Agoraphobia Support Group

Hello everybody,

I guess this post would be quite unorthodox. I want provide a little bit background here not to sound too crazy

I am an architecture student in my final year. As part of the curriculum the final studio is research based and we ought to propose thesis statement. For quite a while I have been interested in how architecture can be more than it is now, as in what is the extent of architecture? Can architecture, not in its traditional sense, have therapeutic qualities? As a result I focused physiology of a human body and its functions, specifically the heartbeat since that is what got me started moving in the direction I am heading now. To put it short I was interested how the heartbeat rate can be altered externally, specifically how can external environment can speed up or slow down the beat. But that wasn't enough for the context so I continued my research and at some point I took agoraphobia as condition to work with. The reason for choosing it was the proposition that agoraphobia is cause by dysfunctional vestibular system that greatly affects spatial orientation, and that really got me interested.

My thesis focuses on how can controllable environment influence physiology and sensory perception of agoraphobic individuals. I came up with an idea of a wearable device that unfolds a space around an individual once one feel threatened or panicky. See the pictures below.

http://img577.imageshack.us/f/devicev.jpg/

However, as i continue the research it was not, dysfunctional vestibular system isn't always the case for triggering agoraphobia, since there are a lot of other factors that are involved. Another aspect I realized that “healing” in most cases, is done by individual through a cognitive behavioral therapy, thus my focus had to slightly change. What I am interested now is how can architectural device help and individual to help treating the symptoms of agoraphobia and help to adjust to the stressful environment.

http://img193.imageshack.us/f/pressured.jpg/

I was also thinking about providing sensory input aiming towards calming down the nervous system through a deep touch pressure. Right now it has taken form of a tight glove with inflatable "bag" underneath the glove. Ideally the air pump would be connected to the sensor, which would read the heart rate and once it exceeds a certain limit air pump would kick in and exert pressure on the arm, that would have a calming effect. Ideally, the glove would be integrated with the unfoldable device. Both of them are still under development and I haven't tested them out yet.

I would really appreciate a feedback about my proposal from the point of an agoraphobic. I am aware that it may sound a bit naive and ambitions, but I am eager to explore all the possibilities. Please let me know what you think, I am will be grateful for any feedback, even if it is extremely negative.

Thanks in advance!

My initial reaction is that devices like this, especially the first one, would never work for an agoraphobic in public. The last thing someone with agoraphobia wants is to draw attention to themselves, so wearing an obvious device like those would not be an attractive option. When someone with agoraphobia goes out into public, they want to appear invisible. We have enough trouble keeping attention away from ourselves because of visible panic symptoms. So I think when looking about a "device" to be worn by agoraphobics, regardless of which way it is supposed to help, it should really be concealed.

I agree with Kevin on both points ,anything obvious would be a definate no no to most agoraphobics.

I would like to add that I think it's pretty cool that you are persueing this avenue of research though ,hope the studies go well for you

I agree with the above post. I also want to thank you for the research you are doing. Having never heard of spatial orientation before I goggled it. Don't know if its the same thing , but when I encounter curves in a road, or enter buildings that are not parallel to the surrounding streets I become panicky. I always have to feel orientated.

This is an amazing concept. My son is studying to be an architect too. The idea of spatial recognition and reintroducing the body to outward stimuli might be useful in a controlled setting. As Kevin stated, the Agoraphobic does not want to bring any attention to himself. However, if you can teach an old dog new tricks it's worth looking into.

I found this site useful in understanding what 'Spatial Cognition' actually is:

http://www.cambridge.org/gb/knowledge/isbn/item2715213/? site_locale=en_GB

"How does knowledge of the body in space relate to an understanding of space itself? Spatial cognition is discussed from two closely related perspectives: the internal mapping of external stimuli (e.g., landmarks and sensory perception of environmental information) and the internal mapping of internally perceived stimuli (e.g., kinesthetic and visual imagery), and their subsequent effects on behaviour."

