Agoraphobia and Panic Disorder Treatment in Malaysia - Psychological Hypnosis Method

What is Agoraphobia?

Agoraphobia is a type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.

With agoraphobia, you fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line or being in a crowd. The anxiety is caused by fear that there's no easy way to escape or seek help if intense anxiety develops. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to fear another attack and avoid the place where it occurred.

Agoraphobia treatment usually includes both psychotherapy and medication. It may take some time, but treatment can help you get better.

Typical agoraphobia symptoms include:

• Fear of being alone in any situation
• Fear of being in crowded places
• Fear of losing control in a public place
• Fear of being in places where it may be hard to leave, such as an elevator or train
• Inability to leave your home (housebound) or only able to leave it if someone else goes with you
• Sense of helplessness
• Overdependence on others

In addition, you may have signs and symptoms of a panic attack, such as:

• Rapid heart rate
• Excessive sweating
• Trouble breathing
• Feeling shaky, numb or tingling
• Chest pain or pressure
• Lightheadedness or dizziness
• Sudden flushing or chills
• Upset stomach or diarrhea
• Feeling a loss of control
• Fear of dying

Panic disorder and agoraphobia

Some people have a panic disorder in addition to agoraphobia. Panic disorder is a type of anxiety disorder in which you experience sudden attacks of extreme fear that reach a peak within a few minutes and trigger intense physical symptoms (panic attacks). You might think that you're totally losing control, having a heart attack or even dying.

Fear of another panic attack can lead to avoiding similar circumstances or the place where it occurred in an attempt to prevent future panic attacks.

Psychotherapy

Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders, including agoraphobia.

Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build upon your initial success.

You can learn:

• That your fears are unlikely to come true
• That your anxiety gradually decreases if you remain in public and you can manage those symptoms until they do
• What factors may trigger a panic attack or panic-like symptoms and what makes them worse
• How to cope with these symptoms
• How to change unwanted or unhealthy behaviors through desensitization, also called exposure therapy, to safely face the places and situations that cause fear and anxiety

If you have trouble leaving your home, you may wonder how you could possibly go to a therapist's office. Therapists who treat agoraphobia will be well aware of this problem. They may offer to see you first in your home, or they may meet you in what you consider a safe place (safe zones). They may also offer some sessions over the phone, through email, or using computer programs or other media.

Look for a therapist who can help you find alternatives to in-office appointments, at least in the early part of your treatment. You may also want to take a trusted relative or friend to your appointment who can offer comfort and help, if needed.

Message from your clinical hypnotherapist (Hiro Koo):

"Give a man a fish, he'll eat for a day; teach him how to fish, and he'll eat for a lifetime,"

I will use clinical hypnosis as an adjunct to psychotherapy session (Psychological hypnosis method): Hypnosis method is used to help patients to reduce cognitive and physical symptoms of anxiety (Frankel and Macfie, 2010; Elkins and Perfect, 2008), and provides you with more control in every day situations (Baker and Nash, 2008). I will also teach you self-hypnosis techniques so you can continue your treatment at home. So next time you feel anxious or overwhelmed, you can practice a brief self hypnosis method and trigger a sensation of calm. 

You can complete the self rating assessment below to understand your condition better (Welcome to email me your result, it will be kept as P&C):
Panic And Agoraphobia Scale

Source:

http://www.mayoclinic.org/diseases-conditions/agoraphobia/basics/definition/con-20029996

http://www.londonhypnotherapyuk.com/agoraphobia-social-phobia/

What stress does to your body

When we experience excessive stress—whether from internal worry or external circumstance—a bodily reaction is triggered, called the "fight or flight" response. Originally discovered by the great Harvard physiologist Walter Cannon, this response is hard-wired into our brains and represents a genetic wisdom designed to protect us from bodily harm. This response actually corresponds to an area of our brain called the hypothalamus, which—when stimulated—initiates a sequence of nerve cell firing and chemical release that prepares our body for running or fighting.

When our fight or flight system is activated, we tend to perceive everything in our environment as a possible threat to our survival. By its very nature, the fight or flight system bypasses our rational mind—where our more well thought out beliefs exist—and moves us into "attack" mode. This state of alert causes us to perceive almost everything in our world as a possible threat to our survival. As such, we tend to see everyone and everything as a possible enemy. Like airport security during a terrorist threat, we are on the look out for every possible danger. We may overreact to the slightest comment. Our fear is exaggerated. Our thinking is distorted. We see everything through the filter of possible danger. We narrow our focus to those things that can harm us. Fear becomes the lens through which we see the world.

We can begin to see how it is almost impossible to cultivate positive attitudes and beliefs when we are stuck in survival mode. Our heart is not open. Our rational mind is disengaged. Our consciousness is focused on fear, not love. Making clear choices and recognizing the consequences of those choices is unfeasible. We are focused on short-term survival, not the long-term consequences of our beliefs and choices. When we are overwhelmed with excessive stress, our life becomes a series of short-term emergencies. We lose the ability to relax and enjoy the moment. We live from crisis to crisis, with no relief in sight. Burnout is inevitable. This burnout is what usually provides the motivation to change our lives for the better. We are propelled to step back and look at the big picture of our lives—forcing us to examine our beliefs, our values and our goals.


