Welcome back to my How-To series on overcoming the beast that is agoraphobia. In part one we touched on the first steps in recovery – getting educated, writing goals, self-care, and getting a support system together. Now I want to talk about the next steps. Literally. Exposure Therapy, baby!
If the idea of exposure therapy has you breaking out into a cold sweat – good. That’s the plan. (Although, if you’re really not ready for this step yet, then go back to Part One and revisit all the initial steps to getting out of the house) When I was severely housebound and reading up on all the ways of curing agoraphobia, it would always come back to doing some form of exposure therapy. And that really pissed me off, because if I could go outside, then I would go outside, and then I wouldn’t have panic disorder or agoraphobia, would I? It was a shitty catch 22 situation. It was about two years before I started taking exposure therapy seriously, and it was also about two years before I started to get any better. So take it from me: the agoraphobic who now goes outside – exposure therapy is the thing that is going to make you better. As much as it sucks, as much as it seems cruel and frustrating and like the most painful bullshit form of therapy ever, it really is where your wellness lies. You won’t teach yourself that the outside world is nothing to fear unless you stop fearing it. And if that makes you want to stop reading and start googling ‘methods of curing agoraphobia that don’t include exposure therapy’ then go ahead, but maybe you also need to take a look at the lists you made in part one of this process, about why you want to get better. I get it (better than most) that the idea of exposure is terrifying. But that’s why you are where you are – and that’s okay, so long as you’re looking to take steps forward from here. So, without futher waffling: here are the steps you need to take to get some exposure therapy happening.
Pick A Day
Whenever people are going to start something important, they always pick a day to do it. More often than not, it’s Monday – when the craziness of the weekend is over, and there is still time to have a ‘last hurrah’ during said weekend. I don’t know about you, but as a housebound agoraphobic, Mondays for me were no different than Saturdays, or Sundays, or Fridays, or Thursdays…every day blurred into the next because I was never actually doing anything. So with that in mind, if you want to start your exposure RIGHT NOW then go for it! But if you’re more of a traditionalist and want to make it seem properly daunting, then pick an alternate day to start out but for the love of god, stick with it. COMMIT, my friends. Your body and mind is probably going to pull out all the stops on that day to make you feel like you can’t start – you wake up with a headache, or an upset gut, or you didn’t get enough sleep the night before…let’s face it, if you’re looking for a reason not to go outside, you’ll find one. But you’ve picked a day, you’ve committed to the cause, and now it’s time to follow through. Remember, it doesn’t matter how slowly you go, as long as you go.
(Quick note – the following steps are designed for someone who is housebound. If you are a little further on in your recovery, you can obviously adjust the steps to suit your needs. Instead of walking outside, you might make the challenge to go to somewhere that is way out of your comfort zone, and use that as your starting point to build on)
(Other sort-of-quick-note – it might seem as if I have made these steps very basic and also been very ‘nonchalant’ about the whole thing. Two reasons for that – 1. It took me a very long time to write this post because there was a LOT I wanted to say, so in order to save you from reading pages and pages worth, I condensed the steps and kept it to the bare minimum of chatter within said steps, and 2. I don’t want to make this seem scarier than it is. Yes, it feels scary to do exposure sessions. You don’t need me to add any more fear on to that. So when you read the steps please don’t think “oh yeah, day 1 go outside, easy peasy, IF I WASN’T AGORAPHOBIC! Lauren you heartless bitch!” I’ve been there. I know the struggle is very, very real.)
Initial Exposure Sessions: Get outside
On Day 1, the plan should be just to get outside. Stand outside your house, whether on your front porch, your garden, your driveway, wherever feels ‘comfortable’ enough for you – but I use that term loosely as we know there is nothing at the moment that is really comfortable for you. Today, your job is to just stand and observe. Observe the feelings you have, observe the outside world, breathe it in, breathe it out. Give it ten minutes – or longer, if you can. Then go inside and give yourself mad props. You did it. Day one down.
Day 2 should be more challenging. You need to walk two houses away, or the equivalent distance. Let’s say twenty steps. How do you feel? This isn’t so bad. Your house and ‘safety’ is seconds away. You got this.
