Abstract
A patient with agoraphobia but no history of panic disorder had numerous panic attacks brought on by anticipatory anxiety which we believe was related to a childhood traumatic experience of suffocation by strong gusts of wind in a snowstorm. She was successfully treated by medication and cognitive-behavioral therapy (CBT). The present report describes the therapy. The cognitive-behavioral treatment consisted of psycho-education, abdominal breathing, autogenic training, systematic desensitization, exposure, and cognitive restructuring. From the changes we observed, we assume that (1) psycho-education and relaxation reduced her tension and vigilance, brought about effective coping strategies, and enhanced her motivation; (2) systematic desensitization and exposure normalized the childhood trauma; and (3) cognitive restructuring soothed her anticipatory anxiety. As a consequence, the symptoms of agoraphobia could be cured. These findings suggest that when the anticipatory anxiety maintaining agoraphobia is influenced by childhood trauma, we must focus on that traumatic experience in addition to using standard cognitive-behavioral strategies for agoraphobic avoidance behavior and cognitive distortion.
