Other Agoraphobia -- exposure doesn't help

[afuneralinmybrain]

Hello! All the agoraphobia threads on here are so old. Anyway, I have terrible agoraphobia. I feel like I'm about to die as soon as I step outside. My therapist tells me to get out and I do. I go to college. Two classes two days a week. Well, it's Christmas break, so not right now.
I've been taking classes and getting out like this for years. My agoraphobia never feels any better. Even if I'm out for 8 hours one day, go out again the next. I'm always afraid. I'm starting to feel so hopeless. Every time I'm out, I have a huge panic attack. And I somehow manage to function a bit at that panic level. All through class I'm shaking and wanting to run away, stuttering and suffering for hours and hours. No amount of exposure helps.
So.
Anyone with similar experiences? Or just agoraphobia talk? I feel so alone lately.

 

[Nam]

https://www.myptsd.com/threads/ptsd-and-agoraphobia.14083/

This is a thread back in 2010, but I still think the info is relevant. Go to post 22. Anthony states exactly what I think might be going on.

 

[anthony]

I was just going to say something similar... in that it sounds to me that you haven't processed the underlying issues yet, and really what you're doing is jumping forward steps that will retraumatise you. You must process the aspects of why you're scared, and resolve those first. Once armed with rational logic and tools to counter the irrational logic that is creating any fear, you will progress much better with actual exposure to the world... but even then, you do it progressively. You obviously need your schooling, so that is more of a non-choice for you, and we all have those aspects in our lives.

I would start at the underlying factors, then try and get through the college days and recover, then use one or two days prior to college to slowly work on exposure to life, giving you far more control. You can then progress to using your college days to enhance your progression by changing and performing tasks to suit, bringing a positive outcome to your experiences with rational logic.

 

[sun seeker]

I was going to say something similar to what Anthony said already, though with the caveat that there are many different ways of processing, from the method suggested above through EMRD, somatic experiencing, art therapy, and so on. Just one other thing to add: exposure therapy is supposed to be gradual and supported. Maybe we don't have all the information here, but from what you've told us it sounds more as if your therapist is throwing you in the deep end. Exposure therapy goes more like this: you identify the minimum level of going out that brings on your symptoms, whether it's going to university or just sticking your head out the door. From what you write, you might need to start with just getting dressed to go out. First, your therapist goes with you and supports you while you do the minimum needed to bring on symptoms, but not so much so that they overwhelm you. You repeat that level of exposure over and over. Then you move on to the next level, maybe sitting in a restaurant or talking to someone. Again you do that over and over with support. Only after it is easy to do with support do you move on to the same steps on your own. Baby steps with support and the chance to process at every step. I've never heard of a successful therapy regimen where someone was told to just jump in and do something they are afraid of to a crippling degree.

Do you know what caused your agoraphobia to begin? Do you have anxiety problems in other areas of your life, or just that one? Do you know what you are afraid of, or is it more of a free-floating fear? These are all important things to consider before finding the best way to treat the problem.

 

[afuneralinmybrain]

Thanks. I am wondering why my therapist hasn't mentioned this. He's the best therapist I have ever had and has been practicing with a PhD for over 30 years. He's constantly saying, "Get out more! Do it; just do it! Come on!!" And then he gives me Zen confidence boosters and we talk abut my symptoms, but I need more. He is telling me now to take another class at college next semester. Steps and all that.

I think I know the root of my problem, though. I can't control anything outside. Inside, I have a modicum of control. I don't like feeling out of control. I get the deer in the headlights feeling constantly. I feel derealized 24/7. My first memory is my father abusing my mother and me not being able to move from sheer fear. I have control issues. I've been in therapy since I was 3. Damn, I should be ABLE to deal with this crap. I'm 22 years old. That's 19 years of therapy. You'd think I'd have things under control. I've even been homeless. I've been in shelters so much. WHY can't I have control? I feel like such a loser sometimes. I'm sorry; I'm crying at the moment.

It's not fair. Nothing about it is fair.

 

[scout86]

WHY can't I have control?