Day 3 and you’re looking at going to the end of the block. At least fifty steps. Remember to breathe, and take it one step at a time. If you start to feel really overwhelmed, SMILE. You might feel like a doofus but really smiling should bring you back into awareness enough to last the distance.
Day 4 is two blocks. I have faith in you.
Day 5 is to walk two blocks and stay there for at least ten minutes. If you feel like it’s too much, take your phone and play some games on there while you wait, or call someone and have a chat, or just drink in your surroundings. Take note of the trees, the plants – is there any that you can name? Anything in the breeze that you can smell? Anything in particular you can hear? Take the focus OFF your body and keep it on the things around you instead of within you. You are not your anxiety.
After you’ve managed five days of simple walking exposure sessions – you should be cured!
Just kidding. You’ve got some more work to do – but don’t forget to acknowledge your badass self for the butt you’re kicking. (If you have an instagram account, upload a photo with the #badassagoraphobic hashtag a La 1000days1000steps! Let’s start a revolution!)
Now is a good time to go back and check out your goals and desires list that we did in part one. How much closer are you feeling to how you want your life to look? If any other things have come up for you in the last week, write them down. Acknowledge your progress!
So now you’ve mastered walking around your house and the neighbourhood, the next logical step would be to go somewhere specific, like to the grocery store. I have a grocery store and little village of shops about a ten minute walk from my house, so that worked out really well for me in terms of my exposure sessions, but if there is nowhere around you that you can walk to, maybe you will jump ahead to the next step, or keep exploring your neighbourhood until you feel really comfortable (and bored) of that. With a visit to the store, you’re going to keep up the graded exposure, so don’t freak out and think I’m NOT f***** ready for that yet!! Because you got this, my friend! Slowly but steady. Or surely. However that saying goes.
I started out just walking to the store. I’d loiter around outside like a creep, then I’d usually make a visit to the public toilet because I couldn’t go five minutes outside without needing to pee (fun anxiety symptom) and then I’d hurry back home again. Then I started going inside and maybe buying one thing. Then I’d go back again the next day and buy more things. I think on my third exposure session to the store I came home with a mango, a packet of iceypoles, and a block of cheese. I’d literally just grabbed things and checked out as quickly as I could. I always kept my eyes downwards when going through the checkout, because I didn’t want to have a conversation. The key to me finally feeling comfortable at the grocery store, however, was the day I actually did have a conversation with the girl who served me. I was sweating profusely and I don’t think I even made much sense – it was one of those ‘How are you going today?’ ‘No thanks!’ kind of conversations, classic Lauren – but it actually made me feel like a normal, functioning member of society to just have a casual chat to someone while buying my groceries. And the next time I went, I deliberately had a conversation and I could feel my anxiety levels dropping. Now when I’m out, especially when I feel a bit nervous, I go out of my way to talk to someone because it completely distracts me from my panic, and makes me feel like I’m actually apart of the world instead of some nervous wreck having a meltdown on the sidelines. So your mission, should you choose to accept it (which you will) is to have a conversation with a stranger. Either the person at the store, or a passerby…anyone you get the opportunity to say hello to. Even if you immediately feel terrified, force yourself to smile and say hello. The next time you might say something more than hello. Human beings are not solitary creatures, and agoraphobia can be a hell of an isolating disorder, so by conversing with another person you are telling yourself that you don’t need to be alone anymore. We’re all in this shit together!
Exposure Sessions In Transit
The next exposure session might be a little more tricky for those of you who, like myself, have more fear tied to being in a car or bus than being outside. If you don’t have access to vehicle, you might like to try taking public transport instead. I have very little advice to offer on that subject, as I am yet to take public transport myself! My only guidance would be to treat it exactly the same as you would any other graded exposure. Perhaps walk to the bus stop/train station one day, then get on the bus/train and go one stop the next day, then two stops the following day, and so on.
With a car, whether you are going to be the one driving or not, your initial task is to just get comfortable in the car.
