Agoraphobia Recovery

A laymen's guide

Note – This is an early draft and will be a continual work in progress.

Intro

Agoraphobia has been the main thing in my life. I don’t mean the main problem, I mean the most consistent, salient thing. Jobs, relationships, health, school, money, whatever - everything else is a side note. That’s what it seems like at least.

It didn’t have to be like this. I got bad advice, and I didn’t trust the good advice. The good advice sounded like they just didn’t get it.

Turns out, I was the one who didn’t get it. Well, now I do get it. I see why I got so bad & I understand how I got better. If I met my 20 year old self, I could get him out of this in a few weeks. I started writing whatever this is with him in mind.

If I get this right, it’ll have everything my 20 year old self would have needed to get over this.

I hope this gets to someone else in that same spot.

The Cure - Starting Point

“The Only Winning Move Is Not To Play”

The way out isn’t easy, but it’s not a mystery. I think the simplicity makes it harder to trust. This section alone won’t be enough to convince you, but it’s important to keep in mind what the cure actually is & not overcomplicate it. It’s the hardest thing I’ve ever dealt with-so don’t interpret this as me saying “just get over it, bro.” I’m with you, but we’ll get there.

First, Drop the Shame

The cure is in minimizing panic attacks and recognizing that you’re not as broken as you think you are. This may feel invalidating - if panic attacks aren’t a big deal and there’s nothing actually wrong with me, why am I so scared? Am I weak?

This isn’t your fault. Your brain wiring combined with your experiences brought you here. You didn’t choose those things. You’re not weak-willed, you’re not a coward. This can be hard to understand from the outside. The people giving you shit about being a shut-in care about you; they want you healthy and happy. They just can’t understand why you’re so scared of going out with a tummy ache or whatever. The advice here will sound annoyingly similar to shit these people have been saying for years.

Keep an open mind.

Understand why you feel this way

The cure begins with recognizing that panic attacks are uncomfortable, but not dangerous.

They feel dangerous because Panic Disorder is a negative feedback loop that hijacks the fight/flight response. There is no way to experience Panic without believing you’re in danger, by definition. That doesn’t mean there actually is danger; that’s just how this works. You will not panic yourself into a heart attack, psychosis, fainting, losing control of the car, etc. If you don’t avoid or resist, the feelings will appear, intensify, peak, and wash away.

No, yours are not different. I know, I know - trust me, they’re not.

Trying to make the feelings go away makes them worse. This is avoidance. Stop all attempts to feel less anxious. No breathing exercises, ice water, meditation—nada. There’s a time and place for all that, but it’s not while you’re in the habit of avoidance. The moment you drop resistance, you’ll see through the illusion.

Don’t buy it? Test it. See what the feelings can actually do if you don’t avoid them. The part of your brain that creates these feelings is deaf to thoughts; it only learns through experience. Show it there’s no threat by acting as if there’s no threat. Changing your behavior is the cure. The feelings will dissipate, but it’ll take longer than you think, and praying for that day to come is avoidance.

The Cure In a word - Accept

The goal of all of agoraphobia treatment is to get you to true acceptance. This is more of a life philosophy and skill than it is a decision. Agoraphobia aside - learning how to accept is a central tenet of most wisdom traditions. It’s in most schools of philosophy and religions. The good news is, agoraphobia gives you a great opportunity to practice acceptance. Once you see the way here, you’ll see it in other areas of life.

Breaking The Illusion

“Why Should I Listen to You? If you’re gonna say it’s that easy, you obviously don’t understand how I feel.”

Glad you asked.

I was unable to find anyone who I believed understood what I was feeling. The illusion that my panic attacks were different kept me from thinking The Cure would work for me. That’s why I’m writing this - I know what you’re feeling.

First of all, I never used the word easy, I said simple. You’re trying to override the the impulse that evolved to keep you safe by any means necessary. Ignoring that might be the most counter-intuitive thing a person can do. What you’re feeling when you go outside could be the same thing people feel with a gun to their head. What I’m telling you to do is simple, possible, and effective. But definitely not easy.

This isn’t about me, but my credibility is in my experience, so I’ll do a quick overview of my history with all this.

Timeline

Things I Tried (That Didn’t Work)

My symptoms

A Few Lowlights

A few times I Was Sure It Wasn’t Anxiety

I could go on.

We’re talking 20 years of crippling agoraphobia, 7 years on benzos. And now I’m 100% fine.

No, I’m not a therapist. I’m not the best writer. I have no aspirations to be some sort of coach or authority figure. There are plenty of reasons not to listen to me. But me not getting it is not one of those reasons.

How do you know nothing’s wrong when it feels like something’s wrong? Food poisoning and panic attacks feel the exact same to me. Or when my throat feels like it’s closing, it literally feels like it’s closing. I never know what it is until way later. You expect me to just go out feeling like that? Just ignore it?

Accept, not ignore. But yeah, sorta.

