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I've suffered from severe agoraphobia for over 10 years. For

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I've suffered from severe agoraphobia...
I've suffered from severe agoraphobia for over 10 years. For the last 2 years the only place I've gone is to my Psychiatrist, and in the last 3 months I haven't been able to get to see him due to severe panic attacks. I used to take Xanax for my anxiety and panic and it was effective but when I stopped I did have awful side effects for weeks. My life has gotten progressively worse since then but, he doesn't prescribe anything that can causes dependency. His nurse suggested I get it from another doctor. I can't leave the house. I know there are online companies you can order controlled medications from, but there are legal risks and medication interactions. I'm not sure what I'll do once my refill run out on my other medications. I've become hopeless. They say they care, but they offer no options suggestions or solutions. I live in a small town and there are no other psychiatrists to contact for help. Icant find anyone that will see me online. I live with my 85 year old parents and I feel just awful they have to be burdened with this. People don't understand. The nurse told me I needed to get out and get some fresh air. That's the only treatment I've reactive. Should contact HHS ?
JA: How long have you been dealing with this? Is there anything in particular that seems to make the symptoms better or worse?
Customer: 15 year but it's gotten progressively worse.
JA: Anything else in your medical history you think the psychologist should know?
Customer: At some points I've had various diagnosis everything. Bi polar, anxiety disorder, at one point a doctor had me on 9 different meds a GP, I became delusional and they locked me up for a few days until someone figured out it was a reaction to an anti psych med which I can't take Ok
Submitted: 10 months ago.Category: Mental Health
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Answered in 3 hours by:
1/15/2017
Mental Health Professional: Dr. Mark, Psychotherapist replied 10 months ago
Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5,334
Experience: Dr. Mark is a PhD in psychology in private practice
Verified

Hi, this is Dr. Mark; I'll be glad to help you with this issue.
First let me say that I can imagine how overwhelming and frustrating this situation must be for you. I'm so sorry that you've had such little relief from the symptoms over the years and that they've gotten worse. I want to focus on this in my answer because I am very concerned that you have not been given enough proactive help.

Here's what I mean:

Psychiatry focuses on medications. Medications can be useful for social phobia with agoraphobia. But it can only help in treatment. It cannot be the primary treatment. This is because medications only treat the associated anxiety that accompanies agoraphobia not the phobia itself. Thus, you are left with the underlying problem being untreated. And it sounds as though over the years, in trying to treat you exclusively with medications, they have only made the situation worse. This is because phobia can only be treated by working on the cognitive issues involved. This is usually done with CBT therapy in association with the meds to help the anxiety.

Feeling isolated, unworthy of love and afraid of people and life itself is a part of the phobic disorder and there are also medications that can help with the anxiety you are experiencing so that your therapy work can be more successful and show results more quickly.
I want you to be hopeful. Working with a therapist who is experienced in treating social phobias is often very successful. And you want to get better, which is the most important thing.

This is really what you need to be referred to: ***** ***** or psychotherapist who is familiar with treatment for agoraphobia along with negative self talk and negative self view. You can see, my focus in therapy for you is very practical. I think that has to be the focus of your seeking a referral: an appropriate type of psychotherapy.
I'll give you some techniques you can work on at home to help with the agoraphobia and to get you started. I'll also at the end of the answer give you a behavioral technique to get started with this. You can use this technique throughout the day when you are having anxiety. It is not a cure; it is something you can use to help yourself.
So let's work on the type of therapy you need to undertake to get this phobia under control and managed. That's first. Second, we're going to use the technique I'm giving you at the end of my answer called Progressive Muscle Relaxation. Let's get started:
I want you to picture yourself and other people in a social situation (SS). As soon as the anxiety rises, as you're picturing the SS I want you to start practicing the PMR, okay? It needs to be really familiar to you.
So at first I want you to slowly imagine yourself going to an SS, like going into a restaurant instead of the drive thru. Start at home in your imagination getting ready to go, then going out the door, getting into the car, driving or riding, getting out of the car, going in the door. Get the idea? Step by step.
And with each step, you pay close attention to what you're feeling. And when you feel anxiety, you do your PMR. And you tell yourself your feel good statement: It will soon be over and I can go have a treat. (Whether that treat is relaxing on the couch, an iced coffee, whatever.) You can make your own feel good statement. It just has to be something that makes you feel a little brighter.
Then you continue with the imagining of the steps. You keep going until you've imagined all the way to leaving the SS. This may take a few times or a lot of times before you can imagine all the different steps without having overwhelming anxiety. But keep working at it. This is phobia work.
If there's a function or event coming up that you can use for this, even better. Or use it to actually go inside a restaurant first. Because as you can imagine: the next step will be to not just imagine the SS but to actually go. And to do your PMR in the car, etc. as you are actually having the experience. And then eventually, you will become less and less anxious as you gain experience with this.
This is what you will be doing with a psychotherapist to help with this.
If your doctor isn't able to refer to anyone, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list CBT therapy in their orientations and anxiety disorders as one of the areas they work with.

http://therapists.psychologytoday.com/rms/
Okay, that should help you get working on these symptoms and get her some relief.
I wish you the very best!
Now, I want to give you a tool to use for when the anxiety is present for you. It is quite easy to do almost anywhere. My patients suffering from anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.
I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety states is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?
My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, ***** *****

INSTRUCTIONS:
1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
5. Continue down your body, repeating the procedure with the following muscle groups:
o chest
o abdomen
o entire right arm
o right forearm and hand (making a fist)
o right hand
o entire left arm
o left forearm and hand (again, making a fist)
o left hand
o buttocks
o entire right leg
o lower right leg and foot
o right foot
o entire left leg
o lower left leg and foot
o left foot
6. for the shortened version, which includes just four main muscle groups:
o face
o neck, shoulders and arms
o abdomen and chest
o buttocks, legs and feet
Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.
What You Need:
• A comfortable place.
• Some privacy.
• A few minutes.
Again:
My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, ***** *****

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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5,334
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