Overcoming Agoraphobia and Extreme Anxiety Disorders

Overcoming Agoraphobia & Extreme Anxiety Disorders

After reading Overcoming Agoraphobia & Extreme Anxiety Disorders, youll be given a better understanding of all things related to the condition, so that you dont have to be afraid anymore. If youve been suffering for any amount of time, dont allow yourself to feel hopeless and alone. This problem is more common than you might think and the first step to overcoming any anxiety issue is by learning all you can about it. Find out what causes panic disorders and discover how you can create a different life for yourself starting today. Here are just a few things youll learn by reading this complete anxiety guide: What anxiety is and why it happensHow anxiety can lead to panic disordersWhat agoraphobia is and how to know if youre at riskHow to recognize symptoms of agoraphobia and how to manage itAn overview of the different types of anxiety disordersWhat you can do to improve this condition once and for allHow to fight the root of anxiety and panic disorders stressWhether or not adrenal fatigue is the cause of your problemsHelpful therapy options that have been proven to be effectiveAlternative remedies for stress, depression and panic disorders

Overcoming Agoraphobia & Extreme Anxiety Disorders Summary


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Efficacy Research on Psychotherapy

Agoraphobia Panic with Agoraphobia Anxiety Disorders. A considerable body of evidence has shown that CBT is as effective as, or more effective than, medications in the treatment of the full range of anxiety disorders (cf. Nathan & Gorman, 1998, for a comprehensive review), Agoraphobia (e.g., Chambless, Foa, Groves, & Goldstein, 1979), Generalized Anxiety Disorder (e.g., Barlow, Rapee, & Brown, 1992), Obsessive-Compulsive Disorder (e.g., Fals-Stewart, Marks, & Schafer, 1993), Panic Disorder (e.g., Barlow, Gorman, Shear, & Woods, 2000), Social Phobia (e.g., Heimberg et al., 1998), and Posttraumatic Stress Disorder (e.g., Foa, Rothbaum, Riggs, & Murdock, 1991).

Psychological Theories of PD

Pure behavioral models focus on the fact that panic attacks and agoraphobia are maintained by negative reinforcement. That is, individuals prone to panic attacks and agoraphobia avoid anxiety sensations and situations that may provoke anxiety. This leads to increased sensitization to anxiety symptoms and fuels further avoidance. Support for this model comes from learning theory and animal stud

Cognitive Behavioral Model

The central feature of the cognitive-behavioral model of panic disorder is the patient's catastrophic misinterpretation of events and or somatic sensations leading to feelings of imminent danger associated with panic attacks (Craske, 1988). Patients develop a fear of the somatic sensations associated with panic attacks, considered part of the body's fight-or-flight alarm response. Catastrophic misinterpretations of these sensations include fears of dying (e.g., having a heart attack or suffocating) and fears of losing control or going crazy. Somatic sensations associated with panic attacks come to serve as cues of danger and potential panic via classical conditioning. Thus, increasing anxiety leads to increased fear of somatic sensations, which leads to increasing anxiety in a vicious cycle. Patients become vigilant to the presence of these sensations, increasing the likelihood that experienced somatic sensations will trigger the escalating cycle and panic attacks. These panic...

Cognitive Behavioral Treatment Studies

Very few studies have assessed the efficacy of CBT in addition to antipanic medication. Marks et al. (1993) evaluated the comparative efficacy of alprazolam and CBT, both alone, and in combination in patients with panic and agoraphobia, and found that alprazolam dampened patients' response to CBT. In the recent multicenter treatment trial that extended over 7 years, CBT alone was compared with placebo, imipramine alone, the combination of both CBT and imipramine, and CBT plus placebo for panic disorder (Barlow et al., 2000). In this study, all active treatments produced responses superior to placebo, but the combined treatment cell was not significantly superior to either CBT or imipramine alone after the active treatment phase. However, the combination of CBT and imipramine conferred more substantial advantage than either treatment alone by the end of the 6-month maintenance phase of the study. The major limitation of this important multicenter study is that the patients studied had...

The Primary VersusSecondary Distinction

In the case of alcohol, there exist empirical data to suggest that consistent temporal relationships between substance use disorders and anxiety disorders exist for some disorders or for certain individuals. A recent review on the comorbidity of alcohol abuse and anxiety disorders notes that simple panic disorder has no consistent relationship to the onset of alcohol abuse, whereas panic with agoraphobia usually precedes the onset of alcoholism (7). This temporal relationship suggests that alcohol abuse may not have a causal relationship to uncomplicated panic, whereas patients with panic and agoraphobia may use alcohol to self-medicate.

Psychodynamic Psychotherapy for Panic Disorder

An open trial of PFPP has been completed (Milrod et al., 2001, 2000). In this study, PFPP followed a 24-session, psychodynamic psychotherapy program, delivered twice weekly in 45 to 50 min sessions, over 12 weeks. Twenty-one patients with primary DSM-IV panic disorder entered the treatment trial. Four patients dropped out. Sixteen of 21 patients experienced remission of panic and agoraphobia. Treatment completers with major depression (N 8) also experienced remission of their depression. Symptomatic and quality of life improvements were substantial and consistent across all measured areas. Symptomatic gains were maintained over 6 months. While the sample size in this study was too small to draw firm conclusions, as a result of this pilot research,

Psychodynamic Model of Panic Disorder

Busch et al. (1991) and Shear et al. (1993) developed a psychodynamic formulation for panic disorder based on psychological, clinical, and temperamental observations and studies about panic patients. Beginning with the studies of temperament of Kagan et al. (1990) and Biederman et al. (1990), the authors postulated that panic patients are constitutionally predisposed to fearfulness of unfamiliar situations early in life. This is based in part on Rosenbaum et al.'s (1988) finding that children of patients with panic disorder, who are likely to develop panic, are found to have a high rate of behavioral inhibition. Behaviorally inhibited children manifested long latencies to interact when exposed to novelty, retreated from the unfamiliar, and ceased play and vocalizations while clinging to their mothers (Biederman et al., 1990, p. 21). In addition, children with behavioral inhibition demonstrated higher rates of childhood anxiety disorders (Biederman et al., 1990). Rosenbaum et al....