When you’re panicking, there’s no way to know with 100% certainty that what you’re feeling is just anxiety. Certainty doesn’t exist. But you’re mixing up two different things:

Tolerance of discomfort vs. A sense of actual danger

Panic attacks can mimic almost any medical condition. Chest pain, nausea, dizziness, numbness, throat closing—whatever. If you’re having a new or alarming symptom, go to the doctor. Maybe even go to the ER. I’ve had multiple EKGs, and I don’t regret any of them - even when it turned out to be nothing.

Tell the doctor what’s going on. If they blow you off, insist. If you’re not convinced, get a second opinion. But once you’ve gotten the greenlight, you need to stop addressing every sensation you feel.

The more inappropriate medical reassurance you seek, the worse your symptoms will get. Every time you go looking for proof that you’re safe, you’re training yourself to believe that you’re not.

Attention amplifies sensation.

Try this right now: Sit still and place all of your attention on your left thumb. What’s the temperature? Is there a breeze hitting your thumb? Do you feel any pressure? Is it resting on your index finger? Do you feel the weight of it? Close your eyes and place your attention like a spotlight on your thumb for 10 slow breaths.

When I do that, it feels cold. It almost throbs, I can feel blood pumping through my thumb with each heartbeat. It feels swollen, like I dropped something on it a few minutes ago.

That would drive me up a fucking wall if I kept my attention there for long enough. You turn the knob up on sensations the more you pay attention to them.

When you panic over a new sensation, you’re throwing rocket-fueled attention on it. One of the main functions of adrenaline is to focus our attention intensely on one thing - usually a threat - so we can respond quickly.

Combine the sensations caused by adrenaline with the rocket-fueled attention on that sensation, and cognitive worries over what this sensation could be, and you end up with an incredibly good illusion of a serious issue.

So you’re telling me just to get my mind off of it. How? I can’t just stop thinking about it when I feel something like that.

Don’t picture a pink elephant.

No, that doesn’t work. You can’t remove thoughts. You can kinda replace them by deliberately paying attention to other things, this is where grounding exercises can help. A common one is to look around and name 5 things you can see, 3 things you can hear, and 2 things you can feel or something like that. There’s a fine line between grounding and distraction(avoidance). Don’t get me wrong, grounding is effective for getting out of your head and in your body. But we’re talking about avoidance right now, we’ll get to that stuff later.

The solution is to accept and allow. To steal a mantra from Barry Mcdonagh - “I accept and allow these anxious feelings, I accept and allow these anxious thoughts”.

Ok fine, that might work for things like chest pains and dizziness, but I literally throw up from anxiety sometimes. I feel sick to my stomach. I need to rush to the bathroom or I might shit myself. How could all these stomach issues just be in my head when they’re physically happening?

Very good question. First of all, what’s so bad about throwing up? Aim for a bag, clean yourself off, move along. Yeah it kinda sucks, but living a normal life where you puke at inconvenient times is far better than living in fear of the possibility of that happening. This is part of acceptance. Life can be uncomfortable. Later we’ll talk about re-defining recovery and getting a better understanding of what it actually feels like to be normal. Normal is by no means comfortable.

Something psychological being “just in your head” is a lazy misnomer. The mind and body are one system and emotions manifest physically. Anxiety is mostly a physical state. Psychogenic is the better term, which just means the origin is psychological.

The adrenaline-attention-sensation spiral affects the gut extremely well. Look at visceral hypersensitivity., for example.

In normal digestion, your intestines stretch (distention) when food is pushed along. Sometimes, the distention is big enough to trigger pain and an urge to shit, even when the rectum is empty. Think of when you’re about to get in the car but sprint to the bathroom one last time in an emergency, then sit down only for nothing to come out. Then you go back out to the car and get hit with the urge again.

People with IBS (very common diagnosis with agoraphobes) have a lower distention threshold than people without. So low in fact, that the nerves send a pain and “uh oh gotta shit now” signal to the brain, even when distention is in the normal range of normal digestion.

They figured this out by shoving balloons up peoples asses and inflating them to different degrees. People with IBS report pain at way lower inflation levels than people without it.

When you’re anxious and your mind is on your gut, these nerves get hyper sensitized. Adrenaline also speeds up the food transit by increasing muscle contractions in the intestines, which can lead to diarrhea. It also pulls blood away from your core and sends em to your limbs, which can fuck up your digestion and make you puke if your stomach is full.

This is all normal, safe, well understood physiology.

So all the stomach issues you’re plagued with are not signs that you have food poisoning and need to cancel the trip. It’ll come and pass in waves.

That makes sense to me now, while I’m calm sitting at home.
But as soon as I try to go do something, I’m gonna panic and forget all of this.
I can’t just ignore the sensations—they’re overwhelming.

Yeah, of course. Understanding what’s happening is just the prerequisite to the cure, it’s not the cure. Bridging the gap between knowing and doing starts with defusion.

Defusion is kind of a double entendre here.

In Acceptance and Commitment Therapy (ACT), cognitive fusion is when you’re completely wrapped up in your thoughts.
You’re fused with them. There’s no space between you and what you’re thinking.
You can’t step back or intervene.

Cognitive defusion means creating some mental distance.
Widening your view. Stepping back. Detaching. Watching the thought instead of being the thought.

