Medicine:Agoraphobia

From HandWiki
Short description: Anxiety disorder
Agoraphobia
Agora of the Competaliasts 01 (cropped).jpg
An ancient agora in Delos, Greece—one of the public spaces after which the condition is named.
Pronunciation
SpecialtyPsychiatry, clinical psychology
SymptomsAnxiety in situations perceived to be unsafe, panic attacks[1][2]
ComplicationsDepression, substance use disorder[1]
Duration> 6 months[1]
CausesGenetic and environmental factors[1]
Risk factorsFamily history, stressful event[1]
Differential diagnosisSeparation anxiety, post-traumatic stress disorder, major depressive disorder[1]
TreatmentCognitive behavioral therapy[3]
PrognosisResolution in half with treatment[4]
Frequency1.9% of adults[1]

Agoraphobia[1] is a mental and behavioral disorder,[5] specifically an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape.[1] These situations can include public transit, shopping centers, crowds and queues, or simply being outside their home on their own.[1] Being in these situations may result in a panic attack.[2] Those affected will go to great lengths to avoid these situations.[1] In severe cases, people may become completely unable to leave their homes.[2]

Agoraphobia is believed to be due to a combination of genetic and environmental factors.[1] The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger.[1] In the DSM-5 agoraphobia is classified as a phobia along with specific phobias and social phobia.[1][3] Other conditions that can produce similar symptoms include separation anxiety, post-traumatic stress disorder, and major depressive disorder.[1] The diagnosis of agoraphobia has been shown to be comorbid with depression, substance abuse, and suicide ideation.[6][7]

Without treatment, it is uncommon for agoraphobia to resolve.[1] Treatment is typically with a type of counselling called cognitive behavioral therapy (CBT).[3][8] CBT results in resolution for about half of people.[4] In some instances, those with a diagnosis of agoraphobia have reported taking benzodiazepines and antipsychotics augmentation.[6] Agoraphobia affects about 1.7% of adults.[1] Women are affected about twice as often as men.[1] The condition is rare in children, often begins in adolescence or early adulthood, and becomes less common in old age.[1]

Etymology

The term agoraphobia was coined in German in 1871 by pioneering German psychologist Karl Friedrich Otto Westphal (1833–1890), in his article "Die Agoraphobie, eine neuropathische Erscheinung." Archiv für Psychiatrie und Nervenkrankheiten, Berlin, 1871–72; 3: 138–161. It is derived from Greek ἀγορά (agorā́), meaning 'place of assembly' or 'market-place' and -φοβία (-phobía), meaning 'fear'.[9][10]

Signs and symptoms

Agoraphobia is a condition where individuals become anxious in unfamiliar environments or where they perceive that they have little control. Triggers for this anxiety may include wide-open spaces, crowds (social anxiety), or traveling (even short distances). Agoraphobia is often, but not always, compounded by a fear of social embarrassment, as a person experiencing agoraphobia fears the onset of a panic attack and appearing distraught in public. Most of the time they avoid these areas and stay in the comfort of their haven, usually their home.[1]

Agoraphobia is also defined as "a fear, sometimes terrifying, by those who have experienced one or more panic attacks".[11] In these cases, the patient is fearful of a particular place because they have experienced a panic attack at the same location at a previous time. Fearing the onset of another panic attack, the patient is fearful or even avoids a location. Some refuse to leave their homes even in medical emergencies because the fear of being outside of their comfort areas is too great.[12]

The person with this condition can sometimes go to great lengths to avoid the locations where they have experienced the onset of a panic attack. Agoraphobia, as described in this manner, is actually a symptom professionals check when making a diagnosis of panic disorder. Other syndromes like obsessive compulsive disorder or post-traumatic stress disorder can also cause agoraphobia. Essentially, any irrational fear that keeps one from going outside can cause the syndrome.[13]

People with agoraphobia may experience temporary separation anxiety disorder when certain other individuals of the household depart from the residence temporarily, such as a parent or spouse, or when they are left home alone. Such temporary conditions can result in an increase in anxiety or a panic attack or feeling the need to separate themselves from family or maybe friends.[14][15]

