Anxiety UK Agoraphobia Webchat
Professor Karina Lovell
Laura: Do you have any tips on beating agoraphobia?
Prof. Karina Lovell: Laura, the best treatment that we know of (the one that has been most researched) is CBT - in particular graded exposure where you gradually face your fears and your anxiety will decrease - it is difficult but does have a good response rate
Laura: I did begin CBT last year but I wasn't really supported very well and I stopped just before the practical sessions started, I'm ashamed to say.
Prof. Karina Lovell: Laura – Don’t be ashamed - but would either try to go back or you could get CBT through Anxiety UK - do try again
Laura: Prof. Karina Lovell, I work full-time about a 5 minute drive (in good traffic) from my house. Do you have any advice for getting through work each day? I worry about getting ill at work but I actually faced that fear last week when it happened, which has perhaps calmed me down about it a little. Oh I also worry when I know it's a time that the traffic would be busy should I need to get home, e.g. school run time
Prof. Karina Lovell: What I would do would be to practice this journey for about an hour at a time at a less busy time - your anxiety/panic should come down (not completely but will reduce) then practice at a bit more of a busy time - I think the problem is that you are only doing a very short journey each time so this is why your anxiety is not coming down.
Laura: Okay that's some sound advice there Prof Lovell...although I think it's being there more than the journey itself that makes me anxious. I have another question...I do sometimes manage to travel a bit further, but I get really scared on motorways. I think it's because I'm going fast and I'm trapped as a passenger in a car and you can go for miles without there being a slip road. Do you have any advice there at all?
Prof Karina Lovell: Laura - I think perhaps what you are doing is taking too many big leaps - I would start off small (like the non busy journeys to work) and slowly build up your confidence and then move onto longer journeys - start with smaller roads to start with and motorways later on
Laura: Okay, perhaps I am. I did panic last time I went on a motorway and asked to come off of it. But I managed to back on about 20 minutes later for the rest of the journey. If I don't trust the person driving I panic at even the shortest of journeys. I remember panicking once when I was in a friend's mum's car just going from one end of the road to another lol
Steve: What is the success rate of CBT?
Prof. Karina Lovell: The success rate with CBT is about 60% - this 60% means moderate or very much improved- success rate between studies does vary but 60% is about right
Wendy: My 24 year old son has agoraphobia with obsessive traits and he is really struggling at the moment. The obsession is that he cannot leave the house without immediately needing the toilet, when he does manage to get out he has to go to the toilet constantly. It is a vicious cycle of anxiety producing the physical systems of actually needing the toilet. He is currently on 30mg of mirtazapine and 600 mg of pregabalin. He was also on a short course of diazepam, but this didn't seem to help either. He is so depressed about the whole thing. In your opinion which medication do you think best helps with panic attacks?
Prof. Karina Lovell: Hello Wendy - and sorry to hear that you son is struggling with agoraphobia - I would suggest that he receives a psychological therapy - it is difficult to say which medication as not a medical doctor - has he been in touch with services - this is toilet phobia or agoraphobia with a fear of losing control of bowel movements
Wendy: He is trying to engage with CBT, but finding it really difficult. They are trying various route things with him, e.g. trying to get him delay going to the toilet, which seems to make things worse alternatively accepting that he should just go while trying not to attach any importance to it. What do you think?
Prof. Karina Lovell: Wendy - this sounds difficult but in a sense I would be talking to your son about risk - and using graded exposure - which means that I would be asking him to gradually go out (not far to begin with) but to stay out for a while until his anxiety reduces - and then to gradually move to the next target and so on until his confidence increases- if you want me to explain more let me know
Wendy: Yes that's what we have been trying to do. Do many people have toilet phobia, he is so embarrassed and finds it so humiliating having this that only immediate family know
Prof. Karina Lovell: Toilet phobia is very common - sometimes it is agoraphobia - sometimes it is because people have Irritable Bowel syndrome - and because of IBS they start to avoid- and understand that he finds it embarrassing and humiliating -but the chances are that if he fights the fear things will improve
Wendy: Thank you it is good to hear that things may get better, it just doesn't feel like it sometimes and we all find ourselves engaging in his safety behaviour
Laura: I get anxious about eating out...I don't know if you have any advice relating to that Prof. Karina Lovell?
Prof. Karina Lovell: What is it that you fear will happen when you eat out?
Laura: I guess that I'll fall ill or the food I'm eating will make me ill
Prof. Karina Lovell: And what would that mean to you
Laura: I also have a small appetite and I worry a little bit if I don't eat much of the portion they give me. But that's minor compared to the other fear. I get really anxious about being ill...especially throwing up :(
Prof. Karina Lovell: What would it matter that you threw up - is that you would feel embarrassed (i.e. from others) or is it that you hate being sick
Laura: I also worry about bowel movements in general anyway but I get very anxious if I need to in a public place and I'd rather be late for something than use a public toilet. But I get anxious about the idea of diarrhoea if I got ill too, especially if I was out. ...That's another part of my emergency kit Claire - Imodium! Mainly that I hate being sick really. Probably because it's something you're not in control of and you
just feel so awful when it's happening. And I would feel really embarrassed if people who weren't close to me saw me be sick.