The D In the DARE response method, stands for Defuse in a different sense-like defusing a bomb. You defuse a threat by calling it’s bluff, like this:

Your throat feels like it’s closing?
Nope. It just feels like that. That’s a specific medical condition you don’t have. It feels a little tight, ok and?

You think you’re gonna pass out while driving?
Nope. Anxiety raises blood pressure, fainting is caused by a drop in blood pressure.

You feel like you’re gonna puke?
You might. So what? Puking is a safe, normal bodily process. Unpleasant? Sure. Dangerous? Nope.

That’s how you bring your rational understanding into a moment of panic.

“Fine maybe I won’t pass out when I drive, but I lose composure and drive erratically. I can’t help it, I’ve swerved across lanes to try to exit and almost caused an accident. How am I supposed to just face that, I’m putting lives at risk.”

Ok let’s break this down - what is the actual cause of the erratic driving? It’s once you make the decision to exit. It’s not the panic attack, it’s your fear of the panic attack causing you to seek an emergency exit right now.

This is circular logic - I think the panic attacks are dangerous because I drive erratically when I panic, and I drive erratically because I think the panic attacks are dangerous.

This changes nothing about the recovery process.

If you had full confidence in your ability to handle any sensation, you’d have no need to swerve to the next exit, would you?

So, how do we develop that confidence without putting ourselves in danger?

Exposure to situations is specific, but exposure to feelings is universal.

These lead to growth in two different ways:

  1. Situational: You re-evaluate the safety of the situation, you see that your concerns don’t actually apply to the scenario. Maybe you see that there is an accessible bathroom, an easy exit, and kind people around. You didn’t become less afraid, you just re-categorized a scenario as “safe”. This won’t work on the freeway.
  2. Feelings: You confront the panic attack itself - the situation doesn’t matter. You see the panic attack appear, rise, peak, and fall away on its’ own. Do this enough times, and there will be nothing for a scary situation to trigger.

**The fear you have is internal, you carry it with you wherever you go. The situation is irrelevant unless you think a panic attack would be unacceptable in that situation.

Your fear of unsafe driving is your fear of having a panic attack. Get rid of the fear of panic attacks, you also get rid of the fear of unsafe driving.

But how do we do this?

It’s time to have a panic attack.

Hopefully, there’s another scenario you can think of that will trigger a panic attack. Say a crowded mall, a football stadium, grocery store. Whatever.

Go intentionally have a panic attack. Approach the feelings with curiosity. What’s actually happening in your body? Treat it like a movie you always walk out of halfway through. Go see what happens at the end.

Remember, you are not trying to get comfortable with the scenario, you’re trying to see the panic attack all the way through. If the panic attack did not occur, you did not do the exposure we’re after.

Go into the panic. Put this video on repeat if you need a hand seeing it through. Do not leave the situation until you’re bored.

Pay attention to how the feelings evolve as they rise and fall. Get very familiar with the process.

Stick to this like you’re in a training camp getting ready for the big event. If you can, do this 7 days in a row.

Once you’ve built up genuine confidence in your ability to handle these feelings, then you can get back in the car for a drive. This time, you won’t need to drive erratically to escape, because you know your body will be perfectly fine in a few short minutes.

Eventually, you’ll need make a leap of faith and cross the bridge before you feel ready. If you’ve been able to see the panic attacks through, there is no difference on the freeway.

Story time: There’s a bridge in my hometown that made me lose that job I wrote about in the beginning, and is the reason I skipped Thanksgiving & Christmas for ~5 years. It’s the San Mateo bridge, look it up. One of the longest in the country.

A specialist I worked with at the time helped me develop the confidence in my ability to handle panic attacks, but I was still terrified to cross the bridge. I told him I didn’t think it was safe to try to cross - the lanes are too narrow, one slip up could be a problem.

He said “I’m not gonna reassure you on this. You know what to do. You are safe.”

The answer annoyed me, but he was right. That Saturday, I drove over the bridge. 3 failed attempts, then 4 successful crosses. The first felt sketchy, I seemed to have a hard time staying in my lane. The 4th was boring. I never had an issue crossing that bridge again.

“You’re just telling me to calm down in different words. How is this supposed to be helpful? The waves don’t come and go. I’m in a constant state of terror & sick to my stomach until I get back home. Even when I rationally know I’m safe and it’s just anxiety, the feelings are overwhelming. This would not work. “

Now we’re onto tolerance of discomfort.

Panic does come and go in waves, but the fear of the next wave coming can keep you in panic mode. It’s like a chinese finger trap. Pull out as hard as you can, you won’t get out. Push in, and the grip loosens, allowing you to easily slide your finger out.

Story time: I tried to follow this approach for years and thought I was doing it right. I saw progress, I was doing more shit, but it was still kind of a nightmare. Stomach all fucked up, irritable, was completely wiped out for the rest of the day after an exposure.

My first glimpse into real acceptance happened on accident.

My girlfriend at the time dumped me, the anxiety was probably the main reason it wasn’t working. I was wrecked. I booked a flight both to get my mind off the break up and to confront the anxiety.

