In my early twenties, I suffered with agoraphobia. Agoraphobia is a fear of crowded places, open spaces, or being in places where it is not easy to escape. A person who suffers from severe agoraphobia may be afraid to leave their own home.
I am a writer and project manager who has lived with anxiety for over ten years. You could look at me nowadays and think that I was completely cured. You could see photos of me travelling the world and think that I had found the cure to anxiety.
Unfortunately for me, and an astounding number of other people in the world, I haven’t found the cure. What I have found, through talking therapy used for treating agoraphobia like cognitive behavioural therapy (CBT) and years of trial, error, and persistence, is how to stop lapses from turning into relapses. By writing this article I hope to share some of my experience so that it can help others.
A lapse is a temporary setback, a brief revisit of old habits that encourages the anxiety to grow. It can make you feel like all your hard work was for nothing. A lapse is not a relapse. A relapse is a return to how you behaved at the height of your anxiety when you let it rule your life.
For me, a relapse would mean not leaving my house, quitting my job, developing a fear of the outside world, and abandoning all the CBT techniques I have used over the past eight years to manage my anxiety, and instead giving in to the negative thoughts.
As of right now, I have never experienced a relapse.
I have, however, experienced lapses. In fact, I experience lapses all the time.
There are so many factors that can influence our anxiety levels, and subsequently influence our behaviour. Some are in our control, and some aren’t. I am especially anxious in hot and crowded spaces, like the tube at rush hour. The sensation of being hot therefore reminds me not only of that hot flush that washes over me during a panic attack, but also of the hot and crowded places I hate so much. Whenever the weather is especially hot, I feel anxious. I associate the heat with anxiety, and so during the summer, my anxiety skyrockets. I can’t control the weather, of course, but I can control how I react to it.
A recent lapse
Recently, while on holiday, my partner and I were driving to a restaurant. At the height of my agoraphobia, I was terrified of restaurants. The idea of being stuck at a table where it would be socially unacceptable to run away used to drive my anxiety wild. I would get so nervous that I would feel sick and lose my appetite, making eating in restaurants impossible. Throughout my course of CBT, I exposed myself to restaurants repeatedly until I became comfortable with them, but suddenly I was afraid of them again. Why? Europe was at the beginning of an intense heatwave, and the hot weather was making me anxious.
I did what you should never do: I gave in to the anxiety.
We didn’t go to the restaurant. I avoided the situation, and so I taught my brain that avoidance gets rid of anxiety. It then became harder to go to a restaurant the next time, and I avoided them again.
By the time we were back home, the thought of going to a restaurant made me feel sick, as if I had made no progress at all in the last eight years. At this point, I had the choice between letting this be a lapse, or letting it turn into a relapse.
How to stop lapses from becoming relapses
The only way to stop a lapse from becoming a relapse is to retrain your brain to know that there is nothing to fear in the situation.
It is within the core principles of CBT — you teach yourself that a situation is not harmful so that your negative thoughts do not cause anxiety, and then the anxiety won’t make you leave the situation.
I did exactly what my mind was telling me not to do, but what I had to do: I went to restaurants.
I sat at the table, feeling sick and frightened, and ordered food even though I truly believed that I couldn’t stomach it. I let myself be anxious. I didn’t leave. I waited for the anxiety to pass, and then I ate. It’s been a few months since that lapse, and I’m happy to say I can enjoy restaurants again.
Using CBT to keep relapses at bay
I first referred myself for CBT with my local Improving Access to Psychological Therapies (IAPT) service in 2014.
I was assigned a course of twelve sessions with a High-Intensity CBT therapist.
The course worked wonders for me and by the end of it, I was able to do many things I couldn’t do before. This includes buses, trains, restaurants, cinemas, and even a long-haul flight to my brother’s wedding in America.
It’s important to understand that I was not cured at the end of the course, despite the successes I achieved. I was taught the coping skills and tools that I needed to start my journey of recovery. CBT teaches you skills that you can use every day, and I use them all the time to prevent relapses.
When you suffer from a lapse
Firstly, go easy on yourself. If you’re experiencing high levels of stress or something has triggered your anxiety, it’s not your fault. Practice self-care and be kind to yourself.
Then, write down what is giving you anxiety, and what you are avoiding. You can then plan to start exposing yourself to it again, using CBT coping skills to help.
When I first experience a lapse, I am terrified. I’m convinced that my anxiety is coming back in full swing, ready to ruin my life again. That fear is what gives me the persistence to keep practising CBT and to keep exposing myself to the things that scare me, and I always manage to stop the lapse in its tracks.