Key to Recovery: Homebased Practice

by Richard C. Raynard, Ph.D.
Clinical Psychologist

Homebased practice is coming to be recognized as one of the most important prognosis for sustained progress, and especially for long-term success.

Homebased practice is simply the everyday exposure you can get in the place of fear within an average walk from home, using the support of people who can help you and the convenience of home. It almost always requires that your family knows of the special time you have set aside, so they protect that time, if not actively assist you. And, following the best practice of exposure therapy, it requires starting at the least anxious situations and setting limited goals that ensure the increasing success, all while practicing the methods in fear management.

The reasons for the effectiveness of this approach are not hard to find. Facing the place of fear every day in itself breeds confidence. The daily progress, however small, is measurable and real and is a solid basis for hope. You can be more flexible about practice at home than anywhere else, particularly in setting up early morning practice. This avoids all the buildup of the worries and "what-if's".

If your practice is successful, as it usually is, the calming effects can last a good portion of the rest of the day. When you write down or "chart" your progress, you can realistically project your ability to travel to those especially important future occasions you don't want to miss.

Perhaps most important of all is that in small amounts of time every day, you have built up an incredible amount of exposure time that is the basis of desensitizing the phobia.

As Dr. Weekes says, "You get cured in the place of fear." And at the same time if you have been practicing the methods of managing fear until they are habitual and automatic, then, when the most fearful situations come up, you are fully prepared.

An added bonus for many is when, after a run of successes and increasing comfort in travel, they reach a point of excitement about their progress and look forward to practice with increasing anticipation of success. This can be a take-off point in accelerating progress through the phobia.

An account by Dr. Hardy in accelerating progress through practice can make this point more clearly. He reported his effort through a team of therapists working on a housebound phobic woman almost round the clock for six days. Phobic five years, and housebound for two years, she could not answer the door or go onto her own patio. A trained staff worked with her in continuous practice from 8am to 8pm every day.

On day 1, she was able to walk around the block four times by the end of the day.

On day 2, her resistance, initially extremely high, fell as she felt confidence in the therapists and their methods. She was able to go in and out of several stores by the end of the day.

On day 3, she mastered much of driving in traffic.

On day 4, expressways, elevators and talking to strangers were the focus of practice. She had passed into a state of excitement about her progress with few anxieties.

On day 5, she focused on doing all of these activities alone, with occasional meetings with her therapists.

On day 6, she kept only telephone contact with the therapists as she moved through stores, airport, escalators, bridges, etc., all alone. She maintained this capacity with several years follow up.

This bold effort at continuous practice speaks for itself: when her practice was that much more frequent, her progress was that much more rapid and dramatic.

For more information about the benefits and methods of homebased practice, refer to:
Agoraphobia: Nature & Treatment (Mathews, Gelder & Johnston, 1981)