After take off I got hit with a level 10 mega panic attack. I couldn’t catch my breath, spinning, dryheaving. There was crazy turbulence, I got this cracking sensation in my chest. After the crack, an ice cold liquid felt like it was spreading throughout my body. I was sure it was internal bleeding and I was about to die. I was so sad about the break up, I didn’t really care.

Not to say I lost my will to live or was suicidal or anything like that - but I thought fuck it, guess this is it. Oh well.

The cold liquid turned warm. The panic washed away and was replaced by a sense of relief so strong it was almost euphoric. It was like I popped a molly or something. I was giddy, giggling like a fucking psycho next to strangers.

When I returned to baseline, I thought “ooooohhhhhhhhh woooooooaaaah that’s what acceptance is.”

What I had been doing before was white knuckling and seeking comfort, not acceptance.

Acceptance has to be experienced to be understood. You have to kinda get a feel for it, but then you can’t unsee it.

Ok, good for you. I’ve tried to accept the feelings, they don’t just go away like that. My panic attacks are different. They’re completely overwhelming, and sometimes can be traumatizing. I’m worried that I’ll get on a plane or something and have a panic attack so bad that I have a major setback and get even more scared of going outside.

We’re back to the illusion of danger. Except now it’s not about the physical symptoms, it’s about losing your mind. It’s still the same exact process, still run-of-the-mill panic attacks. Hate to break it to you, but that means the answer is still accept and allow. We can play whack-a-mole with every symptom and every fear you want. I don’t mind, it’ll get repetitive though.

Panic attacks are not dangerous physically, or psychologically.

Let’s talk about the word “traumatizing” though, because you do have a point.

Trauma is a big word that’s been thrown around a lot. But all trauma means is an experience so distressing that it leads to lasting changes in our thoughts, emotions, and/or behavior.

The first major panic attack in the start of panic disorder probably qualifies as a traumatic event by definition.

Neuroplasticity is another big word thrown around, all it means is that your brain adapts. Adaptations aren’t necessarily good or bad, they’re just a change.

The more emotionally significant(traumatic) a situation is, the less repetitions it takes to lead to lasting change. The higher the stakes (real or perceived), the more adaption takes place.

So, when you’re in a panic attack, the behavior that follows is very strongly imprinted, whether that behavior is avoidance or acceptance.

This is why exposure is so effective, and all non-exposure exercises are not. Well, not on their own at least.

A setback comes from avoidance during high stakes. Growth comes from going through it. Everything you do is habit forming. You vote for the person you’ll be and the behaviors you instill with every single thing you do. This is partially why cross-culturally, religions have the idea that “God is always watching and judging, then rewarding or punishing”. Divorce that concept from the shame and control games religious institutions push, just think about it symbolically.

Your behavior matters, it’s one link in an infinite chain of events. Things beget more of the same.

The traumatic power of a panic attack is due to the fact that the panic state is fertile ground for neuroplasticity. Run away, you’ll want to run more. Face it, you’ll be able to face it more.

A setback is not set in stone, you can undo it with one successful bout of exposure.

So look at the “traumatizing” nature of your panic attacks as an opportunity to quickly make lasting change.

Example: I just watched this documentary of Laird Hamilton - big wave surfer guy. He does wild shit. Some waves are so big and fast, you have be towed into them by a jetski. That was his idea.

Long story short, one day Laird and the guy towing him out to a big wave got caught in a bad spot and barely survived. Watch the doc for the details, but just imagine getting ragdolled by a wave so big it’s physically impossible to surf it without a jetski and being unable to get back to the surface. When you finally do surface, you’re 100 yards away where you went under.

They barely made it back to the shore, his friend got picked up by paramedics and goes straight into emergency surgery for a leg wound, but Laird found some other guy on the beach who was willing to tow him back out to the wave he just barely survived, and went immediately back out there. PSYCHO SHIT RIGHT?

Laird said he knew that if he didn’t go right back out there, he’d be scared of big wave surfing forever and may never be able to overcome it. He instinctually knew that before he leaves that situation and gets out of the danger, he needs to get back out there to prevent this from becoming a traumatic experience. They went back out, he caught the wave, all was good.

Laird still surfs big waves to this day. His jet ski buddy never went near a big wave again. Jet ski guy needed emergency surgery, so it’s not like he had the choice to get back out there. But there’s a lesson in that.

Laird somehow knew intuitively that turning back in that moment would lead to a fear he didn’t want to develop.

“But I can’t handle all the feelings. I will run away if it gets bad enough. So I’m right in thinking that it could be harmful for me to be in a situation I’m not ready for. How am I supposed to act like this is harmless if backing out during a panic attack is harmful?”

This is the reason gradual exposure tends to be more effective than flooding.

Gradual exposure works by starting low and working your way up in manageable steps. Flooding is going fuck it yolo and chucking yourself into a situation you’re genuinely not ready for.

If you haven’t left your house in months, don’t get on an international flight. I mean you’ll still be safe and perfectly fine, but you’re not setting yourself up for a win here.

