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Anxiety Diagnosis & Treatment of Phobias with Cognitive Restructuring Interventions
Diagnosis & Treatment of Phobias with Cognitive Restructuring Interventions

Section 12
Cognitive Intervention Strategies for Agoraphobia

CEU Question 12 | CEU Test | Table of Contents | Phobias
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs, Nurse CEUs

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On the last track we discussed agoraphobia.  We examined five principles of agoraphobia, indicative attitudes of agoraphobics, and how dependency leads to agoraphobia. 

On this track we will discuss Interventions for Agoraphobia.  Interventions for agoraphobia include cognitive strategies, methods to choose acceptance, and action strategies.  As you listen to this track, you might consider your phobic client.  Is he or she agoraphobic?  What aspects of these interventions could benefit your client?  How might these same strategies apply to a different phobia?

Three Strategies for Lessening Anxiety

#1  Cognitive Strategies
First, let’s discuss cognitive strategies which you can share with your agoraphobic to help him or her cope with this phobia.  I stated to Pam, "Thoughts create experiences.  While you can’t change your thoughts, you can select different thoughts, thus changing your experience."  Pam responded, "Usually I think something like, ‘Crap, I have to go outside,’ or ‘Aw hell, I’m outside.’  What else am I suppose to think?" 

Think of your Pam.  What point/counterpoint strategy might you use?  I stated, "You might consider thinking, ‘I am outside and will remain here for 5 minutes."  What other alternative cognitions might you suggest to a client like Pam? 

#2  Choose Acceptance
I began with techniques to help Pam choose acceptance.  I provided her with additional methods to help her clarify her thinking.  I stated, "Often the simple act of choosing to accept reality can be enough to clarify your thinking.  Think of everything that needs to be changed for you to be happy."  Pam thought of each distressing aspect of leaving her apartment and wrote these down in a notebook. 

I stated, "Underline the word need.  Next, go through the list one by one and ask yourself if you can let go of the need or demand to change it."  Clearly, with a deep rooted phobia, clients like Pam are not going to be able to simply choose to accept the feared stimulus

However, Pam benefited from this technique as a strategy to help her begin to change her cognitive processes regarding leaving her apartment on her own.  With the aspects of your client’s phobia which are difficult to accept, you might consider examining the reasons why the fear is so hard to accept. 

Ask your client to look at each reason and come up with one way in which he or she could choose to accept it.  For example, Pam stated, "If I could, I think I might be able to accept being outside on a nice day.  But then there’s always birds to worry about."  Like Pam, even if your client doesn’t immediately begin accepting the reality of the feared situation, at least she is beginning to visualize herself in the situation with less anxiety. 

Think of your Pam.  How might you help your client to choose acceptance?

#3  Action Strategies
Depending on how much your client benefits from methods to choose acceptance, you may want to move next to action strategies.  The first action strategy that I reviewed with Pam was for her to realign herself.  I stated, "Line up your images, choices, feelings, and actions and move them in concert toward acceptance.  When one of the three is out of line, focus on the other two." 

For example, Pam developed the mantra of ‘I feel bad, but I’ll choose to feel good, imagine the best, and act as if I am feeling good.’  Would you agree that because emotional distress is a feeling, in order to create a new feeling clients like Pam often need first to focus on making images, choices, and actions move toward acceptance.  I stated to Pam, "To do this, act as if you accept the current reality.  Ask yourself what needs to be done behaviorally to reach acceptance, then do it."

On this track we discussed Interventions for Agoraphobia.  Interventions for agoraphobia include cognitive strategies, methods to choose acceptance, and action strategies. 

On the next track we will discuss social phobias.  We will discuss the DSM Identification of social phobias, the fear of being evaluated, and features of social phobias. 

- Jensen, Vicki L.; Hougaard, Esben; Fishman, Daniel B. Sara, A Social Phobia Client with Sudden Change After Exposure Exercises in Intensive Cognitive-Behavior Group Therapy: A Case-Based Analysis of Mechanisms of Change. PCSP: Pragmatic Case Studies in Psychotherapy. 2013, Vol. 9 Issue 3.

- What are Panic Disorder and Agoraphobia, Mental Health and Research, Education, and Clinical Center, Long Beach VA Healthcare System. Unit 6/116A. Long Beach, California.

Peer-Reviewed Journal Article References:
Bjornsson, A. S., Sibrava, N. J., Beard, C., Moitra, E., Weisberg, R. B., Benítez, C. I. P., & Keller, M. B. (2014). Two-year course of generalized anxiety disorder, social anxiety disorder, and panic disorder with agoraphobia in a sample of Latino adults. Journal of Consulting and Clinical Psychology, 82(6), 1186–1192.

Boswell, J. F. (2013). Intervention strategies and clinical process in transdiagnostic cognitive–behavioral therapy. Psychotherapy, 50(3), 381–386.

Hoffart, A. (2016). Cognitive models for panic disorder with agoraphobia: A study of disaggregated within-person effects. Journal of Consulting and Clinical Psychology, 84(9), 839–844.

Shikatani, B., Fredborg, B. K., Cassin, S. E., Kuo, J. R., & Antony, M. M. (2019). Acceptability and perceived helpfulness of single session mindfulness and cognitive restructuring strategies in individuals with social anxiety disorder: A pilot study. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 51(2), 83–89.

White, A. J., Kleinböhl, D., Lang, T., Hamm, A. O., Gerlach, A. L., & Alpers, G. W. (2017). Identifying patterns in complex field data: Clustering heart rate responses of agoraphobic patients undertaking situational exposure. Zeitschrift für Psychologie, 225(3), 268–284.

White, A. J., Umpfenbach, K., & Alpers, G. W. (2014). Where have they gone? Tracking movement patterns to document the process of situational exposure in agoraphobia. Professional Psychology: Research and Practice, 45(3), 171–179.

Online Continuing Education QUESTION 12
What are three interventions for agoraphobia? To select and enter your answer go to CEU Test.

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