People with agoraphobia sometimes fear waiting outside for long periods of time; that symptom can be called "macrophobia".[16]

Panic attacks

Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed. During a panic attack, epinephrine is released in large amounts, triggering the body's natural fight-or-flight response. A panic attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes.[17] Symptoms of a panic attack include palpitations, rapid heartbeat, sweating, trembling, nausea, vomiting, dizziness, tightness in the throat, and shortness of breath. Many patients report a fear of dying, fear of losing control of emotions, or fear of losing control of behaviors.[17]

Causes

Agoraphobia is believed to be due to a combination of genetic and environmental factors.[1] The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger.[1]

Research has uncovered a link between agoraphobia and difficulties with spatial orientation.[18][19] Individuals without agoraphobia are able to maintain balance by combining information from their vestibular system, their visual system, and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse (as in wide-open spaces) or overwhelming (as in crowds).[20] Likewise, they may be confused by sloping or irregular surfaces.[20] In a virtual reality study, agoraphobics showed impaired processing of changing audiovisual data in comparison with subjects without agoraphobia.[21]

Substance-induced

Chronic use of tranquilizers and sleeping pills such as benzodiazepines has been linked to onset of agoraphobia.[22] In 10 patients who had developed agoraphobia during benzodiazepine dependence, symptoms abated within the first year of assisted withdrawal.[23] Similarly, alcohol use disorders are associated with panic with or without agoraphobia; this association may be due to the long-term effects of alcohol consumption causing a distortion in brain chemistry.[24] Tobacco smoking has also been associated with the development and emergence of agoraphobia, often with panic disorder; it is uncertain how tobacco smoking results in anxiety-panic with or without agoraphobia symptoms, but the direct effects of nicotine dependence or the effects of tobacco smoke on breathing have been suggested as possible causes. Self-medication or a combination of factors may also explain the association between tobacco smoking and agoraphobia and panic.[25]

Attachment theory

Main page: Philosophy:Attachment theory

Some scholars[26][27] have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base.[28] Recent empirical research has also linked attachment and spatial theories of agoraphobia.[29]

Spatial theory

In the social sciences, a perceived clinical bias[30] exists in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. One such approach links the development of agoraphobia with modernity.[31] Factors considered contributing to agoraphobia within modernity are the ubiquity of cars and urbanization. These have helped develop the expansion of public space and the contraction of private space, thus creating in the minds of agoraphobia-prone people a tense, unbridgeable divide[colloquialism] between the two.

Evolutionary psychology

An evolutionary psychology view is that the more unusual primary agoraphobia without panic attacks may be due to a different mechanism from agoraphobia with panic attacks. Primary agoraphobia without panic attacks may be a specific phobia explained by it once having been evolutionarily advantageous to avoid exposed, large, open spaces without cover or concealment. Agoraphobia with panic attacks may be an avoidance response secondary to the panic attacks, due to fear of the situations in which the panic attacks occurred.[32][33]

Diagnosis

Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder.[34] Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur.[35] Early treatment of panic disorder can often prevent agoraphobia.[36] Agoraphobia is typically determined when symptoms are worse than panic disorder, but also do not meet the criteria for other anxiety disorders such as depression.[37]

Agoraphobia without history of panic disorder

Agoraphobia without a history of panic disorder (also called primary agoraphobia) is an anxiety disorder where the individual with the diagnosis does not meet the DSM-5 criteria for panic disorder. Agoraphobia typically develops as a result of having panic disorder. In a small minority of cases, however, agoraphobia can develop by itself without being triggered by the onset of panic attacks. Agoraphobia can be caused by traumatic experiences, such as bullying or abuse. Historically, there has been debate over whether agoraphobia without panic genuinely existed, or whether it was simply a manifestation of other disorders such as panic disorder, generalized anxiety disorder, avoidant personality disorder and social phobia. One researcher said: "out of 41 agoraphobics seen (at a clinic) during a period of 1 year, only 1 fit the diagnosis of agoraphobia without panic attacks, and even this particular classification was questionable...Do not expect to see too many agoraphobics without panic".[38] In spite of this earlier skepticism, current thinking is that agoraphobia without panic disorder is indeed a valid, unique illness which has gone largely unnoticed, since those with the condition are far less likely to seek clinical treatment.