Gradual exposure helps you build up the confidence. You wanna set yourself up for a win. I think it’s almost time to get onto what to do about all this. But first, let’s make sure the foundations are set:

Panic attacks are uncomfortable, but not dangerous. Your particular flavor of panic is not as different as you think. The cure is in behavior going up, not feelings going down.

Got it?

“No, there are psych meds for a reason. I don’t think this’ll work, I know plenty of people who’ve had success with things like SSRIs, Benzos, supplements, diet change. Maybe I need to try something like that to give me a little help, just to make it tolerable. ”

I get why you’re saying this. I went down that path too (scroll up). But it’s just the wrong direction. The goal is willful confrontation and acceptance of feelings, no matter how intense. Trying to make the feelings diminish is avoidance, and is the fuel that keeps all this alive.

Obviously I’m not a doctor, I’m in no position to discuss meds with you. I will give my take, but this will be the only part of this whole write-up (or whatever the hell this is ) that is explicitly NOT a recommendation or advice. These are just my thoughts.

Supplements: whatever, go for it. I like L-theanine, magnesium, and cbd before bed, seems to help me sleep. Looking for the cure in these things is a problem, but just taking them is not an issue. Who knows, maybe you’re deficient in something that’s causing symptoms that lead you to panic. Probably won’t do any harm in themselves, but the mindset of “I need to take this so I don’t feel weird” is definitely not gonna help.

SSRIs: idk man, I’ve heard some amazing things from some people. I know one person who had crippling anxiety that just completely washed away when she got on an SSRI. But she didn’t have agoraphobia, she had Generalized Anxiety Disorder. That’s not the topic of this write up and isn’t something I have experience with.

Benzos: I’m a little hesitant to say what I wanna say on this topic. But whatever, this is my website. They kill your ability to be chill on your own. Getting off these was brutal. I mean, my use was excessive. Daily for a few years, almost daily for like 7 years total. They made me worse. They make everyone worse long term. The research on this is not controversial. I know it’s a lot harder to get these now than it used to be. I think they’re considered safe for like 2 weeks of use. Past that, it’s known to cause a bunch of issues. Idk, talk to your doc and do your own research on this. But if a doc wants to give you benzos for panic disorder, go somewhere else. Be very, very careful with these.

Beta Blockers: Probably fine. Especially for situational anxiety. I know a lot of people use these before performances or flights or whatever. They just limit the impact of adrenaline. Like supplements, not an issue in itself, but we’re trying to move away from avoidance.

Diet/lifestyle changes: I’ve just written 4500 words about not avoiding bad feelings, so this might sound contradictory - but yeah this can help a lot. Too much to say about this for this section, more on this later.

Now we need to get to the program - what to actually do. But before we do that, we need to be on the same page about the mindset.

Panic attacks are safe. Feelings aren’t the problem, avoidance is the problem. You can get better.

Some of that will sink in better when you actually experience it. But for now, I need you to just buy in. If you have any rebuttals to anything in this section, let me know and I’ll address it. Email is marcantonyw@gmail.com

Maybe you don’t buy it - this wasn’t enough to get your mindset where it needs to be. I’m going to ask you a question that seems dumber than it is, let me explain:

Do you want to get over this? What’s your favorite part of agoraphobia? How does this benefit you? Psychological issues often (always?) come with a Secondary Gain.

For me, it was not having to do things I don’t actually wanna do. I never have to pick people up from the airport. The airport is only 20 minutes away, but I find it really annoying. I do it occasionally, and if someone asks I won’t decline - but I enjoy the fact that people are used to not asking me for rides. Getting over agoraphobia, really, meant I had no reason to decline an airport pick up.

Or what about a 10 day work trip? That’s way too long - I’ll do 3 or 4. It’s just too much for me. I don’t want to handle that, I’m not gonna do that.

Remember how nice a sick day from school was as a kid? It was better to feel a little sick and be able to spend the day playing video games unbothered than it was to feel 100% but have to go to school. The same concept applies.

We’re gonna talk a lot about willingness in the next section. The two main obstacles to willingness are thinking you can’t handle it & not wanting to do it. You have to want to do it.

The program

Now that the mindset bit is covered, let’s get into the practical steps. While a lot of this is based on legit, validated approaches - this is mostly broscience based on my experience of what works. This is still in line with the validated approaches that work, but is my own recommendation based on my experience.

Begin with the end in mind

What’s the point of getting better? We’re not trying to get over agoraphobia just to continue to sit inside all the time - there’s a life we want to live. Agoraphobia gets in the way. I lost sight of this, I think it’s easy to. The focus should be on doing the things you wanna do, not on feeling better. Obviously those go hand in hand, but they are different things.

Open up a calendar and schedule out your next week. Start with your obligations. Work hours, school, appointments, errands, whatever. This is the base.

Calendar showing base obligations

Then, add everything you would do in the open time blocks if you didn’t have any anxiety issues. This is all hypothetical, you’re not committing to any of this. Just get a visual in front of you that lays out your perfect week. How many times are you doing something social after work? What are you doing over the weekend? Any restaurants you wanna try? Any friends you’d like to see? Add those events in

Calendar showing filled schedule

This is the goal. Don’t get lost in the weeds of some ambiguous “I need to beat agoraphobia” goal. This is what we’re working towards.