Laymans terms...The things that happen outside of our control triggers a reaction...a learned response.

So, this is a tool to 're-teach' our brains to react to what we see through 'touch' as a point of reference.

Cheryl

Wow, thank you all for you replies!!

@ Kevin

I totally agree that the device can have the opposite effect on agoraphobic in public. The idea behind it was that the device would tackle spatial orientation issue. It would be in way a "prescribed medicine", worn or 2 hours everyday at home, for instance. If initially the device would create really small space around, then overtime the space would increase. Ideally there was supposed to be a skin on the skeleton of the device to give a proper enclosure, but due to technical difficulties I wasn't able to attach it at that moment. But then again there are a lot of other aspects to tackle.

Concealed device would be problematic. I guess a feasible solution would be to create a wearable virtual space. I talked to one of psychologists on campus, and he told that they use virtual environment training for people who have extreme fear of heights. Slowly, step by step they take them to virtual heights and enabling them to re-learn their responses. I would love to tap into the digital realm, but at the end of the day I have to bring it back architectural discipline and have something tangible. I hope it makes sense what I said

@ Ladygaga

Thank you i am very excited about my project, its kinda tough though. But if i manage to create a something that works and helps that would be just great!

@ Perry

Thanks! I believe that it has to do something with the vestibular system. Not sure what exactly is going on there, as in what part of does not function properly. I did research on agoraphobia and summarized it in few paragraphs. Im posting it below, I hope it would give a better understanding. The information i gathered is from various websites, journals and books. However, please let me know if you disagree with some of the statements of if you have a different opinion.

<>

Agoraphobia

Agoraphobia is the most restricting and misinterpreted phobia. In popular culture agoraphobia is often described as a fear of leaving home, however it is not quite accurate. There are various definitions for agoraphobia with slight variation from one to another. To summarize them all, definition would be that agoraphobia is an extreme and irrational fear of wide, open spaces, crowds and uncontrollable social situations, from which escape would be difficult and help would be unavailable if a panic attack occurs. Therefore agoraphobia is basically a fear of fear.

Agoraphobia has quite insidious nature. The typical scenario in which the phobia develops starts with an individual having a panic attack. This plants seeds of fear of the attack happening again, therefore individual begins to avoid the situation in which the attack happened. For instance, if it happened in the mall a person would start avoiding malls, If the attack happened on the street, individual would stop going out on the streets, thus restricting his/her freedom of movement. No surprise that agoraphobia is the most restricting and limiting phobia there is.

Agoraphobia is occurs twice as often in women than in men. Scientists attribute it to socio-cultural factors that contribute to avoidant coping strategies by women. However some scientists disagree and state that the reason why agoraphobia is commonly found in women is due to the fact the women are more likely to seek help, thus exposing themselves. While men on the other hand tend to abuse alcohol and other substances as a reaction to anxiety and therefore are treated as alcoholics. Nevertheless researchers haven’t found a clear and comprehensive explanation of gender differences in agoraphobia.

Causes and Symptoms and Implications

Agoraphobia in its nature is a panic disorder. It goes hand in hand with underlying social anxiety. Even though it is not quite known what exactly causes agoraphobia, scientists speculate that is caused by several factors. Agoraphobia is linked with the difficulties of spatial orientation, which is caused by weak and sometimes dysfunctional vestibular system. Generally people without agoraphobia rely equally on their vestibular system, visual system and proprioceptive sense when navigating through a space. However individuals with agoraphobia rely more on the visual and tactile input, which are often insufficient and lead to disorientation and confusion. Agoraphobia tends to run in the families therefore for some individuals there might be a genetic factor contributing to its development

The most common symptom of the phobia is a panic attack. Agoraphobic individual encounters a situation that he perceives as dangerous and fearsome. As a result the sympathetic nervous system is immediately activated sending one into fight of flight state. Physical symptoms include: increased heartbeat hyperventilation, excessive sweating, dilated pupils, and dizziness.