According to the DSM-IV-TR, a widely-used manual for diagnosing mental disorders, the condition is diagnosed when agoraphobia is present without panic disorder where symptoms are not caused by or are unreasonable to an underlying medical problem or pharmacological influence.[39] The DSM-5 decoupled agoraphobia and panic disorder, making them separate disorders that can be diagnosed together.[40]

Treatments

Therapy

Systematic desensitization can provide lasting relief to the majority of patients with panic disorder and agoraphobia. The disappearance of residual and sub-clinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.[41] Many patients can deal with exposure easier if they are in the company of a friend on whom they can rely.[42][43] In this approach, it is suggested that people being treated remain in the situation that provokes anxiety until the symptoms anxiety have subsided because if they leave the situation, the phobic response will not decrease and it may even rise.[43]

A related exposure treatment is in vivo exposure, a cognitive behavioral therapy method, that gradually exposes patients to the feared situations or objects.[44] This treatment was largely effective with an effect size from d = 0.78 to d = 1.34, and these effects were shown to increase over time, proving that the treatment had long-term efficacy (up to 12 months after treatment).[44]

Psychological interventions in combination with pharmaceutical treatments were overall more effective than treatments simply involving either CBT or pharmaceuticals.[44] Further research showed there was no significant effect between using group CBT versus individual CBT.[44]

Cognitive restructuring has also proved useful in treating agoraphobia.[citation needed] This treatment involves coaching a participant through a dianoetic discussion, with the intent of replacing irrational, counterproductive beliefs with more factual and beneficial ones.

Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic.[45]

Videoconferencing psychotherapy (VCP) is an emerging modality used to treat various disorders in a remote method.[46] Similar to traditional face-to-face interventions, VCP can be used to administer CBT.[47]

Virtual reality computer stimulated therapy has been suggested to help people with psychosis and agoraphobia manage their avoidance of outside environments. In the therapy, the user wears a headset and a virtual character provides psychological advice and guides them as they explore simulated environments (such as a cafe or a busy street).[48]

Medications

Antidepressant medications most commonly used to treat anxiety disorders are mainly selective serotonin reuptake inhibitors. Benzodiazepines, monoamine oxidase inhibitor, and tricyclic antidepressants are also sometimes prescribed for treatment of agoraphobia.[49] Antidepressants are important because some have anxiolytic effects.[43] Antidepressants should be used in conjunction with exposure as a form of self-help or with cognitive behaviour therapy.[43] A combination of medication and cognitive behaviour therapy is sometimes the most effective treatment for agoraphobia.[43]

Benzodiazepines and other anxiolytic medications such as alprazolam and clonazepam are used to treat anxiety and can also help control the symptoms of a panic attack.[citation needed]

Alternative medicine

Eye movement desensitization and reprocessing (EMDR) has been studied as a possible treatment for agoraphobia, with poor results.[50] As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma.[51]

Many people with anxiety disorders benefit from joining a self-help or support group (telephone conference-call support groups or online support groups being of particular help for completely housebound individuals). Sharing problems and achievements with others, as well as sharing various self-help tools, are common activities in these groups. In particular, stress management techniques and various kinds of meditation practices and visualization techniques can help people with anxiety disorders calm themselves and may enhance the effects of therapy, as can service to others, which can distract from the self-absorption that tends to go with anxiety problems. Also, preliminary evidence suggests aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided.[52]

Epidemiology

Agoraphobia occurs about twice as commonly among women as it does in men. It can develop at any age but is much more common in adolescence and early adulthood and occurs more often in people of above average intelligence.[53]