What would it take for you to be able to live out that week? How close can you get? What seems do-able, what seems impossible? Just look at the calendar and try to visualize going through each day as realistically as you can. Notice which scenarios are exciting and which are daunting.

Now we convert these events into themed time blocks. Maybe call em Social, Active, Explore/Nature, or whatever matches your ideal week.

Calendar showing themed timeblocks

Work Backwards

Now we have a concrete goal in mind and a structure we can work with. How can you fill those time blocks in enjoyable ways with where you are now? This is not about exposure, do things that you’re comfortable with today.

Maybe dinner at a restaurant seems uncomfortable, what could you do instead to be social for a couple hours on those weeknights?

Could you go to a friends house? Invite one over? Go to a cafe? Facetime someone? Get on whatever version of chatroulette exists nowadays? Whatever social thing you can do where you are, do that.

Your active block could be a backyard work out, a nearby gym, a drop-in fitness class, or maybe you’re comfortable going straight to that class you’ve been wanting to try but have been hesitant to.

Nature/Adventure block could be a walk through the neighborhood, maybe down a different path than usual. Or the same path in the opposite direction. Or a nearby park. Or a lil hike. Just introduce some novelty and get some fresh air.

You get the point. Fill your time & get as close as you can to your goal lifestyle while still enjoying it. Deliberate exposure comes later - just enjoy yourself a bit more now.

Here’s why I think this is a good place to start:

  1. Your mind is on the goal, not on anxiety. With fear ladders and exposure hierarchies, the thing you’re actually doing is kind of a side note, the main focus is the level of anxiety you expect to experience there. If a level 4 exposure is dinner with a friend, the dinner itself is almost an afterthought, it’s still all about feelings.

With the calendar exercise it’s the other way around. The main focus is the thing you’re doing, the anxiety/limitation is a side note.

  1. You get quality of life improvements without needing to progress. Spending time deliberately is just good to do, for everyone. You end up living a more balanced life and spend time doing things based on values and goals, not feelings.

  2. It changes how you make plans in an important way. If you have nothing scheduled, you’re just gonna do what you feel like doing in the moment. Consulting how you feel before deciding what to do is not a good habit, especially for a recovering agoraphobe. We’re going for values based actions, not feelings based actions.

I’m gonna expand on the third point a bit, because it’s really important. Agoraphobia recovery is in your behavior, not in your feelings. What you do should be based on your values & your goals, not on your feelings. Feelings are fickle and not that important. One of the key mindset shifts we’re going for is to take feelings more lightly. They should be a much smaller part of your overall life than they are now. Feelings are important, but if you’re agoraphobic, you definitely need to place less importance on them. Some people need to be more in touch with their feelings - that’s not you right now.

This is your task right now. Don’t worry about exposures, just go have a nice week.

“I can’t think of anything I wanna do. My entire day is empty, I don’t know how to fill it. I’ve been like this so long, I have nothing to do. I just wake up, try to get through the day, and kill time before I can go to bed again. How do you even know where to start?”

I get that. This is gonna be individual, you need to spend some time thinking about your values and goals. There are plenty of online resources to help with this. I’ll link some resources here if I come across em, but for now, I’ll leave that to you. ChatGPT is pretty good at this.

There are some universals that I think apply to everyone. If you don’t know what to do, create a timeblock for each of these categories:

That takes a lot more time than you think.

I personally like having a very regular routine. This is based on a lot of experimentation and is always changing, but this has been stable for a bit - because it works very well for me.

7am - 8am: Wake up, shower, tidy up a bit, get moving, head to a cafe.

8am-11am: Cafe focus block. This is when I do creative stuff or work projects. It’s currently 9:45 AM on a friday, I’m writing this from the outside section of a cafe.

11am-noon: errands and eat.

noon-2pm: Second work block on weekdays.

2pm-330pm: work out. Lift or run.

330pm-430pm: eat & finish up work.

430pm-730pm: get out of my head. Surf with some friends if there are waves, go for a walk, do some DIY around the house. Maybe grab happy hour with a friend.

730pm-830pm: Dinner time

830pm-10pm: unwind, do whatever I want.

10pm-midnight: free time until I’m sleepy.

I stick pretty closely to this unless life gets in the way. Which is totally fine, this is just a structure I like, it’s not something I need to stick to in order to feel ok.

Ok, stop reading this. Go enjoy your week, check back in next Sunday.

Sunday retrospective

How’d it go? What was easier than you thought? What felt hard? What did you stick to? What didn’t you stick to? Why?

It takes a while to change habits, so it might take a few weeks to find your rhythm. It might be useful to just stay here for a bit and do some self-discovery. I mean, you’ve probably spent so long worrying about how to recover from agoraphobia, you forgot how to have a nice day. Treat yourself well.

In the next section, we’ll go over integrating exposures with the calendar. But we’re setting ourselves up for wins right now - this is still the foundation. I think it would be great to get to a point where a pretty full week feels like a habit before starting the next step. Use your judgment, but here are my recommendations:

Move to the next phase if you:

Stay here for the next week if you:

Next step: Expand.

