We often think of Agoraphobia only as of the inability to leave one’s house. But it may present in more subtle ways and still be very debilitating.
The DSM-5 gives Agoraphobia examples of marked fear or anxiety about:
· Using public transportation (cars, buses, trains, ships, planes)
· Being in open spaces (parking lots, marketplaces, bridges)
· Being in enclosed places (shops, theaters, cinemas)
· Standing in line or being in a crowd, and also maybe being outside of the home.
A person with agoraphobia fears or avoids these situations where escape may be difficult.
They are afraid of having attacks of panic or embarrassment (like fearing falling, fainting, or incontinence). Often, the person needs someone to go with them to get through these.
Agoraphobia responds well to psychotherapy and medications for anxiety.
Some old-school beliefs in the field about the care of someone with agoraphobia would purport that teletherapy or telepsychiatry further enables a person to stay in their comfort zone. They believe it prevents the therapeutic exposure process. While there is some truth to that, what about the people not there yet? The ones who need a few more steps before walking into an office. The ones who cannot even make a phone call because of profound anxiety. I believe telehealth is a way to reach these struggling people. Exposure therapy is gradual. I have worked with people who delayed therapy and psychiatry for because even making a phone call is anxiety-provoking.
Phone Call Anxiety
Phone Call Anxiety is one reason I created the ability in my practice to directly text me and any of our clinicians before scheduling a visit.
For some people with anxiety, the act of making a phone call or downloading a mental health app is too big or high of a step. I intentionally left out the patient portal experience with the passwords and the stuff that makes reaching out even scarier. I feel like this small detail of texting me, like texting a friend, was the stepping stone for someone with high anxiety to get support. When I searched for systems that allowed me to maintain HIPAA-compliance, they all said the doctors and providers don’t want patients to be able to directly contact them. So, I devised my own HIPAA-compliant texting system because being approachable and accessible sets this practice apart from traditional psychiatry practices.
On my end, your information is housed in a HIPAA-compliant portal, on your end, it’s as easy as texting a friend 833-AYS-PSYC or 833-297-7792
American Psychiatric Association. (2013). Agoraphobia. Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books.9780890425596.807874