Panic disorder with or without agoraphobia affects roughly 5.1% of Americans,[44] and about 1/3 of this population with panic disorder have co-morbid agoraphobia. It is uncommon to have agoraphobia without panic attacks, with only 0.17% of people with agoraphobia not presenting panic disorders as well.[44]

Society and culture

Notable cases

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  • Olivia Hussey (b. 1951), Anglo-Argentine actress[54][55]
  • Shirley Jackson (1916–1965), American writer – her agoraphobia is considered to be a primary inspiration for the novel We Have Always Lived in the Castle.[56][57]
  • Elfriede Jelinek (b. 1946), Austrian writer, Nobel Prize laureate in Literature in 2004[58]
  • Mike Patton (b. 1968), American musician.[59]
  • Bolesław Prus (1847–1912), Polish journalist and novelist[60]
  • Peter Robinson (b. 1962), British musician known as Marilyn[61]
  • Barbra Streisand, her stage fright became so severe after forgetting the words to a song during a 1967 performance in Central Park that it manifested into agoraphobia[62]
  • Brian Wilson (b. 1942), American singer and songwriter, primary songwriter of The Beach Boys, a former recluse and agoraphobic who has schizophrenia[63]
  • Ben Weasel, singer and songwriter[64]


See also

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 217–221, 938, ISBN 978-0-89042-555-8, https://archive.org/details/diagnosticstatis0005unse/page/217 
  2. ↑ 2.0 2.1 2.2 "Agoraphobia". https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024921/. 
  3. ↑ 3.0 3.1 3.2 Wyatt, Richard Jed; Chew, Robert H. (2008) (in en). Wyatt's Practical Psychiatric Practice: Forms and Protocols for Clinical Use. American Psychiatric Pub. pp. 90–91. ISBN 978-1-58562-687-8. https://books.google.com/books?id=4ZUikjcnM2QC&pg=PA91. 
  4. ↑ 4.0 4.1 Craske, MG; Stein, MB (24 June 2016). "Anxiety.". Lancet 388 (10063): 3048–3059. doi:10.1016/S0140-6736(16)30381-6. PMID 27349358. 
  5. ↑ Drs; Sartorius, Norman; Henderson, A.S.; Strotzka, H.; Lipowski, Z.; Yu-cun, Shen; You-xin, Xu; Strömgren, E.; Glatzel, J. et al.. "The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines". Microsoft Word. pp. 110, 112–3. https://www.who.int/classifications/icd/en/bluebook.pdf. 
  6. ↑ 6.0 6.1 Shin, Jin; Park, Doo-Heum; Ryu, Seung-Ho; Ha, Jee Hyun; Kim, Seol Min; Jeon, Hong Jun (2020-07-24). "Clinical implications of agoraphobia in patients with panic disorder". Medicine 99 (30): e21414. doi:10.1097/MD.0000000000021414. ISSN 0025-7974. PMID 32791758. 
  7. ↑ Teismann, Tobias; Lukaschek, Karoline; Hiller, Thomas S.; Breitbart, Jörg; Brettschneider, Christian; Schumacher, Ulrike; Margraf, Jürgen; Gensichen, Jochen et al. (2018-09-24). "Suicidal ideation in primary care patients suffering from panic disorder with or without agoraphobia". BMC Psychiatry 18 (1): 305. doi:10.1186/s12888-018-1894-5. ISSN 1471-244X. PMID 30249220. 
  8. ↑ Pompoli, A; Furukawa, TA; Imai, H; Tajika, A; Efthimiou, O; Salanti, G (13 April 2016). "Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis.". The Cochrane Database of Systematic Reviews 2016 (4): CD011004. doi:10.1002/14651858.CD011004.pub2. PMID 27071857. 
  9. ↑ "Collins dictionary". https://www.collinsdictionary.com/dictionary/english/agora. 