Now we’re gonna start working towards the goal lifestyle we established in the first week of this exercise. Later we will get to anxiety-based exposure ladders, but we’re gonna try to treat agoraphobia recovery as values-based lifestyle design as much as we can.

We now have a lot of important information: How you’d like to spend your time in a perfect world across different life dimensions if anxiety weren’t an issue, what you’re willing to do right now, and what you’re currently comfortable doing. Brainstorm a bunch of activities you’d like to do under each dimension.

Example:

Social

Dinner with a friend Group hike Hit the bars Go to a concert Weekend camping trip Host a Sunday family dinner Picnic day in the park Museum visit Get lunch downtown

Which of those are you completely comfortable doing, which are you a little uncomfortable with but willing to and which are you not willing to do at all? Put them in order from most to least comfortable. Hopefully last week you already did some of the activities at the bottom of the list.

This is where we start the progression - every week, work your way up the list. Take your time, it’s ok to do the same thing for a few weeks. But eventually, you’ll get bored of it and wanna move up the list.

“I’m stuck. When I try to move up the list at all, I panic and go home. I made it through a few times but I hated it. I don’t wanna keep reverting back to the bottom of the list, but this isn’t working. ”

This is perfectly ok and expected. Don’t worry, this is exactly where we want to get to.

What actually happened? What was the final straw that made you turn back? What made the experience suck?

Refer back to the top of this write up - was it: The illusion of danger or the intolerance of discomfort? Did any safety/avoidance behaviors creep up? How did you respond when the feelings started? Did you accept & allow or white knuckle and distract?

You’ve already made a shit ton of progress even if it doesn’t feel like it.

You decided to do something about it - the important part is done. You’ve set yourself up to win, we just need to troubleshoot the issues as they pop up and keep showing up.

**Panic attack toolkit

I’m not gonna send you out there unarmed. I’ll defer to the experts on this bit, because they’ll do a better job of explaining the techniques than I will.

Some of these are low cost, but not free. If you’re broke, email me and I’ll see if I can help. No promises though

Get the DARE app . This has everything you need. It’s incredible. Do the Daily Dares every morning, listen to the lessons, and use the “SOS” tracks to help walk you through exposures. We’ve covered the general theory on how to face this shit, you don’t really need more information, you need a hand putting it in practice. This app does just that better than anything else.

Some audible recs:

Anything By Claire Weekes

DARE

The Panic Switch

Un-Agoraphobic

Listen to that content all the time so the truth sinks in. Use them to help you work up your activities lists.

Shouldn’t I get a therapist? This seems hard to do on my own. I need someone to talk to me.

If you have the means, 100% yes. My last therapist was very helpful. You can recover without one, but a good therapist is worth their weight in gold. Find one that specializes in CBT, ERP, or Acceptance & Commitment Therapy. Look up agoraphobia specialist or “anxiety center near me”. Every therapist out there claims to specialize in anxiety and depression. Ignore that, go for a specific agoraphobia specialty.

There are a lot of different approaches to anxiety treatment. As the saying goes, to a hammer, everything looks like a nail. This is unfortunately a very apt analogy in psychotherapy.

Many therapists will focus on removing shame and just general validation & reassurance. Dropping the shame is definitely important, but the way some therapists validate their patients is harmful for agoraphobia in my experience.

So, yes, if you can get one, do it. If you can’t, that’s ok. Use the free & low cost resources online, you can beat this without one.

“Ok, now what? I’m working my way up the activities lists, I’m using the DARE app to talk me through the hard moments, and I can do more stuff now, but it’s still so hard.”

Remember earlier when I said “You’ve already made a shit ton of progress even if it doesn’t feel like it.”? I wasn’t exaggerating.

If you’re doing the activities you wanna do and are getting towards living the life you wanna live, you no longer qualify as having agoraphobia.

Remember, we’re not trying to feel better. We’re trying to live our life despite how we feel. You’re doing that! Aren’t you living according to a values based calendar right now? What you do has nothing to do with your feelings. You just won the game.

Seriously, go look at the DSM-V definition of Agoraphobia. If you’re not avoiding stuff, you literally don’t qualify as having the disorder anymore.

“What?! No I still have anxiety. I still have to work pretty hard to be able to do the stuff I wanna do. If I was cured, I wouldn’t feel this way. This can’t be it.”

I know, you’re still highly sensitized and feel intense panic in a lot of situations where you think you shouldn’t. But now we’re not talking about agoraphobia, we’re talking about learning how to deal with panic attacks. Yes, they go hand in hand, but they are different.

Look at what you just said, “No I still have anxiety”. Be specific in your speech. You know that’s not a problem - anxiety is a healthy human emotion.

There is no such thing as an anxiety-free person. Your emotional world is a lot more similar to people without agoraphobia than you think it is. Once you get to the point where avoidance is no longer running your schedule, you need to update how you’re framing this to yourself.

Agoraphobia is incompatible with a full, healthy, happy life. Panic attacks themselves are not.