So Day 1 would be just spending at least ten minutes in the car without going anywhere. Try and stay in the car until your anxiety fades to a manageable level. (This took only a short amount of time for me, because I knew in the back of my mind that I wasn’t actually going anywhere)
Day 2 is to build on day 1 – so, if you were bored as hell just sitting in the car going nowhere, then your task is to start that car and go for a drive around the block. If you’re still struggling with being in the car at all, then your task today is to just spend more time getting comfortable in the car. Twenty minutes, thirty minutes – however long you can manage.
Day 3 and your task is to drive to somewhere nearby, perhaps a park. You don’t have to get out of the car, but if you do – awesome. The idea is to drive somewhere and stay there for at least twenty minutes. Take something to do if you need to, read a book when you get there, or listen to an audiotape.
Day 4 is similar to day 3, only this time you will be driving to the shops. Either a grocery store, a cafe, a library – wherever is a relatively comfortable distance away, but you need to get out of the car, walk around, even sit down and have a drink if you can. Remember how far you’ve come today, and remember to use all your methods from part one. Utilise your support network, think back to any inspirational material you’ve looked at or read, chat to someone, look around and play the 10 things game – (name 10 things you can hear, 10 you can see, 10 you can smell..etc) use every bit of knowledge you’ve come across so far to propel yourself forward and support yourself. You’re doing great.
Day 5 is to drive somewhere you’ve never been before. You will need to use all your learned skills so far for this one. You’ve come this far, and you’ve survived. You’re doing it! Just make sure (if you are the one driving) that you take it slowly. And if you aren’t the one driving, remember to trust in your driving buddy and know that you are safe. Bonus points if you drive to the new location, get out of the car and have a good look around. Hell, pack a picnic and celebrate. You’ve just done ten days of exposure sessions!
What Happens if I Panic??
If the ‘unthinkable’ happens, which – spoiler alert: it will, you need to know that YOU GOT THIS. If you bail out and run home with your tail between your legs, then that’s okay – so long as you get back out there and try again. For a long time, panic attacks would mean that I’d turn the car around and come home as fast as I could. Sometimes I’d cry the entire day and not go out again for weeks. Bad move, I’d end up housebound again. One time I cried for a few hours, then I got back in the car and drove myself to the place I’d intended to go before I freaked out. That was awesome, because I’d conquered my fear and proved that I could do it.
Another time when I had a panic attack while going somewhere, I couldn’t actually turn the car around and bail without making a seriously bad parenting decision, so I had to keep on going. I rode out the panic attack, and it went away. And that was seriously fucking awesome, because not only did I conquer that fear but I rode the wave of elation and success for long afterwards.
Now I’m annoyed if I don’t have a panic attack when I go out for an exposure session, because it almost feels like a waste of time. If I start to feel panicky when I’m out, I think Awesome. Bring it on. Which then makes the fear leave anyway. Go figure. (Turns out Susan Jeffers knew what she was talking about, after all)
So yes, you will have a panic attack at one point. And initially, your goal will be to not have a panic attack, because that is where your fear lies, and that is why you have panic disorder in the first place, so panic=bad time and I completely, 100% understand that. But so long as you keep on trying, keep on doing exposure sessions, and try to get yourself to the point where you actually have a panic attack and you actually ride it out because you’ve actually come this damn far and you’re actually not feeling so bad after all..! – as long as you keep trying, you are progressing.
As for dealing with panic attacks when they happen, use the floating method, use your 10 things method, use hypnosis tapes, distraction techniques, anything you need to. Eventually you will find that you don’t need to deal with them anymore, because they just become apart of the background noise.
When you have mastered all of these little exposure sessions, you should now have the tools to go forward and try some exposure sessions of your own. You might like to do something that is more fitting towards your life – like, I began exposure sessions when I had a newborn, so going to mothers group and the library for story time and the health centre for the vaccinations were exposure sessions that worked for me at the time. Remember all the lists you made in part one, and think again about how you would like your life to look. What exposure sessions can you do that tie in with the life you want to live? Do you want to start going to art classes? Dance classes? Back to school? Back to work? Traveling? How can you build up to those goals?