  10. ↑ Elster, Charles Harrington (2009) (in en). Verbal Advantage: Ten Easy Steps to a Powerful Vocabulary. Diversified Publishing. p. PT717. ISBN 978-0-307-56097-1. https://books.google.com/books?id=aJxfrKSb7u4C&pg=PT717. 
  11. ↑ "Agoraphobia – Dictionary of Psychotherapy". http://www.dictionary.nowok.co.uk/agoraphobia.php. 
  12. ↑ "Agoraphobia". https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/agoraphobia. 
  13. ↑ "Agoraphobia Symptoms". Psych Central.com. 2016-05-17. http://psychcentral.com/disorders/sx29.htm. 
  14. ↑ "Agoraphobia – Symptoms and causes" (in en). https://www.mayoclinic.org/diseases-conditions/agoraphobia/symptoms-causes/syc-20355987. 
  15. ↑ "What Are Anxiety Disorders?". https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders. 
  16. ↑ Adamec, Christine (2010). The Encyclopedia of Phobias, Fears, and Anxieties, Third Edition. Infobase Publishing. p. 328. ISBN 978-1-4381-2098-0. https://books.google.com/books?id=E2imSyZZDh0C&q=macrophobia. 
  17. ↑ 17.0 17.1 David Satcher (1999). "Chapter 4.2". Mental Health: A Report of the Surgeon General. http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html. Retrieved 2006-03-07. 
  18. ↑ "Relationship between balance system function and agoraphobic avoidance". Behav Res Ther 33 (4): 435–9. May 1995. doi:10.1016/0005-7967(94)00060-W. PMID 7755529. 
  19. ↑ "Panic, agoraphobia, and vestibular dysfunction". Am J Psychiatry 153 (4): 503–512. 1996. doi:10.1176/ajp.153.4.503. PMID 8599398. 
  20. ↑ 20.0 20.1 "Surface dependence: a balance control strategy in panic disorder with agoraphobia". Psychosom Med 59 (3): 323–30. 1997. doi:10.1097/00006842-199705000-00016. PMID 9178344. 
  21. ↑ "High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality". Eur. Psychiatry 21 (7): 501–8. October 2006. doi:10.1016/j.eurpsy.2004.10.004. PMID 17055951. https://hal.archives-ouvertes.fr/hal-03411683/file/EurPsy2006.pdf. 
  22. ↑ "The effects of medication on counselling". Counselling: The BACP Counselling Reader. 1. Sage. 1996. pp. 211–4. ISBN 978-0-8039-7477-7. https://books.google.com/books?id=wnIBEQKQi7IC. 
  23. ↑ Ashton H (June 1987). "Benzodiazepine withdrawal: outcome in 50 patients". Br J Addict 82 (6): 665–71. doi:10.1111/j.1360-0443.1987.tb01529.x. PMID 2886145. 
  24. ↑ "Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship". J Clin Psychiatry 68 (6): 874–80. June 2007. doi:10.4088/JCP.v68n0608. PMID 17592911. 
  25. ↑ "Cigarette smoking and panic: a critical review of the literature". J Clin Psychiatry 71 (5): 606–15. May 2010. doi:10.4088/JCP.08r04523blu. PMID 19961810. 
  26. ↑ G. Liotti, (1996). Insecure attachment and agoraphobia, in: C. Murray-Parkes, J. Stevenson-Hinde, & P. Marris (Eds.). Attachment Across the Life Cycle.
  27. ↑ J. Bowlby, (1998). Attachment and Loss (Vol. 2: Separation).
  28. ↑ Jacobson K (2004). "Agoraphobia and Hypochondria as Disorders of Dwelling". International Studies in Philosophy 36 (2): 31–44. doi:10.5840/intstudphil2004362165. 
  29. ↑ Holmes J (2008). "Space and the secure base in agoraphobia: a qualitative survey". Area 40 (3): 357–382. doi:10.1111/j.1475-4762.2008.00820.x. Bibcode: 2008Area...40..375H. 
  30. ↑ J. Davidson, (2003). Phobic Geographies