Another common symptom that many agoraphobics share in common is a similar behavior patter, which is characterized by persistent avoidance of going outside their safety zone. For many individuals the safety zone is the boundary of their homes. For some it is frightful to go to the front porch, while for others the boundary is the neighboring city.

Agoraphobics tend to link their location with the fear of panic attack, which explains their idea of a safety zone. The concept of the safety zone is very relative in its nature, since there is no ultimate and total safety zone. Agoraphobic can easily inflict a panic attack simply by imagining oneself in a stressful situation. Safety zone is the zone where the amount of distress is reduced to the minimum.

Treatment

There are different types of treatment available for treating agoraphobia.

One of them is medical therapy, which includes prescribed medications, members of the serotonin selective reuptake inhibitor (SSRI) and the minor tranquilizer (benzodiazepine) groups. Examples of SSRI medications include sertraline, paroxetine, and fluoxetine. Medications directly affect the chemical processes in the brain restoring the balance of nervous system.

Another type treatment deals with cognition. This includes talk therapy, psychoanalysis and cognitive-behavioral therapy. Cognitive-behavioral therapy is the most poplar among other treatments. It focuses on stopping the negative thoughts associated with particular location or situation replacing them with rational thoughts. Here individuals are taught to break the linkage that their brain makes between their location and fear.

Self-exposure is another kind of agoraphobia treatment that encourages individuals to expose themselves to stressful situations.. Step by step agoraphobics expose themselves to supposedly threatening situations and through constant cognition and relaxation techniques they learn to control their emotional state and master the anxiety.

<>

@ KittenMittens

Spatial Cognition!! Thats terminology i was missing! Im definitely going to check out this book, seems like it can fill in the gaps of my understanding of spatial cognition. I think learned response plays vital part in agoraphobia since it triggers the panic attacks. I guess it will make sense to dig deeper in this area. Thank you!

AMN, I also agree that it's great you are tackling the issue of agoraphobia. I never would have associated architecture/engineering and agoraphobia before!

The info on agoraphobia you posted is dead-on, and I think the most important point is that while we all share a lot of common problems, we definitely have a lot of different issues as well. Some people could care less if they have a dozen people in their house, because they're in their house, while someone like me would prefer to go out into public with just one or two people. etc, etc...

My uncle works in pharmaceutical research for Duke and he has told me they use what sounds similar to what you mentioned about virtual environment training. They are actually using virtual reality machines to bring patients through difficult situations, such as going through a grocery store, etc. This is very similar to a technique many of us use called 'visualization.' For example, if I have to do something difficult, I visualize myself doing it from start to finish several times, so I can get an idea of what I will feel. In a way it sort of "prepares" you for the actual situation. As far as the virtual reality machines, I think they would be best for those with the most severe cases of agoraphobia, but I don't think they're very accessible for the average patient at this point.

Another example of how agoraphobics differ in some aspects... Perry mentioned that he had difficulty with curves in the road or unparalleled buildings. My main issues stem with interaction with people, particularly because of my fear of having an embarrassing panic attack in front of them -- and of course this fear has been instilled in me because I have had many embarrassing panic attacks in public. But as far as I know, I don't have too much of a problem with spatial orientation, save extreme examples like going to a stadium full of people.

Because of the wide variety of issues associated with agoraphobia, there are a wide variety of treatments. For example, I have major trouble even on the phone. I have gotten better, but I used to be completely unable to make a phone call to a stranger, period. I have gotten better, but not good enough. One way I tackle this is to share my number with some other agoraphobics so I can get used to talking on the phone with new people.

In any case, good luck with your research and feel free to come back with any questions you have

AMN, your sensory device and pressure on the skin reminded me of something. I think I was reading about sensory issues autistic people may have. Or maybe it was the sensory disorder that may or may not be associated with autism. Anyway I read about a man who felt jumpy because of his sensory tactile issues and he felt calmer when he wore tight stretchy pants so he wore them under all his clothes. If I find more on this I will you know.