At the risk of saying something that you're going to find truly alarming, you can't have control because that isn't the way the world works. It's just NOT. It would be nice, I guess, to think we could control things. It would also be a lot of work and a lot of responsibility. What you CAN control is YOU. (As @anthony keeps saying lately!)

I don't pretend to know anything about agoraphobia, beyond that it doesn't sound like much fun. But, if you're trying to deal with it by controlling things you can't control, it's not going to work. You might need to find a different approach.

 

[anthony]

Unfortunately a PhD and 30 years experience doesn't equal a quality therapist for PTSD or trauma. Let alone treating all kinds of problems. Therapists quite often are specialists and excel within certain strengths, just as we all do in life. There is no such thing as a mental health expert across all fields, because the variety and specialities are so vast that even psychiatrists typically specialise within certain demographics of mental health. Whilst they can treat all, it doesn't make them good at treating all issues.

 

[aka]

I totally understand having Agoraphobia. I don't have really bad agoraphobia but it is still hard to deal with sometimes. I sometimes get really frighten when I think of going outside the house and it takes a lot of energy to accomplish that. This has been going on for years so me keep going out does not seem to be helping. I do notice that once going to a place becomes a routine (like work) it does get easier. But going out to do shopping which is done when needed is very hard to do some days.

 

[risingsun]

I go to college. Two classes two days a week.

Good for you for pushing yourself to get out. But do it at your pace and not what someone thinks you should be doing.

I know how hard it is and how little it is understood. I am a caregiver for an agoraphobic and nobody seems to understand it at all or acknowledge the severity of it.

It seems like you are getting out "at your own pace" so reward yourself for the small steps you have taken and continue to take. I commend you for even doing all that you have been doing. You are never alone my friend. My prayers are with you. No Fear. Things always get better. There are no permanent situations in life. Warmest, Rising Sun.

 

[sun seeker]

That's 19 years of therapy. You'd think I'd have things under control.

Not if you haven't had the right kind of therapy. If it had been the right kind, there's no way it would have taken 19 years. I can totally sympathize with the frustration that comes of doing what seem like all the right things to heal yourself but not getting results, but the thing is, you have to choose carefully what therapies you engage in and not go with whatever is most available out of desperation. (I don't know that you have done this without more information - just saying the problem seems to be with the kind of therapy more than the amount.)

A therapist who tells you to "just get over it already", which is what it sounds like he is doing, is not much of a therapist in my opinion. If you could do that, you wouldn't need to be in therapy, right? No matter his 30 years experience and his credentials, he may be good for some kinds of problems but he doesn't sound as though he has any idea how to conduct trauma therapy. He doesn't even sound as though he knows what exposure therapy is supposed to look like, which seems odd if that is what he is claiming he is doing by telling you to just go out. In other words, it sounds to me as if the reason it has taken so long and exposure therapy hasn't worked, is because you haven't yet begun doing exposure therapy!

Is it possible for you to find a different therapist who specializes in trauma? If you decide to pursue this, the approach I described is called "graded exposure therapy" as opposed to "flooding". Both are recognized methods, with more people preferring the former, for obvious reasons. Even so, it doesn't sound as though what he's having you do is real exposure therapy. The purpose of exposing yourself to the trigger is to retrain your amygdala into not recognizing it as dangerous. To do that, you have to stay with the trigger until you feel calm, rinse and repeat. Just telling you to go out without any further instructions is not therapy - unless there is more to this that you haven't told us yet?

 

[afuneralinmybrain]

No no no, my therapist is the best. I couldn't live without him. He's like the father I never had. And he does specialize in PTSD. He is not telling me to get over it. He tells me I will NEVER be cured, but I can learn to maintain and deal better. He wants me to expand my coping skills.
Also, I only developed agoraphobia about 4 years ago. But I've had the panic disorder all my life.

 

[sun seeker]

Our posts crossed as I was editing. Okay. Sorry if I sounded a bit harsh about your therapist. But is he leading you through the graded steps as outlined?