  31. ↑ Holmes J (2006). "Building Bridges and Breaking Boundaries: Modernity and Agoraphobia". Opticon 1826 1: 1. doi:10.5334/opt.010606. http://www.ucl.ac.uk/opticon1826/archive/issue1. 
  32. ↑ Bracha HS (2006). "Human brain evolution and the "Neuroevolutionary Time-depth Principle:" Implications for the Reclassification of fear-circuitry-related traits in DSM-V and for studying resilience to warzone-related posttraumatic stress disorder". Progress in Neuro-Psychopharmacology and Biological Psychiatry 30 (5): 827–853. doi:10.1016/j.pnpbp.2006.01.008. PMID 16563589. PMC 7130737. http://cogprints.org/5013/1/2006_P.N.P._Neuro-evolution_of_fear_circuit_disorders.pdf. 
  33. ↑ "[Primary agoraphobia specific symptoms: from natural information to mental representations"] (in it). Italian Journal of Psychopathology 17 (3): 265–276. 2011. http://www.gipsicopatol.it/issues/2011/vol17-3/02%20Spiti.pdf. 
  34. ↑ American Psychiatric Association, 1998
  35. ↑ Barlow DH (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford Press. 
  36. ↑ pmhdev. "Agoraphobia – National Library of Medicine". https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001921/. 
  37. ↑ Kenny, Tim; Lawson, Euan. "Agoraphobia". http://www.patient.info/health/agoraphobia-leaflet. 
  38. ↑ Barlow, D. H. & Waddell, M. T. (1985) Agoraphobia. Ch 1 in Barlow, D. H. (Ed) Clinical handbook of psychological disorders: A step-by-step treatment manual. New York: Guilford.
  39. ↑ American Psychiatric Association (2000). "Diagnostic criteria for 300.22 Agoraphobia Without History of Panic Disorder". Diagnostic and Statistical Manual of Mental Disorders (4th, text revision (DSM-IV-TR) ed.). ISBN 0-89042-025-4. http://behavenet.com/capsules/. Retrieved 2007-06-28. 
  40. ↑ Administration, Substance Abuse and Mental Health Services (June 2016). "Table 3.10, Panic Disorder and Agoraphobia Criteria Changes from DSM-IV to DSM-5" (in en). https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t10/. 
  41. ↑ "Long-term outcome of panic disorder with agoraphobia treated by exposure". Psychological Medicine 31 (5): 891–898. 2001. doi:10.1017/S0033291701003592. PMID 11459386. 
  42. ↑ "Agoraphobia – Diagnosis & Treatment". Mayo Clinic. 18 November 2017. https://www.mayoclinic.org/diseases-conditions/agoraphobia/diagnosis-treatment/drc-20355993. 
  43. ↑ 43.0 43.1 43.2 43.3 43.4 Gelder, Michael G.; Mayou, Richard.; Geddes, John (2005). Psychiatr. New York: Oxford University Press. ISBN 978-0-19-852863-0. https://archive.org/details/psychiatry0000geld. 
  44. ↑ 44.0 44.1 44.2 44.3 44.4 44.5 Sanchez-Meca; Rosa-Alcazar; Marin-Martinez; Gomez-Conesa (September 11, 2008). "Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis". Clinical Psychology Review 30 (1): 37–50. doi:10.1016/j.cpr.2009.08.011. PMID 19775792. 
  45. ↑ "Agoraphobia – Diagnosis and treatment – Mayo Clinic" (in en). https://www.mayoclinic.org/diseases-conditions/agoraphobia/diagnosis-treatment/drc-20355993. 
  46. ↑ Fernández-Álvarez, Javier; Fernández-Álvarez, Héctor (2021). "Videoconferencing Psychotherapy During the Pandemic: Exceptional Times With Enduring Effects?" (in English). Frontiers in Psychology 12: 589536. doi:10.3389/fpsyg.2021.589536. ISSN 1664-1078. PMID 33679513. 
