The simple act of stepping outside one's front door is something most take for granted, but for people with agoraphobia, it can be the challenge of a lifetime. In the past, agoraphobics confined to their homes would have suffered in isolation. But now they are alleviating some of their anxiety by connecting with others, through online communities and app-based therapy. Newer technologies like virtual reality could make the process of leaving the house even easier.
Agoraphobics suffer from an anxiety disorder that causes a paralyzing fear of leaving safe environments like home. The National Institute of Mental Health estimates that 0.8 percent of the U.S. population (totaling just over 255,000 people) may have it, and less than half of them are receiving treatment. Within the medical field, treating them has always had an obvious barrier: getting patients to come to therapy sessions.
Dr. Andres Fonseca, a London-based psychiatrist who has worked with agoraphobia patients for over 18 years, first saw the need for innovation after working with a 37-year-old woman who was sent to the hospital after a severe panic attack at the supermarket. After she missed three referrals for treatment, Fonseca went to her home and discovered that she'd also been ignoring a toothache, had lost her job, and couldn't begin receiving disability allowance because she was afraid of leaving the house.
Fonseca decided that aiding her with exposure therapy, in which the patient is exposed to what it is he or she fears in a controlled setting, would be the best treatment, along with anti-anxiety medication. But he then found that the hospital he was working for couldn't accommodate her at-home requirements.
"[They] said, 'Don't even bother referring her; we don't do any home visits. Send her to us when she is able to come to the clinic,'" he told Vocativ.
The encounter left him feeling bad for letting his patient down and forced him to think about how the medical system, designed for the convenience of clinicians, hurt patients like her. This led him to develop an app called "Agoraphobia Free," released in June, which walks patients through simulated situations they're likely to face that are scary.
With the Agoraphobia Free app, patients experience the therapy in a format that mimics an interactive game. The app teaches users about the condition and then employs methods based in the principles of cognitive behavioral therapy, in which patients seek to change their unwanted patterns of thinking or behavior, and desensitization, wherein users are educated on skills for coping with their phobias in advance of facing them. Activities include cataloging goals, attending virtual therapy sessions, and receiving coached breathing exercises.
The therapy appears to be working. A preliminary study from researchers at the University College of London and University of Roehampton that evaluated the effectiveness of the app found that over the course of 12 weeks, symptom severity decreased significantly in the group of 25 subjects that completed the trial.
Virtual reality is another technology that shows promise in treating agoraphobia. In Australia, one researcher has found that patients can benefit from talk therapy combined with virtual reality simulation of outdoor environments, helping agoraphobes change their perceptions in a realistic manner and reduce their anxiety symptoms significantly when out in the real world. Of course, since virtual reality headsets are far from being considered common household items, this technology isn't exactly as accessible as an app that can be downloaded and accessed within the patients' own home.
While new advancements in technology are helping pose ways of experiencing a kind of exposure therapy lite, most of the psychotherapeutic community maintains that there's no real replacement for actually making that step outdoors. To do that, some agoraphobes are also turning to online forums to find motivation from those who share that fear, a natural progression from the Agoraphobics Anonymous hotline that appealed to the homebound in the 80s.
On forums for anxiety disorders like agoraphobia, those working to recover use the platform for commiserating, seeking or sharing tips, and setting up "challenges" in which they hold one another accountable for their own individual goals. On Instagram, people in recovery use the platform in the same way, often documenting their journeys in hopes of helping others.
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Today I walked a little further into the park, basically one road up (or about 220 extra meters) from the other place I've been going. I got pretty anxious (maybe a 6-7, where the urge to run is palpable) while walking up to where I wanted to stop, but oddly enough the anxiety pretty much died down by the time I started my 5 minute timer. I'm happy with my progress today, and it gives me some hope that maybe I can beat this thing if I keep it up. Quitting coffee has definitely helped reduce the number and the impact of my intrusive thoughts. I'm still craving it, but not quite as much as yesterday. #agoraphobiarecovery #agoraphobiachallenge #agoraphobia #panicdisorder
And then there are other, less social ways to use social media platforms in order to prepare for a trip that's inducing anxiety. Wesley, a 27-year-old psychology student from Georgia, said that YouTube videos can help him prepare. He considers himself to be in recovery, having now traveled to several states to attend a bachelor party for which he was the best man and on a vacation with his girlfriend, milestones he hopes can bring solace to others with his condition.
He says that the first-person perspective videos taken by other people driving through the areas he would be traveling in helped address a major trigger of his symptoms.
"A lot of my anxiety when I'm in a particular situation comes from being overstimulated," he told Vocativ. "Being confronted with that feeling in real life is jarring, so seeing it with your own eyes before you get there helps you know what to expect."
While most of these videos were not taken for this purpose, providing Wesley with relief by sheer happenstance, some people with agoraphobia have taken to sharing the videos of their own driving exposure therapy. In addition to a clear view of the open road, these videos are commonly peppered with motivational commentary and upbeat music.
Similar to how Wesley has used driving videos to help him prepare, some agoraphobics like to go on a kind of virtual test run of their planned route for the day by using Google Maps "street view" feature.
"A part of my identity before [my diagnosis] was traveling," Wesley said. "Now I'm finally getting back the feeling of excitement that comes with going somewhere new."
This article originally appeared at Vocativ.com: The tech that's helping people face their fear of going outside