Agoraphobia
This is the fear of being in open spaces and situations in which the person thinks there is no escape or help would be difficult to obtain. As such, the person fear being in busy streets or in crowded stores, theaters, or churches. The fear maybe so incapacitating that the person may not even dare leave home. Two-thirds of those agoraphobia are women. If they are married, there is usually marital discord because their husbands do not understand their behavior and tends to be critical. Most people with agoraphobia are perfectionist and have personality disorders. Symptoms develop between the ages of 18 and 35. The onset may be sudden or gradual. Agoraphobia often starts unpredictability of the panic attacks “trains” the individual to anticipate future panic attacks and, therefore, to fear any situation in which an attack may occur. As a result, the person avoid going into any place or situation where previous panic attacks have occurred.
NURSING INTERVENTION:
Treatment for phobia is either behavior therapy or medication or a combination of both.
1. Behavior therapy by systematic desensitization – the patient meets with a trained therapist and confronts the feared object or situation in a carefully planned, gradual way. The person first imagines the feared object or situation, works up to looking at pictures that depict the object or situation, and finally actually experiences the situation or comes in contact wit the feared object. By confronting rather than fleeing the object of fear, the person becomes accustomed to it and can lose the terror, horror, panic, and dread he or she once felt.
2. Medications re used to control the panic experienced during a phobic situation as well as the anxiety aroused by anticipation of that situation and are the treatment of first choice for social phobia and agoraphobia.
3. Nursing Care:
· Do not reason out of behavior.
· Videotaping with review and feedback and role-playing are two therapeutic strategies that can help a person with social phobia.
· Caring for patients with phobias can involve monitoring medications for effectiveness and adverse reactions, reinforcing concepts presented in therapy, and educating patients and their families on the significance of the phobia as debilitating problem and not just a “character flaw” to be overcome.
· Nurses can also teach patients to recognize the signs of increasing anxiety and to select anxiety-reduction measures appropriate for them. One of the most important things for nurses to remember when caring for a patient experiencing phobia is to refrain from confronting or humiliating them.
· Be sure to carefully screen for suicidal ideation among people with phobias because environmental factors that predispose to phobias also contribute to the risk factors for suicide. When social phobia is identified, especially among young adults, screening for substance abuse and depression is also important.
· Culture may be an important overlooked factor that impacts the experience and expression of phobias. A problem with the interpretive process and cultural influences can hinder the detection or evaluation of a phobic disorder. Culture may also influence treatment seeking and adherence with medication and therapeutic management.