  47. ↑ Bouchard, Stéphane; Allard, Micheline; Robillard, Geneviève; Dumoulin, Stéphanie; Guitard, Tanya; Loranger, Claudie; Green-Demers, Isabelle; Marchand, André et al. (2020-08-21). "Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial". Frontiers in Psychology 11: 2164. doi:10.3389/fpsyg.2020.02164. ISSN 1664-1078. PMID 32973638. 
  48. ↑ "Virtual reality could help people with psychosis and agoraphobia". NIHR Evidence. 20 July 2023. doi:10.3310/nihrevidence_59108. https://evidence.nihr.ac.uk/alert/virtual-reality-could-help-people-with-psychosis-and-agoraphobia/. 
  49. ↑ Lydiard, R. Bruce; Ballenger, James C. (16 June 1987). "Antidepressants in panic disorder and agoraphobia". Journal of Affective Disorders 13 (2): 153–168. doi:10.1016/0165-0327(87)90020-6. PMID 2960710. 
  50. ↑ Goldstein, Alan J.; de Beurs, Edwin; Chambless, Dianne L.; Wilson, Kimberly A. (2000). "EMDR for Panic Disorder With Agoraphobia : Comparison With Waiting List and Credible Attention-Placebo Control Conditions". Journal of Consulting and Clinical Psychology 68 (6): 947–957. doi:10.1037/0022-006X.68.6.947. PMID 11142547. 
  51. ↑ Agoraphobia Resource Center. "Agoraphobia treatments—Eye movement desensitization and reprogramming". http://www.agoraphobia.ws/treatment-emdr.htm. 
  52. ↑ National Institute of Mental Health. "How to get help for anxiety disorders". http://www.nimh.nih.gov/health/publications/anxiety-disorders/how-to-get-help-for-anxiety-disorders.shtml. 
  53. ↑ "Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey.". Arch Gen Psychiatry 53 (2): 159–68. Feb 1996. doi:10.1001/archpsyc.1996.01830020077009. PMID 8629891. 
  54. ↑ Olivia Hussey—People Magazine—March 16, 1992
  55. ↑ Biography for Olivia Hussey on IMDb
  56. ↑ Churchwell, Sarah (2017-02-10). "Shirley Jackson: A Rather Haunted Life by Ruth Franklin review – beyond spooky". http://www.theguardian.com/books/2017/feb/10/shirley-jackson-ruth-franklin-review-a-rather-haunted-life. 
  57. ↑ [1] essay by Jonathan Lethem
  58. ↑ Mike Conklin. (2004-12-10). "Where is Elfriede Jelinek?". Chicago Tribune. http://articles.chicagotribune.com/2004-12-10/features/0412090437_1_literature-social-phobia-place. 
  59. ↑ Hatfield, Amanda (July 19, 2022). "Mike Patton discusses agoraphobia diagnosis, canceling Faith No More shows in new interview". Brooklyn Vegan. https://www.brooklynvegan.com/mike-patton-discusses-agoraphobia-diagnosis-canceling-faith-no-more-shows-in-new-interview/. 
  60. ↑ Stanisław Fita, ed., Wspomnienia o Bolesławie Prusie (Reminiscences about Bolesław Prus), Warsaw, Państwowy Instytut Wydawniczy (State Publishing Institute), 1962, p. 113.
  61. ↑ Whatever Happened to the Gender Benders?, Channel 4 documentary, United Kingdom.
  62. ↑ V, Justin (2014-11-21). "Famous People With Agoraphobia". https://www.morningsiderecovery.com/addiction-blog/famous-figures-suffered-agoraphobia/. 
  63. ↑ McNair, James (3 September 2007). "Brian Wilson: Here Comes the Sun". The Independent. https://www.independent.co.uk/news/people/profiles/brian-wilson-here-comes-the-sun-401202.html. 
  64. ↑ "Ben Weasel featured on Carson Daly" (in en). 14 October 2010. https://www.punknews.org/article/40202/ben-weasel-featured-on-carson-daly. 

Further reading

External links

Classification
External resources



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