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TREATING AGORAPHOBIA WITH A STRESS MANAGEMENT GROUP
People with agoraphobia often are prey to panic attacks (or the fear thereof) in social situations where they feel trapped, insecure or out of control and it appears as an embarrassing or dangerous situation with no escape. Some Agoraphobics are comfortable seeing visitors only in a defined space wherein they feel in control and may live for years without leaving their home, happily seeing visitors and working, but having to stay within their “safety zones”. These safety zones can vary from just being unable to leave home to avoiding eye contact. Leaving their safety zone can trigger an anxiety attack. This restrictive and debilitating fear-laden form of stress severely compromises living a rewarding life and often ends in severe social anxiety, resulting in withdrawing from mainstream and lonely isolation. Often, the setting of a support group can add social dimensions to dealing with agoraphobia that can be very helpful.
There For Each Other
There are unique advantages to the stress management group approach to helping the agoraphobic. This basic Cognitive-behavioral group therapy model can be advantageous in several ways
- It offers the integration of cognitive restructuring and exposure techniques in the therapy office as well as in the client’s world beyond it. This repatterning of the agoraphobic’s response mechanisms to perceived stressful situations is placed in a social context after first being facilitated in the therapist’s office “safety zone.” This works on several levels:
- it short-circuits avoidance of feared social situations allowing the agoraphobic to experience the natural stress reduction gained by staying in the group environment long enough repeatedly.
- it enables the agoraphobic to practice social behavioral skills previously long avoided, such as conversation, asking questions, assertiveness, laughter, etc.
- most importantly, it gives agoraphobic an opportunity to repeatedly test the validity of his or her dysfunctional beliefs, such as, “I won’t be able to think of anything to say” or “I’m not confident enough to join the other group members for lunch.”
- It gives the therapist/group facilitator control of the scope of interaction using group size, gender/age mix, and setting. At the in-session level, limited exposures allow the interactive process to begin in a protected environment, under the observation and control of the therapists offering a less threatening setting, thus the agoraphobic can approach feared situations at the proper intensity.
- “Homework” can be assigned. Much as in a traditional classroom environment, the therapist/facilitator can gauge the progress of group members and scale the “outside” assignments proportionately to the capabilities of group members. The group milieu gives a web of accountability and shared challenge, as well as mutual encouragement, for the individual’s success with his or her assignment.
- The group facilitates mainstreaming back into normal day-to-day living. A period of being with a group, sharing the triumphs and tragedies of other members, celebrating achievement, growth and recovery together closely mirrors life “outside” the group. The shared commonality of each human experience is a great leveler of the tumultuous peaks and valleys of the individual participant and can expedite the agoraphobic’s integration back into society.
Group therapy provides the therapeutic environment where, in the independent stage, members will achieve autonomy, and have a sense of who they are and how they can continue in their lives. The group members may even begin choosing the direction and leading the group independently. As group begins giving constructive feedback to one another, they can reveal their feelings and work through their problems.
A good Stress Management Group can offer the agoraphobic this support:
- Unconditional acceptance
- Active listening
- Motivation to recover
- Reward progress and accomplishments
- Patience with mistakes and setbacks
- Respecting autonomy
- Word is their bond
- Instill confidence
So in addition to working through the problems inherent in agoraphobia, the agoraphobic, as we all should, can also explore the four basic identity questions: Who am I? With whom do I identify? What do I believe in? and Where am I going? And aren’t we all examining these?
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