Agoraphobia
Advanced Therapeutic Solutions provides exposure therapy for the treatment of Agoraphobia.
Many people misunderstand what agoraphobia is, thinking it’s a fear of leaving the house. Actually, it’s a fear of not being able to escape. If panic symptoms or other incapacitating or embarrassing symptoms (e.g., vomiting, soiling oneself, falling) should arise, how can they escape if they are:
- On public transportation (“can’t get off”)
- In open spaces (“can’t find anyone to help”)
- In enclosed spaces (“can’t get out”)
- In line or in a crowd (“can’t get out”)
- Outside of the home alone (“can’t find anyone to help”)
The fear that something terrible might happen is out of proportion to the actual danger posed. The fear of not being able to escape the situation or that escape may be difficult leads an individual with agoraphobia to play it safe by staying home. Another safety behavior may be only going out if someone goes with them, just in case, because then that person can help them escape a situation in case panic arises. If the individual with agoraphobia can’t avoid the situation or can’t have a companion with them, then the situation is endured with intense fear or anxiety.
Agoraphobia peaks in late adolescents and early adulthood, affecting 1.7% (1 of 58) of adolescents and adults. For individuals over 65, the prevalence decreases to .4%. Up to half of individuals with agoraphobia have had a panic attack preceding the onset of agoraphobia. There are two incidence risk phases: late adolescence/early adulthood and again after age 40. Mean age of onset is 17 years old for those who have had panic attacks before developing agoraphobia, and 25-29 years old for those who have no had preceding panic attacks or panic disorder.
Left untreated, the avoidance can become so severe that it can lead the individual to be completely housebound. Complete recovery without treatment is rare (10%). Treatment for agoraphobia includes cognitive behavioral therapy to address the cognitions that feed the fear, as well as determining what avoidance or safety behaviors are being used that prevent the individual from learning that their fear is inaccurate. Exposure therapy is used to target the situations that are feared. Instead of “white-knuckling” through it, or distracting oneself during it, the therapist helps the individual focus on the situation while systematically reducing the safety behaviors in the moment.
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Clinical Procedures for Agoraphobia Evaluation and Outpatient Treatment
Free Phone Intake Consultation
Up to 30-min phone consultation so we can hear about your presenting issue, the symptoms you are experiencing, when they started, the severity of symptoms, and if we are the appropriate place for your treatment. The diagnostic intake process is discussed, and your insurance/billing questions are answered. If the treatment you need is within our scope of services, we begin the scheduling process. If it is deemed that we are not the appropriate place, we will provide you with referrals and resources to help you. We want to make sure to connect you with services, and that includes helping you find treatment elsewhere if that's what you need.
Free
CPT CODE: 0
Diagnostic Evaluation
A 90-min diagnostic intake interview with the child’s parents to assess symptoms, collect history, review systems (school, home, community), differential diagnosis, review of prior records, review parents’ families psychiatric histories, and follow up/clarify any questions that arose from reviewing the questionnaires parents/child/teen filled out before the intake session.
Starting at 295
CPT CODE: 90791
Adolescent Intake Interview
A 60-min interview with the adolescent allows us to hear their perspective. Symptoms are assessed, and may include additional questionnaires for diagnostic clarification, allowing us to define a baseline. Interventions are tested out and discussed, using an age-appropriate model, to assess the adolescent's motivation and response to intervention for treatment planning purposes.
Starting at 195
CPT CODE: 90837
Parent Feedback Session, Guidance, and Treatment Planning
A 1-hour feedback session with parents is held which includes presenting diagnoses, symptom severity, diagnostic rule outs, and discussing the recommended treatment plan. Parents are asked for their specific goals for their teen and what they hope to gain from treatment at ATSA. Decisions are made as to whether the teen will start with therapy sessions only, allowing for the future addition of psychopharmacological treatment as an adjunct, or whether to start with combined treatment (or in rare cases to start with psychopharmacological treatment before CBT). Parents will be provided guidance on the behavioral techniques to implement at home and in the community with their child, to help maintain and generalize treatment gains. Parents are provided feedback about their child’s behavioral challenges and gains from the initial assessment sessions, and the specific techniques that will be used to successfully help their child overcome his/her specific barriers in the exposure process. Throughout treatment, parents are provided with additional feedback sessions to discuss next steps, including help with transfer of skills outside of the clinic setting.
Starting at 195
CPT CODE: 90846
Adolescent Exposure Therapy Clinic Session
60 min exposure sessions to present the adolescent with the phobic stimulus and begin the process of fear extinction. The key to exposure therapy is to activate new learning, which is done by presenting the adolescent with the phobic stimulus, and assisting the adolescent to approach (vs avoid) the stimulus, using a hierarchical approach. Motivational interviewing may be applied to foster rapport and trust in preparation for exposures, particularly when exposures become more challenging as we move up the hierarchy. Parents are also taught how to facilitate approach coping and reduce enabling avoidance. We will use modeling, shaping, corrective feedback, and contingent reinforcement with adolescent and parents. Our data show that when parents are involved in treatment, gains are more likely to transfer into the home and community settings.
Starting at 175
CPT CODE: 90837
Adolescent Exposure Therapy in Home, School, or Community Settings
60-min exposure sessions provided in the school, home, or community setting to help transfer treatment gains into these domains. To increase transfer of treatment gains, reduce avoidance of the phobia across settings, and reduce others rescuing the adolescent from approaching the phobia (to rescue them from distress), in-vivo and in-situ exposure therapy is most effective. Not only does the adolescent develop distress tolerance, new learning, and fear extinction, so do the adults in these settings, which helps them reduce rescuing and enabling. We will train school staff on how to appropriately prompt, monitor, and reinforce your adolescent's approach behavior with guidance via modeling and demonstrating use of skills. Home visits are used to help adolescents and parents use skills at home, and Community sessions provide exposure practice in new settings.
Starting at 185 + travel
CPT CODE: 90837