The process of recovering from a panic disorder and agoraphobia is straightforward, but difficult. The affected individual has to experience panic attacks over and over again, purposely, and then remain in the threatening situation long enough for the panic attacks to go away. There are different ways of provoking a panic attack, such as by inhaling carbon dioxide which causes shortness of breath, but our practice at the Anxiety and Phobia Center at White Plains Hospital is simply to place the phobic person repeatedly in those situations in which he, or she, is likely to feel trapped and, therefore, more likely to feel panicky. Inevitably, sooner or later, that person does become panicky. If he, or she, can be persuaded to remain in the phobic situation until the panicky feelings subside, the condition will evaporate. But that situation needs to be replicated many times before that feeling is seen to be just that, only a feeling. The panicky person does not lose control. Usually, this treatment is prolonged and involves the phobic person going further and further into the phobic situation. One example, would be a person who is afraid of driving first driving in a driveway or around a block, and then in the streets of the neighborhood and, finally, on a highway and then farther and farther along the highway. Panic attacks will occur unpredictably along the way.
Sometimes the phobic person will arrive at a place or a set of circumstances beyond which he, or she, seems unable to go—at least, temporarily. These are called “stuck points.” Stuck points can be overcome by coming at the phobic situation in a different way. For instance, if the phobic cannot get past a particular intersection, approaching that intersection from a different direction may work. Sometimes just stopping and waiting before entering a particularly difficult phobic situation, such as crossing a bridge, makes it possible eventually to drive across.
This is advice I give phobics towards the end of treatment:
Having dealt with your anxious feelings over and over again, you may find yourself more or less calm during these ultimate trials. You may no longer be phobic, but until you go past the last obstacle, you cannot be sure. Is it necessary for someone afraid of heights to throw himself out of a plane skydiving or, short of that, climb a mountain? No. These are activities far removed from ordinary life. They are potentially dangerous or likely at least to become unpleasant for reasons having nothing to do with a phobia. Similarly, one need not drive on icy roads, walk through bad neighborhoods, hang out a window, hurtle up and down a roller coaster, handle poisonous snakes, juggle on television, or ride in a submarine. However, do not try to convince yourself that there is a danger looming in front of you when you really know there is none.
Try to be open in your relationships with others. You may not be phobic, but like the rest of us you still have weaknesses and occasional failures. Try not to hide them, for then you will be hiding from them. You cannot become the kind of person you would like to be without first accepting yourself the way you are. Try to express your feelings openly. If the panic attack represents a welling-up of unconscious impulses, expressing them in an appropriate way should lessen their severity. But saying what is on your mind should not require special justification. It is the only way others can know what you want and need. Even more important, perhaps, speaking freely is one way of finding out who you really are; and it is the final standard of true independence: being able to state your opinion and your wishes no matter who is present and no matter what they may think.
Remember the goal should be: to live an independent, assertive and joyful life.
Excerpted from “Fighting Fear. An Eight Week Guide to Treating Your Own Phobias” By Fredric Neuman M. D., Director, The Anxiety & Phobia Treatment Center. © Fredric Neuman Follow Dr. Neuman's blog at fredricneumanmd/blog/