A phobic disorder is marked by a persistent and irrational fear of an object or situation that presents no realistic danger. Agoraphobia is an intense, irrational fear or anxiety occasioned by the prospect of having to enter certain outdoor locations or open spaces. For example, busy streets, busy stores, tunnels, bridges, public transportation and cars. Traditionally agoraphobia was solely classified as a phobic disorder. However, due to recent studies it is now also viewed as a panic disorder. Panic disorders are characterised by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly (Weiten, 1998).
For a person diagnosed with agoraphobia, there are a number of restrictions and consequences associated with the disorder. A serious consequence is the incidence of severe and paralysing panic attacks. In the early stages of agoraphobia people suffer recurring panic attacks when in certain public places or situations. These attacks cause the person to feel generally uncomfortable in public settings. Eventually, fear of the recurrence of the panic attacks results in an obvious reluctance or refusal to enter all situations associated with the attacks.
Other consequences of agoraphobia may include fear of being alone, fear of being in places where escape might be difficult, feelings of helplessness, dependence on others and depression. These consequences place many serious restrictions on a person with this disorder. Agoraphobia causes people to restrict their activities to smaller and smaller areas in order to avoid crowds, and open and public places or situations. This may finally lead to the inability of a person to leave their home without suffering a panic attack.
As with all other phobias, agoraphobia is often acquired through classical conditioning. Classical conditioning is a type of learning in which a stimulus acquires the capacity to evoke a response that was originally evoked by another stimulus (Weiten, 1998). Describing and explaining exactly how agoraphobia is acquired can be achieved by identifying the antecedents of the phobia. Antecedents are the events that precede a particular response. In the case of agoraphobia, this response is a panic attack. Agoraphobia is essentially anxiety of three kinds, phobic anxiety, panic anxiety (the panic attacks), and phobic anxiety, which is worry about the panic attacks returning. However, it is the panic attacks that form the basis of the phobic disorder. Agoraphobia starts suddenly with an unexpected panic attack. This usually strikes while the person is outdoors. This is likely to cause the person to avoid the situation or place where the original panic attack occurred. The panic attacks then begin to occur more frequently, and once they begin to happen monthly or more often, it is likely that the full agoraphobic pattern will emerge. The reason why these initial panic attacks occur is not known, but stress is a major factor in the majority of cases. The antecedents of the panic attack response of agoraphobia are simply the four key elements in classical conditioning. One of these is the unconditioned response (UCR). The UCR is an unlearned reaction to an unconditioned stimulus that occurs without previous conditioning. In the case of agoraphobia, the UCR would be a panic attack. The unconditioned stimulus (UCS) is a stimulus that evokes an unconditioned response without previous conditioning. In the case of agoraphobia, the UCS would be the situation the panic response first occurred in, for example, a busy street. The conditioned response (CR) is a learned reaction to a conditioned stimulus that occurs because of previous conditioning. In agoraphobia, this would be the panic responses of fear and anxiety. The conditioned stimulus (CS) is a previously neutral stimulus that has, through conditioning, acquired the capacity to evoke a conditioned response. In agoraphobia, this would be the situation the panic response first occurred in. The conditioned stimulus is then paired with the unconditioned response to elicit the conditioned response of fear and anxiety (Weiten, 1998).
Just as classical conditioning can lead to the acquisition of agoraphobia, classical conditioning techniques can also be used to eliminate or extinguish it. The technique by which agoraphobia can be extinguished is called systematic desensitisation. Systematic desensitisation is a behaviour therapy used to reduce phobic people’s anxiety responses through counterconditioning (Weiten, 1998). This technique involves the person being exposed to the situation or place that frightens them, in order to overcome their anxiety. Systematic desensitisation includes three steps. The first step is to help the person construct an anxiety hierarchy. An anxiety hierarchy is a list of stimuli related to the specific source of anxiety, in this case being in a busy public place. The stimuli are ranked from the least to the most feared or avoided. An example of an anxiety hierarchy for someone with agoraphobia might include:DegreeOf fear5Getting out of bed.
10Leaving the bedroom.
15Standing behind the front door of the house with someone else.
20Standing behind the front door on my own.
25Opening the front door and looking outside with someone else.
30Looking out of the front door on my own.
35Walking through the front door and standing outside with someone else.
40Standing outside the front door on my own.
45Walking away from the front door towards the street with someone else.
50Walking towards the street on my own.
55Approaching the street with someone else.
60Approaching the street on my own.
65Entering an empty street with someone else70Entering an empty street on my own.
75Walking down an empty street with someone else80Walking down an empty street on my own.
85Entering a busy street with someone else.
90Entering a busy street on my own.
95Walking down a busy street with someone else.
100Walking down a busy street on my own.
The second step in systematic desensitisation involves training the person in deep muscle relaxation. The person must know how to completely relax in order to complete the third and final step of systematic desensitisation. The final step is for the person to work through the experiences in the hierarchy. The person learns to remain relaxed while imagining each stimulus. Starting with the least anxiety-causing stimulus, the person imagines the situation as vividly as possible while remaining relaxed. The person must be able to imagine a scene with little or no anxiety. Once a particular scene is overcome, the person is allowed to move on to the next stimulus situation in the hierarchy. This process is concluded when the person has been actually exposed to the feared situation. Once a person has conquered all of the imagined phobic stimuli, they are encouraged to confront the real stimuli. Usually these real life confrontations prove harmless and the agoraphobic pattern has been broken (Weiten, 1998).
The procedures leading to the acquisition and elimination of agoraphobia are based on a number of behavioural principles. The underlying principle is that of classical conditioning. Classical conditioning is a type of learning in which a stimulus acquires the capacity to evoke a response that was originally evoked by another stimulus (Weiten, 1998). Eliminating agoraphobia is basically achieving self-control through behaviour modification. Behaviour modification is systematically changing behaviour through the application of the principles of conditioning (Weiten, 1998). The specific principle used here is systematic desensitisation. The two basic responses displayed are anxiety and relaxation, which are incompatible responses. Systematic desensitisation works by reconditioning people so that the conditioned stimulus elicits relaxation instead of anxiety. This is called counterconditioning. Counterconditioning is an attempt to reverse the process of classical conditioning by associating the crucial stimulus with a new conditioned response (Weiten, 1998). This technique’s effectiveness in eliminating agoraphobia is well documented.
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