Prof. Karina Lovell: Laura you seem to be saying that your fears are centred around losing control of your bodily functions (i.e. bowel movements and being sick) this is really common - but would start gradually and build up
Laura: Yeah, I think most of my fears are centred around those really, I think it goes back to when I was 10 and on my way to Cornwall on holiday. We were stuck in traffic and I felt nauseous and needed the toilet. :(
Mark: Hi, I have been having panic attacks at work which I can at the moment stop progressing to full attacks but my work though initially supportive are now unhappy that I am still anxious and unable to really explain or for them to understand why I have the attacks. The attacks are mainly caused in me by paranoia and some other issues which I don’t feel comfortable talking about. I also find it hard to be in a crowded room with people talking amongst themselves.
David Hadley: Mark - The AnxietyUK Helpline is 100% Confidential if you feel you can chat in confidence
mark: David, Thank you, the paranoia started initially because I believe I smell bad all the time and I picked up on people reacting to this but now I feel everybody is against me at work and I mishear what people say (I think they are saying stinks when they say any word that ends in an s) that then starts me thinking bad thoughts, being paranoid which then ends in me panicking and I’m worried that although I can stop the panic attacks at the moment using breathing exercises this is only because nothing really bad has happened at the moment.
Prof. Karina Lovell: Mark - explain this to me - help me understand - is it that you think you smell or do you think that other people think you smell
Mark: Both, I have had problems with my stomach which I now believe is caused by the anxiety (I get Diarrhoea every time I go out for a meal which still happens so I only go out 5-6 times a year and had a period of about a year when I was getting 20 to 30 short (1-2 minutes long) stomach aches every day and when I ate which led me to losing 2.5 stone (down to 8 stone). These stomach aches come back when I am very anxious at work but otherwise have gone. But I believe I smell in every way possible (feet, breath, BO, etc (I have several times heard people call me smelly bum and due to my stomach sometimes I go to the loo (No2) 7 times a day on a bad day) but when I ask people they deny it and my GP and dentist and people at work all say
I do not smell but I can always come up with a reason that they would not tell me. I also shower twice a day, use mouthwash and change my clothes. I am getting help from my GP and am on 20mg Citalopram and other medication to try to help my stomach
David Hadley: mark - could be IBS
Claire: I'm the same mark, I am so loose all the time, I do know that is the anxiety, same as the chest pains, I no longer believe they are heart attacks
Prof. Karina Lovell: Mark - thank you for sharing your story - I was going to ask if you had been checked out for IBS - but there is a relationship between anxiety and IBS so I would check this out - in terms of the fear of smelling is something different - it is likely that a psychological therapy would be helpful both to help manage the bowel movements but also to help you with the fear that you smell - do see your GP and
ask for a referral to psychological services - I know it is difficult but it is likely to be helpful
Prof. Karina Lovell: You can gradually (and emphasise the gradual) overcome these fears - it does take time and effort - but by starting slowly with something that you feel that you can manage and gradually your anxiety will start to reduce - once reduced move onto the next part of the fear and so on - anxiety UK have some really useful material - they have a toilet phobia DVD and a book and this might be helpful for both Mark and Claire
Mark: Hi Prof. Karina Lovell Thank you, as I understand it IBS is diagnosed when other problems are ruled out i.e. colitis or an allergy to certain foods and I am with a digestive diseases clinic at the local hospital still investigating the symptoms but I am now determined to "get fixed" with everything rather than just put up with it as I have done for the last 15 to 20 years as I feel I have wasted my life up to now by avoiding going out and anything I was remotely anxious about and I now know that what was only mild anxiety 15 years ago has slowly progressed and worsened both physically and mentally until it is really affecting my life and the people I work with. Also a couple of years ago I would never have discussed this with anyone even my GP but the stomach aches forced me to do something about it.
Prof. Karina Lovell: Mark - yes you are correct they do often rule out other bowel problems before they diagnose IBS - but as well as the clinic you are attending - I would get a referral to psychological therapies as I think they will help with the going out and fear of smelling - I am so pleased that you are feeling able to talk to someone
Mark: Prof. Karina Lovell Thank you, I will speak to my GP about psychological therapy and take it from there as I have had an assessment at a mental health clinic (I think) who diagnosed anxiety and the GP prescribed the Citalopram but I have another assessment coming up as the local time to talk group referred me back to the mental health clinic instead of giving me an appointment with themselves so I will just have to see what happens.
Steve: I have had CBT three times, the last time was better as the psychologist seemed to understand just how difficult what I was being asked to do actually is for me. My experience is more often that facing some of the fears causes such extreme anxiety it makes things worse, the avoidance then increases which compounds the problems. It a cycle but its like jumping feels like being asked to jump of a cliff sometimes, if that makes sense. I end up feeling stuck and the agoraphobia then gets more intense
David Hadley: Steve – I’m glad you keep trying!
Prof. Karina Lovell: Steve - what is really important in exposure is that the person should set the limits rather than the therapist - usually I ask people to devise a hierarchy from easiest to most difficult and then ask the person what they feel they could manage to do (as a ball park figure I usually suggest to people that they take a task which they rate at moderate anxiety – i.e. on a 0-8 scale of anxiety - go for something that is around 4.
Claire: I am in Kent and there are not therapists in my area and I do not think I would benefit from cbt over phone
Prof. Karina Lovell: Our experience with using the phone is that people often feel some trepidation before starting but once have tried it find it helpful. Claire I would try telephone CBT - one of the reasons we set it up was for people like yourself who could not access face to face therapy due to their agoraphobia.
Prof. Karina Lovell: I have to log off in a minute but thank you so much for inviting me and it has been a pleasure to speak to you all.