Panic Disorder Epidemiology and Course

Panic Disorder (PD) (with and without agoraphobia) is a debilitating condition with a lifetime prevalence of approximately 1.5 (American Psychiatric Association ApA , 1994). Studies have demonstrated that this prevalence rate is relatively consistent throughout the world. Approximately twice as many women as men suffer from PD. Although PD typically first strikes between late adolescence and the mid-30s, it can also begin in childhood or in later life. Although data on the course of PD are lacking, PD appears to be a chronic condition that waxes and wanes in severity. Consequences of PD include feelings of poor physical and emotional health, impaired social functioning, financial dependency, and increased use of health and hospital emergency services.

Other Anxiety Disorders Definitions

The DSM-IV diagnostic system includes the following anxiety disorders separation anxiety disorder, panic disorder, agoraphobia, specific phobias, social phobia, obsessive-compulsive disorder, and generalized anxiety disorders, as well as the previously considered posttraumatic stress disorder and acute stress disorder (see Ref. 164 for review). Separation anxiety disorder is defined by excessive and developmentally inappropriate anxiety about separation from parents or other primary attachment figures. Typically less common in adolescents than younger children, a relationship between separation anxiety disorder and adolescent SUD has not been established. Panic disorder and agoraphobia are rare in adolescent samples. Specific phobias are relatively common but probably not a factor in SUD development. Social phobia is nearly as common in adolescent as in adult samples and may influence SUD development and course. Obsessive-compulsive disorder often begins during adolescence, but a...

Demographic Features of the Anxiety Disorders

Anxiety disorders can occur across a wide range of cultures, ages, sexes, and income levels. In most cases, anxiety disorders are more common in women than in men. The more frequent occurrence in women is most pronounced for Panic Disorder with Agoraphobia and certain specific phobias (particularly animals and storms). For other anxiety disorders, such as Social Anxiety Disorder, blood and needle phobias, and Obsessive-Compulsive Disorder (OCD), the differences between men and women are smaller. The typical onset of anxiety disorders varies, with some tending to begin in early childhood (e.g., animal phobias), others beginning, on average, during the teen years (e.g., Social Anxiety Disorder, OCD), and others tending to begin in early adulthood (e.g., Panic Disorder).

The Categorical Versus Dimensional Debate

The selling of DSM. The rhetoric of science in psychiatry. Hawthorne, NY Aldine de Gruyter. Klein, D. N., & Riso, L. P. (1993). Psychiatric disorders Problems of boundaries and comorbidity. In C. G. Costello (Ed.), Basic issues inpsychopathology (pp. 19-66). New York Guilford Press. Magee, W. J., Eaton, W. W., Wittchen, H.-U., McGonagle, K. A., & Kessler, R. C. (1996). Agoraphobia, simple phobia, and Social Phobia in the National Comorbidity Survey. Archives of General Psychiatry, 53, 159-168. Robins, E., & Guze, S. (1970). Establishment of diagnostic validity in psychiatric illnesses Its application to Schizophrenia. American Journal of Psychiatry, 126, 983-987. Spitzer, R. L., Endicott, J., & Robins, E. (1975). Research diagnos

Psychodynamic Model

D, a 45-year-old single woman with health fears and agoraphobia, was referred for treatment. Her history is notable for gastrointestinal distress, numerous negative medical work-ups, fears about serious illness secondary to the gastrointestinal complaints, and secondary panic attacks, which led to agoraphobia. Ms. D's physical complaints emerged shortly after her mother was hospitalized for a chronic debilitating medical disorder. Long the caregiver of her mother and one who had subverted many of her own passions and interests to her mother's needs, Ms. D found that she was no longer able to help her mother, or even to visit her mother, because of her own physical problems, illness preoccupation, and agoraphobia. Puzzled by her own deterioration and a near inability to leave her own home, Ms. D sought treatment. Within the first 10 sessions, it became apparent that Ms. D's relationship with her mother was a difficult one as a result of her mother's lifelong narcissism and...


One line of evidence for a biological etiology of PD comes from studies that demonstrate that panic tends to run in families. These studies have found that approximately one half of all PD patients have at least one relative with PD, that first-degree relatives of PD patients are approximately five times more likely to develop PD than first-degree relatives of normal controls, and that PD and agoraphobia with panic attacks are more than five times as frequent in monozygotic twins than in dizygotic co-twins of patients with PD (Woodman & Crowe, 1995).


Noyes et al. (1986) reported that pharmacologic treatment of 60 patients with panic disorder and agoraphobia resulted in a diminution of panic attacks as well as a significant decrease in hypochondriasis, as measured by the Illness Behavior Questionnaire dimensions of disease fear, disease conviction, and bodily preoccupation.