Overcoming agoraphobia is possible, but it requires a deliberate, goal orientated CBT approach with a heavy focus on exposure therapy.
Exposure means gradually facing your fear until anxiety decreases enough to make the situation, at a minimum, tolerable. The treatment of agoraphobia, graded exposure therapy is the most effective intervention. Graded refers to the pace at which the feared situation is confronted which is done is a gradual, deliberate manner.
The Anxiety Institute developed and utilizes a treatment approach termed Exposure-Focused CBT, which is a model designed to make the process more gradual, where treatment begins by deliberate discussion of the anxiety provoking situation (Conversational Exposure), followed by imagining the situation vividly (Guided Imaginal Exposure), prior to exposing oneself to the situations virtually (Virtual Reality Exposure), and in real life (In-Vivo Exposure). The Anxiety Institute’s 4 step process is expanded across social, family, and school domains to assure that the scope of recovery matches the scope of impairment.
There are four essential rules in making EfCBT effective, each of which should be maintained until the anxiety is tolerable.
Rule 1: Repeated Exposures: it is important to practice the exposure in same situation multiple times until the anxiety level (SUDS score) consistently diminishes with repetition. Once mastered, practice the same exposure in a different situation or location. Practice a minimum of 30-60 minutes each day.
Rule 2: Prolonged Exposures: it is important to stay in the anxiety provoking situation long-enough until the fear decreases, typically 30-60 minutes. Allow enough time during each exposure for you to habituate to the situation or the sensation.
Rule 3: Focused Exposures: It is important that the person in the exposure focus
on the situation and sensation as fully as possible. They should not distract, avoid or use safety cues to avoid the discomfort nor should another person “rescue” them from the anxiety as this will interfere with the effectiveness of the intervention.
Rule 4: Monitored Exposures: After each exposure write down your anxiety level during the exposure. Pay attention to patterns. If anxiety has not decreased over a number of repetitions, ask yourself if you are using any of the maintaining factors or distractions. If your anxiety has decreased congratulate yourself.