Mental Health U

Opening Doors to Hope: Navigating Agoraphobia with Compassionate Telehealth Strategies

• Bill Emahiser

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Discover the transformative power of understanding and confronting agoraphobia with Kim Grower-Dowling, a seasoned clinical counselor specializing in trauma and anxiety disorders, who joins us on Mental Health U. As we navigate the complexities of this condition, Kim shares her innovative Open Doors Telehealth Treatment Group approach, offering a unique and gentle path to recovery for those affected. Get ready to gain profound insights into the world of individuals grappling with agoraphobia and learn how incremental challenges can lead to reclaiming a fulfilling life.

We shed light on the oft-misunderstood diagnosis of agoraphobia. From the safety of their homes, individuals are gently encouraged to participate in Kim's telehealth group, slowly stretching their comfort zones without the pressure of immediate physical exposure. Explore the nuances that differentiate agoraphobia from other anxiety disorders, and witness the courage it takes for one to step out, open up, and embrace the world anew through Kim's compassionate and skilled guidance.

Kim Grower-Dowling:

And when someone feels safe, they're able to fully engage in life. When someone's experiencing agoraphobia, their world continues to progressively become smaller and smaller, and sometimes limiting them to such an extent that they lose all quality of life.

Bill Emahiser:

Hello and welcome. I'm your host, Bill Emahiser, and you're listening to Mental Health U, the podcast dedicated to demystifying and de-stigmatizing mental health issues. So if you or someone you know is struggling with depression, anxiety, trauma or some other mental health issue, then this podcast is for you. Welcome to today's episode. I am super excited to introduce our special guest, Kim Grower-Dowling. Kim is a licensed professional clinical counselor specializing in trauma and anxiety disorders. With her compassion, extensive qualifications and unwavering passion, Kim is dedicated to helping individuals navigate the complexities of mental health. Join us as we delve into her insights on agoraphobia and learn about her innovative approach through the Open Doors Telehealth Treatment Group. Welcome, Kim, how are you?

Kim Grower-Dowling:

I am super fantastic and I'm also really excited to be here today.

Bill Emahiser:

Well, we are excited to have you. Before we get going too far, can you tell us a little bit about your professional experience?

Kim Grower-Dowling:

Yeah, I'm about 17 years into being a licensed professional clinical counselor and I've had the opportunity to work with people with so many life experiences and one of my first opportunities was working with survivors of domestic violence and I am just in awe of our clients and what they're able to do to manage their particular circumstances, and one of the many things that I've noticed is that when someone experiences unresolved trauma, anxiety is a prominent symptom as part of the aftermath, and that can have a lot of different flavors, including agoraphobia.

Bill Emahiser:

What inspired you to focus specifically on agoraphobia and why is it so crucial to address?

Kim Grower-Dowling:

Okay. So when people experience that unresolved trauma, one of those anxieties can be agoraphobia, and when someone feels safe, they're able to fully engage in life. When someone's experiencing agoraphobia, their world continues to progressively become smaller and smaller, and sometimes limiting them to such an extent extent that they lose all quality of life.

Bill Emahiser:

For our listeners who may not know what agoraphobia is, can you kind of give us an overview of what agoraphobia is and how it might differ from other anxiety disorders?

Kim Grower-Dowling:

Yeah, all of our emotions are there for a good purpose and when we're talking about helpful anxiety that might be able to observe a new environment, get the lay of the land, have a heightened awareness before an exam or in a competition, or have anticipation of something exciting adding to life, an anxiety disorder interferes in life in some way and it's unhelpful and detracts from our life and some examples of anxiety disorders about our phobias or social anxiety.

Kim Grower-Dowling:

Agoraphobia is specific to having a fear of or an anxiety about being unable to escape or avoid a perceived situation to safety. Often we hear about someone who does not leave their home, sometimes for years, because that's their perceived place of safety. But it also could be a fear of not being able to get to safety in a big, open space with no one being able to help, or in crowded places with not being able to get out to help, such as like at concerts or in planes, buses, trains or, really commonly, grocery stores, or being in an enclosed space and feeling out of control. Agoraphobia is an extreme fear of feeling out of your comfort zone and not being able to escape to safety.

