Phobia case studies

John is a 27-year-old postman, married with three children and has a sixyear history of agoraphobia. John recalled having his first panic attack in a crowded shop five years earlier after returning from a two-week summer holiday. At the time of this first panic attack, it started with severe sweating, and then feeling dizzy, followed by increased heartbeat leading him to think he was going to collapse or faint. His fear had gradually worsened and he gradually began to avoid more and more places. The pattern was that he would give up going into places after having a panic attack as he feared further attacks (for example, crowded shops, restaurants, hairdressers, buses, quiet shops and lifts). In addition he always carried a bottle of water, wore shorts and loose clothing, and carried a hand-held fan. Two months earlier he had had a panic attack at work and had been off sick since and worried that he could never return. However, his work attendance had suffered over the preceding year as he disliked walking and delivering post when it was hot, so he asked to begin his round earlier and earlier during summer months.

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