Beating Agoraphobia and Unemployment

Dear Arthur,
My emotional state has reached to a critical point. I have been taking anti-anxiety drugs for the last 20 years.

I’m unemployed, almost running out of unemployed insurance coverage, which means that soon I will have no financial resources left. I do have some savings that will allow me to pay for your fee.

Let me explain to you why I feel skeptical toward a scientifically unknown (Rowshan) method which could be complementary to my pharmacological treatment that during the past 20 years was supposed to help me. But it did NOT help me feel free because I continue to suffer from anxiety and agoraphobia. I can cope with the situations that cause me anxiety, but almost always I avoid them which increases my fears. I know I shouldn’t but I can’t help it and I don’t know what to do.

If you believe that you can help me, please do so. I trust honest people like you. Help me!
Yours truly,
John


On receiving this email from John, I replied that I could indeed help him. He immediately made an appointment to see me.

John was a big tall man in his forties. He said that over the past 20 years he had suffered from agoraphobia, panic attacks, fear of driving, of being alone and of dying. He also said that he had doubts about his health and he was probably a hypochondriac because he had gone to see several doctors and specialist to rule out a heart condition. Of course all the doctors had confirmed the psychiatrist’s diagnosis that he had anxiety. But John was not convinced. He suspected that he actually had a heart problem that could lead to his death.

He would go out of the house to take his daughter to school but when he did, he followed a precise route in order to always maintain a hospital, a doctor’s office or a health clinic nearby – just in case he had a panic attack. His worst panic attack occurred in a crowded sports stadium when a soccer player failed to make an easy goal! He felt like he was going to have a heart attack and became very scared. This episode added to his fears and made him worry about dying of an anxiety attack.

I learned that John had been on anti-anxiety medication for two decades and was attending regular psychotherapy sessions. The psychologist provided by social services would see him once a month and would give him advice. However, neither the medication nor the psychological advice had helped him overcome his fear and anxiety.

I talked to him about his own efforts to improve his condition.

“You tell me that you avoid all the situations that might cause you anxiety or provoke a panic attack. Whenever you cannot avoid these situations and places you ask for help from your wife and family members. You do these things because you are very much afraid of having a panic attack, of being anxious and fearful. These things are like an army of darkness that can assault you at any moment and in any place. They are ruthless and cause you terror.”

I used this imagery because he said that he had lost ‘his battle with life’ and was a weak man unable to live a normal life.

“You have become weak and feeble while your fears have grown. You say that 20 years ago you became afraid of being alone in open places, and gradually you became afraid of more things and situations such as driving and dying. As you can realize, over the years this army of darkness has grown in size and strength.”

This imagery caught John’s attention because he felt he was at the mercy of his fears. Then I gave him a task to do until our next session:

“For the next seven days I want you to think of yourself as a beaten hero. You are like a soldier of light that has been fighting with the army of darkness for 20 years. However, even though they have been attacking you and making you suffer much, they haven’t been able to defeat you completely. You are not dead. You are still alive. You are still on your feet, maybe weaker, but not dead. So you are some kind of a hero fighting against a horde from the darkness.”

traffic agoraphobia
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I paused before continuing.

“I want you think about how this small army of darkness has grown in size and strength. After all, as you explained. The fear has evolved into multiple phobias. So I want you to consider the possibility that whenever you avoid showing up at the battlefield, you make your enemy stronger. Whenever you hide or run away from confronting theses demon-like combatants, you become weaker and in turn make them stronger. I’m not asking you to stop avoiding situations or stop asking for help because you are not ready yet. I just want you reflect on this: whenever you avoid the battlefield and run away you are feeding this army of darkness.”

I also gave John a simple task to carry out in order to know exactly where her felt his fear the most. A week later John came back and said that he was hopeful that I could help him. He said that whenever he avoided a place or a situation he recalled the imagery of ‘feeding his enemy’. He had developed a new fear: he was becoming afraid of making his condition worse than it was. Even though he still had his fears (after all, just seven days had passed), he felt confident that there was a solution.

I explained to him that there are two kinds of fears. There is fear that limits us. This is the case when we become afraid of fear itself. He identified with this because any phobia, especially agoraphobia and panic attacks, is simply fear of fear. However, I told him that there is a second category of fear that is not negative. Being afraid of worsening your life through avoidance is actually a good fear because it helps you to avoid avoiding.

“I thought about what you told me”, John said, “about me being a hero and feeding my fear: the army of the darkness.”

“Yes, a hero that avoids his battles becomes weak”, I added, “When we do not use our muscles, they become atrophied. You know much about anxiety, fear, panic attacks and agoraphobia. You have read everything you could find on these subjects. You have been in psychotherapy for many years.”

“Yes, the psychologist suggested that I learn all these details. He said this information would help me realize that my fears are irrational.”

“Has your knowledge about your fears and anxiety helped you feel better?”, I asked.

“No!”

“As you have discovered by your own experience, knowing that your fear is irrational does not necessarily lead you out of the labyrinth of fear and anxiety. What can change your condition is not knowledge. It is action.”

“You mean I should force myself to go to those places that scare me?”

“No. I don’t mean that you should expose yourself to your fear. You are not ready yet. Soon, but not now. Avoiding avoiding is the kind of action I’m talking about. And you have started to take action by putting fear against fear itself. This is also action that will lead you to freedom.”

He had followed my instructions and had realized, to his surprise, that his comfort zone in his hometown was larger than he thought. In the following weeks, I gave more tasks and exercises for him to perform. His anxiety and the frequency of his panic attacks diminished as a result.

Then it came time for him to drive. So far he had taken trains and buses to come to see me. This decision also coincided with a job opportunity. But he was afraid of the interview. I helped him to show up at the interview and got the job. He was to start the new job in three weeks but he needed to drive.

So we began to work towards this goal. I gave him more exercises and specific tasks which allowed him, in three weeks time, to drive and began his new job. John still got scared once in a while but was able to go places he would have never imagined possible before coming to ask for my help.

In the following weeks, John’s self-esteem and self-confidence increased gradually as he drove to different places and managed to fare well in situations and places that had caused him terror and panic before. At the beginning of our last session he came and reported that he was feeling well and happy. Once in a while he would get nervous but was able to overcome it in matters of minutes.

I reassured him that a life without anxiety was impossible. We all need anxiety because it is a much needed and natural mechanism that prepares us for action. Under stress and in new and challenging situations, getting a rush is normal and healthy. The goal is not to erase anxiety from our lives, rather it is to learn to use it to our advantage.