Bill Emahiser:

I'm thinking about your new group, OpenDoors Telehealth Group, that addresses the unique challenges of individuals with agoraphobia. Can you tell me what makes this group an effective solution for folks with agoraphobia?

Kim Grower-Dowling:

So it's. It's fabulous for people with agoraphobia because they can start out in telehealth already in their perceived safe place. So that's part of what makes it gentle. And they don't need to visually expose themselves if they don't want to in the beginning, so they can get used to hearing the sounds of other people's voices. And you know, eventually we're going to encourage them to be brave enough to open up their camera and so that kind of starts the treatment right from the very first session, because we're encouraging them and supporting them and they can see by the end of the session that they've made a real step. The safer an individual feels, the more open they become to challenging themselves, and the curriculum provides a guided way to do that.

Bill Emahiser:

Before telehealth right, people may not have ever engaged in treatment. They may not feel safe enough to even go to a therapist's office and start that process. So now we can reach them through your open doors group telehealth group right in their home, which is a great place to start. If somebody suspects they might be that they might have agoraphobia, what are some signs that they should look out for and when is the right time to seek professional help?

Kim Grower-Dowling:

Well, if someone is noticing that their world is starting to get smaller and smaller and they're feeling less and less safe, or if something's excluding you from what you used to be able to do, it's definitely time to reach out, and we're here to help.

Bill Emahiser:

So are there specific techniques or strategies that you would recommend for managing and coping with agoraphobia on a day-to-day basis, and I'm really thinking about those people who may not have immediate access to professional help, almost like if you were giving some self-help tips for somebody. What are some ideas that maybe somebody could utilize?

Kim Grower-Dowling:

Okay. So if they're serious about doing the exposures, then the first step is to make a list of their feared situations, rate the associated fear or anxiety level. So let's say, if 10 is the worst and 0 is nothing, they're going to rate each of those situations and break it down, and then break it down some more. We want to get to the simplest of the simple in order to make progress and to not have so much fear that we don't make any steps at all. So if someone's limited to their room, maybe they consider repeatedly getting to the bedroom door until the anxiety level is maybe a 2 out of 10. And then maybe they step through the bedroom door and then repeat, repeat, repeat until they're feeling more and more comfortable and then push themselves to stand at the top of the stairs.

Bill Emahiser:

Yeah, these are very action-oriented. Sometimes people think of therapy as I show up and I talk about things, but what you're advising sounds like it's a very like I actually have to. If I want to get on the other side of agorapobia, I need to actually practice being uncomfortable. Is that accurate?

Kim Grower-Dowling:

Absolutely because we habituate to things. If we got bitten by a dog as a little kid, if we weren't in a situation where there was a helper or some way for us to feel safe, we might, as a little kid, assume that all dogs are dangerous. And so if we habituate ourselves to safety, we will feel safe. So maybe if I have a fear of being in a closed space, like getting on the bus, you know, maybe I'm listening to sounds of the bus, after I've felt safe, looking at pictures of a bus, maybe I look at the bus route and initially I'm going to plan a safe bus route for myself. But maybe eventually I just say, okay, I'm going to take this line and get off at this stop. But if I prepared myself step by step and I feel safe, then logically I can also think about I am safe.

Bill Emahiser:

Yeah, well, it's very interesting that this is not a you're not suggesting that people have to go right out and kind of jump in the deep end, if you will, where it becomes overwhelming.

Bill Emahiser:

And I think that's one of the neat things about your OpenDoors telehealth group is that you really do your starting at maybe the safe, where a person feels the safest, and then the self-help tips that you're giving would be, you know, if they're having difficulties within their own home and we know that sometimes people with agoraphobia it's difficult for them to navigate their own home in some very severe cases so just practicing going into other rooms and then practicing going outside and then maybe practicing getting on a bus, if that's one of the things that they're having difficulty with and just practicing over and over and over again. And it makes me think about, maybe, family members that know that they have a family member that has agoraphobia. And I'm thinking what is some advice or what suggestions would you have for friends or family members who want to support someone who's dealing with agoraphobia? How can they contribute positively to their loved one's recovery?