You feel uncomfortable feelings more than you would like to, and more than you think would be appropriate for a given situation. Don’t fret, things will get easier over time, I swear. But let’s get our theory caught up to our current situation:

You are not an agoraphobe. You defeated that when you decided to stop avoiding the things you fear and start living according to your values. You should be very proud of yourself if you’ve reached this point. The hard part is done, the spell has been broken.

This does not mean you have a healthy relationship with anxiety & panic. There is still plenty of progress to be made. Progress in this dimension happens on its own - you can’t force it. Remember, trying to feel better is avoidance. We don’t do that around here.

As Claire Weekes puts it, this part of the process is just letting time pass. Trust your threat system to update when it has enough experience to do so.

I was technically cured for like a year before I realized I was. I had panic attacks all the time, felt dread before leaving the house pretty often, and really hesitated before committing to plans that would be hard to bail on.

But I still did it all. I got on the planes, went on the dates, bought the concert tickets. Anxiety annoyed me, but it didn’t stop me anymore.

Changing my self-identity from an agoraphobe to a normal person feeling anxious did a lot for me psychologically.

“Ok but when do the panic attacks stop? Fine, I can put up with this and not avoid stuff for a while. But I can’t just live like this forever. This is exhausting, it still sucks. I’m annoyed that you’re calling me recovered when I still feel so shitty so often”

Its helpful to be specific in the terminology. You can have panic disorder without agoraphobia. But why do you wanna hang on to the label so much? Do you think it helps you? Does it invalidate your fears and make you feel weak?

I’ll say it again - you are not a coward. Just because an emotion is normal does not mean it’s easy to deal with. Every human on earth has bailed on something out of fear and has had a panic attack. They might not understand it that way, they may not frame it that way to you, but that’s the truth. This is where self-identity comes in.

My mom has no issues with anxiety. Once I was having an annoying bout of DPDR and was talking to her about it. It’s a hard thing to describe, but after a while my mom understood the feeling I was trying to explain. She went “ooohhhhh yeah, wait that’s what that is? I totally get that sometimes. Like sometimes I’ll be puttering in the kitchen and just feel - not real. Like I don’t feel like I’m in my body and I can’t think straight. It’s creepy, I don’t like it. Sometimes it lasts a couple days too. Hmm, I didn’t know that was a thing. ”

My mom had experienced DPDR many times, to a pretty significant degree, but she’s not in the habit of placing a lot of importance on how she physically feels. This highly uncomfortable experience did not even register as a thing worth remembering to her.

This was a long talk - at the end I was convinced my mom had felt exactly what I was freaking out about - yet she just brushed it off as a weird couple days.

Surely, a realistic “recovered” state would be around the same level as people who had never been diagnosed with an anxiety issue, right? So what are we actually aiming for here? What are our expectations?

Let’s get to when the panic attacks will stop. I lied in the beginning of this when I said I don’t get panic attacks anymore. that’s not true, here’s a video I recorded during a panic attack a couple months ago.

Panic attacks hit people sometimes. It is what it is. The reason I said I don’t get them anymore is because they don’t scare me anymore. I’ll get the same level of physical sensations I used to get, but it’s about as distressing as an annoying headache. Headaches suck, they’ll make you lay down for a minute and can kinda ruin part of a day. But, it’s just a headache.

I have a few events coming up that will probably include panicky feelings - A long flight for a wedding, a flight for a bachelor party, and a flight to another wedding where I’ll be a groomsman. There will probably be some discomfort there. Maybe more than the average person would feel in that same scenario.

Let’s reset expectations on the “cured life”

Cured is not a finish line, it’s a new starting point. It’s what happens after you break the spell that has limited your behavior. It’s not a post-anxiety utopia.

Emotions can be hard, that’s fine. This isn’t gonna be some Goggins invocation, I’m not gonna call you buttercup. I’m not saying life is hard, get over it. What I’m saying is that the goal for anyone dealing with difficult emotions should be to process them in a way that leads to as little uneccessary suffering as possible, and doesn’t have negative consequences on your life. We want a healthy relationship with emotions - one where we can accept and allow whatever we feel. We can allow ourselves to completely feel our emotions without fear that they’ll reach an intolerable point and there’s no turning back.

The cured person feels sick to their stomach on their way to a first date. Their palms sweat, they might dry-heave. Their heartrate will be through the roof. They’ll take 7 shits before walking out the door. They’ll get flushed and dizzy in the car on the way.

But they never think they need to bail. They’re ok with the first date nerves - this is just part of the process.

In the next section we’ll get into improvement above the baseline, but it’s a different process that must be done after we break the spell.

Only move on to the next section if you have completely stopped avoidance behaviors & don’t think that panic attacks signify a problem. You don’t have to enjoy the hard stuff, but you have to be willing & unafraid.

This is important, because the next section will be about lowering your baseline anxiety and adjusting your lifestyle in ways that make you feel better & less anxious. If you’re still in the habit of avoidance, this could be counter-productive.

Go buy yourself a steak dinner or something. You’ve done incredible work to get here. The resilience you’ve shown deserves recognition. I hope you don’t think of yourself as a coward anymore(if you ever did, I mean) - replace that shame with pride.

Everything from here on out is just gravy.