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Author: At Your Service Psychiatry, PLLC

Agoraphobia & Phone Call Anxiety

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

Until We Can End Mental Health Stigma, We Work Around It

“I would never want to have a mental health diagnosis on my record”

A quote from Gold, Andrew, Goldman, & Schwenk (2016) retrieved from These researchers found the reason many female physicians will not obtain mental health care is due to their concerns for having a mental health diagnosis in a permanent, sharable, electronic medical record. This concern is valid. Physicians must often report their depression, anxiety, mood disorder, or substance abuse issues to the board of medicine. Physicians often must sit in front of their licensing boards and hope someone who they don’t know, doesn’t further stigmatize them. They worry they will lose their license due to the board findings.

Many factors play into the tragedy of the epidemic of physician suicide- moral injury, burnout, dehumanizing electronic medical records, bureaucracy, and also ACCESS & STIGMA! We need to do better for the mothers & fathers of medicine.

One day I was speaking with my colleagues about the privilege of treating those in the field. We all acknowledged we have a quiet system for psychiatric treatment on the “down-low” for physicians and clinicians, and those in the public eye. We bring the person in on off-hours, paper chart kept in a lockbox and other privacy measures. We all agreed it would be nice if there were no stigma, no need to do this, but we all do it. #endphysiciansuicide

Telepsychiatry provides a de-stigmatizing, accommodating, private way for physicians, clinicians, and those needing anonymity to get treatment for mental health or substance abuse support. At Your Service Psychiatry, PLLC offers the ability to seek treatment outside of an electronic medical record system, alternative consent sign-up, scheduling, and payment. Those who need additional privacy measures may call or text 833-AYS-PSYC (833-297-7792) for details on exclusive care.