Q. I have a friend who suffers from agoraphobia and is trying to find help. She is extremely nervous about getting treatment, but finding treatment that she can afford is taking all of her motivation. She lives at home with her mother and they are barely making ends meet. She really is starting to lose all hope. I would love to be able to give her hope back. Is there anything I can do? Do you have any advice?

A. It's great that you are trying to be of help, and I do appreciate the difficulties of affording professional care. Still, anything you can do to help your friend find such professional treatment at an affordable rate would be a huge help. For example, is she eligible for payment under Medicare or related programs? A social worker may be able to answer this.

If your friend also suffers from panic attacks (as do most patients with agoraphobia), medication may be part of a therapeutic program that she can afford, since many MDs can provide patients with free samples. SSRI-type medications (e.g., Prozac, Zoloft, Paxil) are usually the medications of choice for panic attacks. However, agoraphobia (basically, fear of leaving the house) almost always requires a behavioral form of treatment, in addition to medication. The key to this is gradually helping the person become de-sensitized to leaving the house.

In many cases, this can be fostered by a friend or family member, though it is best done as part of a professionally-designed program. For example, treatment may start by accompanying the phobic individual for just a few feet outside the house, then going back inside. This may be repeated several times before striking out, together, on a longer walk. Eventually, the person's phobic anxiety decreases as he or she is exposed to the fear-provoking stimulus.

Of course, some patients will experience panic symptoms in such cases, and there needs to be a plan in place to deal with that. That's why I would make every effort to get your friend seen by a mental health professional. (Her family MD may be a start, and could also begin a medication trial). There is, of course, online help of all types for individuals with agoraphobia, including chat rooms, pen-pals, etc. You can check out the site http://panicdisorder.about.com/cs/agorasupport for links and addresses. If your friend has access to the internet, this may be of some help.

If all else fails, you might try buying your friend the "Anxiety and Phobia Workbook", by E. J. Bourne, PhD. This may give your friend a better understanding of her condition, and some ways of dealing with it. Good luck!

July 2002

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