way do I intend the title to make light of the hard work it can take to recover from agoraphobia. Believe me, I know what it takes from personal experience.

The purpose of the newsletter was to explain how powerful visualization can be in your recovery from agoraphobia and why it is important to reprogram both sides of the brain (left AND right).

So many self-help programs emphasize changing your thinking (left side), but to make a complete recovery from agoraphobia, it’s important to change the pictures in your mind (right side), too. This month’s newsletter has some basic instructions to help get you started.

If you haven’t already, sign up for the Agoraphobia Report to read why and how to change the pictures in your mind.