Kim Grower-Dowling:

So I think you know it can be a very frustrating situation for family members because someone might say I cannot go out without you and so they have to, or feel they have to, adjust their schedule. So I think the most important thing is to freely give praise and support and if someone has a challenge, encourage them to go back one step and repeat until they feel comfortable and then try the next step again. And reinforcing behaviors that are encroaching on their well-being, like assuming that they can't do anything without their safe person or their safe object, is not honoring their dignity. So maybe, to put it in a different frame of mind, completely listen to them and understand. It's a process and if they need assistance which is different than reinforcing dependence and carrying out one of their practice experiments be there for them.

Bill Emahiser:

Yeah, because I would assume right. So I've worked with folks in the past and maybe you can talk a little bit about this where the family member or the friend, the significant other becomes the quote unquote safe person. As long as this person goes with me, I can do things, however the person then I mean. So now you're dependent upon another person now to get out of the house and you're dependent upon them for your feeling, your sense of safety. What if that person is sick or wants these going vacation or is not available, can't go out with that person? I would assume that that puts a like that support person.

Bill Emahiser:

That's a lot of a burden. I don't use the word burden, maybe that's like, but I can't imagine that it's a healthy or long term. Would be a healthy solution for the family member to constantly and always be the safety person, to cart someone around and go to every location where they might not feel safe? Can you talk a little bit? I mean like, is that? Should family members stop doing that, or is that? What would you recommend to the family member that feels that's that safety person?

Kim Grower-Dowling:

Family members want to be part of the support plan, right? So if we plan to go to the grocery store in the middle of the night with our support person, because that's what we can do, that's what we do initially, and then we move it up to a busier time, and then we move it up to maybe the support person is standing at the front of the store but not with them. The support person might wait outside the store, but the plan is always I will feel safe without this person because I want to live my own life. Right, right.

Bill Emahiser:

It's not stopping cold turkey, it's like, okay, get in the car and go by yourself. It's that you, you're slowly but surely that person, that support person. Start stepping away a little bit so you can support your, your loved one, through the process of healing and getting better. Yeah, it's a really cool. And again, just thinking about how useful your group is going to be to start that process and how many people you might be able to reach, who?

Bill Emahiser:

would in the past, before telehealth might not even reach out and get help, and that kind of makes me think about some of the misconceptions or myths about mental health in general. What are some of the misconceptions or myths around agoraphobia, and how can we work to educate the public and reduce stigma around this condition?

Kim Grower-Dowling:

Well, I think you know again, maybe because of family stress, that people who are in a position where they're asking their family members or other safe people to do errands for them, that they're lazy or irresponsible or babied or scary, you know that they're scary people. There are reasons for every behavior that we have and in the moment they're adaptive and we want to work to change the ones that are no longer working for us in the moment.

Bill Emahiser:

How can people reach out, contact you or get more information about agoraphobia or about your Open Doors Telehealth treatment group.

Kim Grower-Dowling:

Anyone can always go to the Unison website. That is just always the easiest, I think, to go to unisonhealthorg and if you're good at remembering things, unisonhealthorg, forward slash open doors. And my contact information will also be on the website and I'm really looking forward to meeting anyone who thinks that they might benefit from the Open Doors program.

Bill Emahiser:

Kim, it has been a pleasure to have you on the podcast. I really appreciate you taking the time to share your expertise. It's always a pleasure to have you on. I know I'm going to have you on again because we have you on the schedule to chat about social phobia and social anxiety.

Kim Grower-Dowling:

Thank you, Bill. I'm so glad to talk about agoraphobia and that Open Doors is here to help.

Bill Emahiser:

To our listeners today. I hope that we provided you with some value and, until next time, have a super fantastic day. This podcast has been brought to you by unison health. Unison health is a nonprofit mental health agency dedicated to serving the Northwest Ohio community for the past 50 years.