I'm here to sing the praises of exposure therapy and tell you a little of my story.
For the vast majority of my recovery from agoraphobia, I had no idea what CBT was. I have been agoraphobic since the late nineties, but only learned about CBT in April this year. Every bit of progress I made up to that point was purely down to exposure therapy. It took me from being afraid to walk up my street, to being able to walk up to 40 minutes away from my home, alone. I learned to use public transport, got a job, met my wife, and took day trips in the car with my 'safe people' up to 2 hours away. I even went on holiday with my wife (then my fiancee) and stayed in a hotel for a week.
Let me reiterate: I did all this knowing nothing about CBT. CBT is a wonderful thing, I'm delighted to have discovered it, and have already had opportunities to see it work its effect. But it is so often perceived as the solution, and I worry that exposure therapy is occasionally sidelined in people's minds as the 'lesser' part of the therapy.
Why Exposure Therapy Should Not Have Worked For Me
I had every bad habit in the book. I employed every safety behaviour I could think of. If I began to feel panicky on my trips out, I would immediately turn around and go home. That's not how you are supposed to do it!
What Happened
After years of resistance ("Who are these people to tell me to go out every day? They don't know how it feels!"), I finally realised I had to buckle down. Instead of feeling proud of myself for going out once every fortnight, I determined I would go out as near to every weekday as I could (I even gave myself the weekends off). I managed to motivate myself to stick to a routine of going out at 10 o' clock every weekday. I followed this routine for months, in all sorts of weathers.
It was simply a matter of walking until I felt a bit scared. At this point I would look back at my house, or the route to my house, and assess whether I felt like I needed to head back, or I could go just a little bit further. If I went a little bit further, it was almost always just a few steps. Then I would look back and see how I felt from my new position, and make the decision again. Day after day of this made those few steps at a time accumulate. The further away I got, the easier the few more steps seemed to be. I stopped thinking in terms of "How long will it take me to get back home from here?", and started thinking "How long will it take me to get back to Villa Road where I know I feel fine?".
Before I knew it, I could get to the town centre (20 minutes walk). Once there, I was able to find places to 'hang around' and get used to the idea (especially the library - nice and quiet). I started to take buses to town and back, and also started to vary my times of going out. Once I felt comfortable being there at different times of the day, I got a voluntary job in a charity cafe. This led to a part-time job there, and I used the spare time to expand my horizons further.
In April I got married and had a week's honeymoon in the Lake District (2 hours drive from home).
Why Did it Work?
I think there are three elements that made this successful:
1. It doesn't have to be terrifying
I came to realise that going out of the house didn't have to be a big deal. I used to pace around, procrastinating, worrying about the task of leaving the house. "I don't think I can get as far as I did last time. It's too scary to contemplate. I should go when I'm feeling more up for it. If I don't get very far then it's just a waste of time." And of course, these thoughts used to prevent me going out. Once I dropped all expectations of how far I 'should' be going, it became much easier. "I'm going out. I don't have to go as far as yesterday if I don't feel like it. Even if I only go a little way, at least I've done something productive." This made it much easier to take the initial step of leaving the house, and I quickly found that the anticipatory anxiety was frequently much worse than the actual event.
2. A place to be
After a while, I realised it might be good for me to aim for places where I could do something other than just turn around and head back home. Bus stops were very useful for this. Once I had inched my way by degrees to a bus stop, I had a place where I could stop for a while without looking odd. I would take a magazine out with me and sit at a bus stop and read, ignoring the buses as they came and went. It really helped to drum into my head that Being Here is Okay. I didn't have to go straight home once I'd reached a landmark, it was fine to hang around and be calm. Once I reached the town centre, the opportunities to hang around exploded. So aiming to reach places where I wouldn't need to immediately turn on my heel and head back was extremely useful.
3. Consistency
This was the most important element of my recovery. If I had not found a way to motivate myself to do this five days a week, I would still be where I started. Years of weekly or fortnightly trips out had done very very little to help me. It was only when I put my head down and made myself do it every weekday that I began to see fruitful results, and they came much faster than I had every expected they would. Whatever it takes, whatever tricks you have to pull to make yourself do it, make sure you do it as often as possible. Even when you don't feel like it. Even when it's weather that scares you. Remember point 1: you don't have to go far, as long as you are willing to take the initial step of getting out of the door. As frequently as you can.
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Kitti