My Top Tips For Exposure Sessions:
Add-on exposures when you can – sometimes when I’m out (like after being to the doctors office, for example) I’ll just take the opportunity to drive around, because I’m already out and about. I like to push the boundaries and see if I can drive places that scare me, or places that have otherwise been way beyond my ‘safe area’. If you’re already out and you’re feeling comfortable, see if you can push yourself to feel uncomfortable. These little impromptu trips are really fantastic for proving to yourself that you will be okay in any situation.
Take the long route – It’s easy to want to take shortcuts when you’re nervous. I used to drive like a bat out of hell and I’d always take the quickest way possible to get somewhere because I just wanted to limit the time in the car so that I wouldn’t panic. That was dumb for obvious reasons, but also because I always panicked anyway. Now when I’m driving, if time allows, I take the long way and I deliberately drive slower than the limit so that I can prove (to myself) that there is no hurry, there is no danger. It’s all good, baby.
Don’t listen to your body – this sounds like a shitty statement to make, but this is one of those times when you need to just power through regardless of how you physically feel. You logically know that the panic won’t kill you, but you feel like it will. I think a lot of people with panic disorder border on hypochondria because our bodies tell us in every way possible that there is something seriously scary on the way. Our pulses race, we sweat, we shake, we go numb, we get dizzy, we have palpitations, stomach-aches, headaches, earaches…you name it, we’ve probably thought we were dying from it at some point or another. Your body has began making a learned response to an imaginary danger, so it isn’t wrong, but it isn’t right either. When I get in the car to go out, my stomach starts making weird noises and I immediately think I’m going to be sick and die. I never do, clearly. And when I’m actually at the place I needed to go I forget all about that feeling and I feel fresh as a daisy. My body lies to me, because it’s learned to do so. I now know how to push through that feeling (but it certainly took some practice).
Use your safe guards, until you don’t need to – When I first started doing exposure sessions, I always went out wearing gym clothes. I just felt safer in them. I also had a little bag in my car packed with a bottle of water, a change of clothes, some dried lavender, prescription sedatives, and extra headphones (for my hypnosis tapes). I never went out in the morning, and I would often make sure I’d done a workout beforehand, because it would burn off some of my anxiety and made me feel more confident. Even though doing all this made me feel like a bit of a weirdo, these were my safeguards and the things that gave me extra reassurance that I’d be okay out in the big bad world. I don’t do those things anymore (though I probably still have the bag in my car somewhere) because I no longer need to, but in the initial stages of getting out and about, everything that helped to make me feel safer was a positive. You might have quirks/coping habits/safeguards similar to mine, or maybe yours are different. Some agoraphobics can only handle the idea of going out late at night, or with a friend, or under the light of a full moon, or whatever. It’s all good. If your quirks help you to feel like you can manage getting outside better, then utilise that. Eventually, you won’t need them anymore.
Use Google Maps – Something that I found really helpful in very stressful times, and that severe agoraphobics may find useful is Google Maps street view. The fact that you can virtually walk through a street and see landmarks and houses and roads and cars without having to leave your home is – initially – a very handy tool. I used to use street view to look around shops or carparks to make sure that I knew my way around before I physically went there. I don’t use it anymore so I know I’m progressing, but in the beginning it was a huge help to me. You can even make notes if you feel so inclined. Whatever you need to add to your arsenal to make yourself feel more prepared and ready for fight-or-flight battle, do so.
Make sure you trust your partner – If you are using a buddy or a partner to help you with your exposure sessions, it’s imperative that you discuss some ground rules with them. Make sure they understand your cues, and they know how to help you when you feel like you’re having a panic attack. (Usually for me, this involves my partner-in-crime knowing when to just pipe down and drive me home, no questions asked!)
Make sure that your partner knows not to guilt you if you have a bad session. Everybody is allowed to have a bad day. The important part is to keep trying.
And finally – Good Luck! If you need any words of encouragement, I am always more than happy to help. You can email me or get in touch with me via any of my social media outlets.