Source: http://www.thebodysoulconnection.com/EducationCenter/fight.html

Definition and DSM-5: Classification: Tic Disorders

Tourette syndrome (TS), also known as Tourette’s Disorder, is a neurodevelopmental disorder characterized by multiple motor tics and at least one vocal tic present for greater than one year. Among the neurodevelopmental disorders in the DSM-5, TS is the most complex of the spectrum of tic disorders, which includes:

• Tourette’s disorder
• Persistent motor or vocal tic disorder: one or more motor or vocal tics have been present for greater than one year
• Provisional tic disorder: motor and/or vocal tics have been present for less than a year.

Psychiatric disorders, such as obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) frequently co-occur in TS. Tic symptoms typically begin in early childhood, peak before puberty, and attenuate later in adolescence. 

Symptoms and phenomenology

Tics are rapid, repetitive, non-rhythmic movements or vocalizations. Motor and vocal tics are divided into two classes: simple and complex. Simple motor tics are brief movements involving one muscle group. Simple vocal tics are characterized by simple sounds.

• Simple motor tics include eye blinks, facial grimaces, head and neck jerks, and shoulder shrugs.  Briefly sustained postures (e.g., blepharospasm, oculogyric movements, and sustained mouth opening) can also be classified as simple motor tics.
• Simple vocal tics include coughing, sniffing, throat clearing, grunting, and squeaking.

Complex motor tics are more purposeful or orchestrated patterns of movement; complex vocal tics are longer, more orchestrated patterns of speech.

• Examples of complex motor tics are turning while walking, echopraxia (imitating gestures) and copropraxia (obscene gestures).
• Complex vocal tics include repeated words or phrases, echolalia (repeating another person's words or phrases) and coprolalia (uttering obscenities). Although coprolalia can cause considerable social distress, it is infrequent, and occurs in only approximately 10% of patients. 

A distinguishing characteristic of tics are the sensations that may precede the movement or sound, termed premonitory sensations or "urges." Sometimes patients can localize these feelings to particular parts of the body from which the tic emerged.

Even if not localizable, patients often describe a feeling of inner discomfort, using words such as a “build up of tension," or describe an unexplainable urge or impulse to perform the tic. Most patients experience an intensification of these sensations or urges when they suppress their tics.

Patients also often describe a strong need to repeat the tic until it feels "just right". After performing the tic, a sense of relief is experienced, although sometimes brief.

Descriptions of these sensations may be difficult for younger patients to express, but there is a quantitative, pictorial rating scale of these urges that can be used with children.

Epidemiology

TS is reported worldwide, with prevalence from 0.3% to 0.9%. It affects boys 3 to 4 times more frequently than girls.The vast majority of individuals with TS have behavioral and/or emotional symptoms or disorders; only 12% across all ages are reported to have only tics without other associated conditions. 

From a worldwide dataset, ADHD is the most common comorbid psychiatric disorder, and accounts for about 55% of the behavioral findings. Other disorders, such as mood and anxiety disorders and learning disorders, are also frequently present. 

Etiology

The cause of TS remains unknown, although evidence from genetic studies suggests that TS is inherited. Genetic factors seem to be the most important etiology, given significant familial aggregation and supporting twin studies. 

Monozygotic twin studies show 53% concordance for TS and 77% for persistent (chronic) motor tics, whereas dizygotic twins show 8% and 23% concordance, respectively.

Environmental factors, including perinatal insults, sex-hormone exposure during brain development, and psychosocial stressors, are also thought to contribute, and thus the overall expression of TS is thought to be multifactorial. 

Diagnosis

Diagnosis is made by a comprehensive clinical history from reliable sources, most often parents. Currently there is no identifiable biological marker for a TS diagnosis. A thorough, detailed history focusing on onset, time course, phenomenology such as urges or sensations, exacerbating and ameliorating factors, family history, and comorbid symptoms is essential. A general medical and neurological exam is indicated.

When eliciting history from the parent and patient, inquiry regarding onset of tics is important, as they typically begin in early childhood, followed by a waxing and waning course. Often tics worsen in late childhood prior to puberty.

Although tics tend to wax and wane, with one tic replacing another, sometimes tics can present abruptly or in acute bursts. Explosive, acute onset over 24 to 48 hours, particularly of OCD symptoms, may be suggestive of infectious or autoimmune etiology.

Potential day-to-day exacerbating factors, such as medications (stimulants in some patients, including caffeine and over-the-counter decongestants or cold remedies), fatigue, boredom, and stressors should be noted.

Tic symptoms may be difficult to disentangle from other common childhood symptoms of allergies or cough-variant asthma. Inquiry regarding seasonal patterns, and presence of other allergy-associated symptoms such as rhinitis and post-nasal drip, can be helpful in the differential diagnostic process.

Additionally, at times it may be difficult to differentiate complex motor tics from compulsions, as OCD symptoms frequently co-occur in children with TS. Repetitive behaviors preceded by urges or sensations are more likely to be complex tics, whereas repetitive behaviors that are preceded by a cognition, often a worry, are more likely to be compulsions.

Source: http://www.news-medical.net/health/Definition-and-DSM-5-Classification-Tic-Disorders.aspx

At newmindcentre.com, we provide help by using intervention such as:

1) EEG biofeedback training for Tics and Tourette Syndrome

2) Habit Reversal Therapy combined with Clinical Hypnotherapy

We are one of the international contacts of Tourette Association of America. We provide information and support to families in Malaysia.

For information on the latest treatment options, please visit the Tourette Association of America's treatment page or contact us via email: [email protected]