Symptoms of agoraphobia (physiological, cognitive and behavioral)

Let's see what signs and symptoms people affected by this psychological disorder show.

Can you imagine being afraid to go out alone in the street? Experiencing constant worry and fear about the possibility of suffering an anxiety attack? Being unable to take a bus to work or go to a shopping mall to buy a gift for your child?

Well, this is what daily life can be like for a person suffering from agoraphobia.

What is agoraphobia?

Agoraphobia, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), is the occurrence of anxiety in places or situations in which it is very difficult to escape from, or where help cannot beor where it is not possible to receive help in the event of an anxiety attack.

The situations before which this fear or intense anxiety appears can be:

• Public transportation.
• Open spaces.
• Closed places.
• Standing in line or in the middle of a crowd.
• Being away from home alone.

The psychologist from Malaga Ana Claudia Aldaof the cabinet Psychologists Malaga PsicoAbreu, points out that the fear that appears in the agoraphobia is not a specific fear to the situations, if not that it is a fear to the fear. That is to say, it is the fear of experiencing the symptomatology of anxiety and its possible consequences.

Therefore, the fear and anxiety that appears is disproportionate and excessive compared to the real danger posed by such situations.

Types

Agoraphobia can appear in the following forms:

• Anxiety disorder with agoraphobia.. The person has suffered anxiety attacks on several occasions and, in addition, is worried about the occurrence of another crisis and its possible consequences.
• Agoraphobia without history of anxiety disorder.. A panic attack has never appeared, but agoraphobia appears because of the fear of developing symptoms that resemble a panic attack.

What are the characteristic symptoms?

The most common symptoms in agoraphobia are the following.

At the physiological level. changes appear such as:

• Hyperventilation.
• Choking sensation.
• Palpitations.
• Chest pain.
• Dizziness.
• Sweating.

At the cognitive levelAt the cognitive level, there are anticipations related to the possible occurrence of an anxiety crisis, as well as concerns about its possible physical consequences (heart attack, not being able to breathe, etc.), mental (loss of control, going crazy, etc.) and social (others thinking that the person is crazy).

At the behavioral levelAt the behavioral level, the person tends to avoid the feared situations or face them, but with a high emotional discomfort. It is common to find safety behaviors that help to endure the discomfort, such as, for example, being accompanied, taking medication or always carrying water with you.

Vulnerability and maintenance factors

There are different variables related to the development and maintenance of agoraphobia that facilitate the understanding of this phenomenon.

Vulnerability factors

• Genetics and temperament. Neuroticism or predisposition to experience unpleasant emotions in the face of stressful stimuli appears as the trait most associated with the development of anxiety problems.
• Sensitivity to anxiety. It refers to the belief that anxiety and its symptoms can have negative physical, psychological and social consequences. This characteristic determines the appearance of the fear of fear referred to above.
• Interoceptive awareness. People with agoraphobia have a high awareness of their own physical sensations, as well as a good ability to detect them.
• Onset of panic attacks. When agoraphobia presents with anxiety attacks, agoraphobia usually appears as a consequence of the fear experienced during the attacks. The worry of not knowing if it will appear again or if he/she will be able to cope with it, leads the person to the development of agoraphobia.

Maintenance factors

• Interoceptive conditioning. Due to previous experience, the person experiences any physiological change as the beginning of a distress crisis. Thus, physical sensations that may resemble anxiety (sexual arousal, physical exercise, etc.) arouse an emotional response of autonomic activation that facilitates the onset of another attack.

• Catastrophic interpretation of bodily sensations. The person interprets any somatic sensation as a symptom of the occurrence of a crisis. Thus, the belief that anxiety will have negative consequences (anxiety sensitivity) favors this catastrophic interpretation.

What is the most appropriate intervention?

Cognitive-behavioral psychological treatment has shown great efficacy.becoming the main line of intervention.

There are two intervention programs within the cognitive-behavioral current that have obtained great results. Both use very similar cognitive and behavioral techniques, but differ in their conceptualization of the problem.

1. Cognitive therapy program for Clark's panic disorder

This program is based mainly on the idea that the main factor maintaining the problem is the catastrophic interpretation of bodily sensations. of bodily sensations. All the techniques used in this program are aimed at restructuring catastrophic beliefs about physical sensations.

2. Barlow's Panic Control Treatment Program

In this case, priority is given to habituation to interoceptive sensations in order to eliminate existing interoceptive conditioning through exposures. conditioning by means of exposures. Like the previous one, it also works on the restructuring of catastrophic beliefs based on the exposures made.

Bibliographical references:

• American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington D. C.: American Psychiatric Association.
• Barlow, D. H. and Cerny, J. A. (1988). Psychological Treatment of Panic. New York: Guilford Press.
• Barlow, D. H. and Craske, M. G. (1989). Mastery of your anxiety and panic. Albany, New York: Graywind Publications.
• Barlow, D. H. and Craske, M. G. (2007). Mastery of your anxiety and panic (Workbook) 4ª edition. EEUU: Oxford University Press.
• Clark, D. M. (1989). Anxiety states: panic and generalised anxiety. In K. Hawton, P. M. Salkovskis, J. Kirk Y D. M. Clark (Eds), Cognitive therapy for psychiatric problems: a practical guide. Oxford: Oxford University Press.
• Salkovskis, P. M. y Clark, D. M. (1991). Cognitive therapy for panic disorder. Journal os Cognitive Psychotherapy, 5, 215-226.
• Vallejo, M. A. (2016). Manual de terapia de conducta. Madrid:Dykinson.