Agoraphobia exposure therapy: a night in the woods

A personal account by Sam Courtright. A cold camping trip in 2017 became one chapter in his experience of living with agoraphobia and practicing what he had learned in therapy. The story describes that experience, rather than a treatment exercise for readers to copy.

When avoidance made my world smaller

The first time I felt an unfamiliar tension in my chest, I was in high school. Shortness of breath followed, then racing thoughts about what could be wrong, then what a retired EMT I once met called a “sense of impending doom.”

I ended up in an emergency room, receiving lorazepam to help me come down from my first panic attack. Too many energy drinks had triggered it. So I gave up energy drinks.

An easy solution. Until it wasn’t.

Over the next few years, the cycle repeated. Different triggers meant different things, places, and situations to avoid. Panic attacks at airports became so frequent that I could no longer fly. Eventually, I was diagnosed with agoraphobia.

My world shrank. I was afraid of having a panic attack, afraid it might be physically dangerous, and afraid I would be beyond the reach of help when it happened. Those fears began making decisions in nearly every part of my life.

Avoidance had seemed sensible. We learn early to stay away from things that hurt us. But each thing I stopped doing made the next decision a little more restrictive. I needed help finding a way back.

Talking to my doctor about agoraphobia exposure therapy

I spoke to my doctor about the panic attacks and the limits I was putting on my life. I wanted to know how to overcome agoraphobia, preferably fast. Was there a quick cure?

Those conversations introduced me to exposure therapy. I began working with my therapist on facing situations my anxious mind treated as dangerous, and on accepting panic rather than fighting every sensation it produced.

That work helped make my life less limited. Progress was ongoing. It did not mean I suddenly became comfortable with everything I had been avoiding.

Taking therapy into the woods

In the spring of 2017, I wanted an opportunity to put what I had been learning into practice.

Inspired by a long drive along the pine-flanked corridor of Interstate 35 North, I reserved a campsite in a fit of self-efficacy and an imagined lust for woods. Only after confirming the reservation did I notice the forecast: a rather balmy overnight low of 30°F.

The anxiety arrived before we did.

I bounced between wondering whether I could cope with being away from help and wondering how we were going to stay warm in a flimsy tent. Our sleeping bags were rated for 30 degrees. I tried to take comfort in that.

Preparing meant balancing the Boy Scout motto, “Be prepared,” with the uncertainty I was learning to tolerate. I read advice from REI, Reddit, Quora, and more camping blogs than I care to count.

We needed to pack light because our car would be on the other side of what the park described as a “challenging” one-mile hike. We also needed food and enough equipment for a night in the woods.

Our compromise was two external-frame backpacks that had been collecting dust in my parents’ garage. By the time my wife and I wandered onto the trail, each of us had 20–30 pounds of “essentials” secured to our backs.

Uphill, both ways

The trail to the backpack campground offered a comfortable mix of woodland and the reassuring signs of a state park. We were reconnecting with our wild roots, but with curated paths and assistance somewhere nearby.

The trek was also the embodiment of the story adults tell children about how easy they have it these days.

Uphill. Both ways.

Our map suggested a descent and re-ascent of roughly 300 feet. We covered it on paved paths, timber staircases, rain-gouged dirt trails, and a bridge built from enormous wooden beams held together by rivets as big as fists.

Benches appeared at convenient intervals. Each seemed to taunt me with “had enough yet?” as we passed, then offer an “it’s okay, buddy” when we finally accepted its help.

To keep my spirits up, I whistled the Hobbits’ theme from The Lord of the Rings, between bouts of heavy breathing.

At the campsite, we put up our shelter and collected firewood and water. Then we made a smaller pack from our considerable stock of gear and went exploring: the prairie restoration to the north, the flooded banks of the St. Croix River to the east.

A little room for something besides fear

Paying attention to my surroundings helped ground me. A physical task, a detail in the trees, something happening in front of me: these gave my mind somewhere to go besides another round of anxious speculation.

The sun peeked through the clouds along our path. My continued whistling of Hobbit tunes began to seem less comical and more like an apt soundtrack.

A doe and her fawns kept a wary eye on us as they moved through the meadow. Bluebirds darted between trees. The remnants of an old farm dotted the green hills, left as shelter and a reminder of what had been there before.

The St. Croix illustrated the most significant difference between Minnesotans and Wisconsinites: they were over there, and we were over here.

As we all know, our side is better.

We wandered, talked about our life, and veered in whichever direction seemed worthwhile. Eventually, we returned to camp.

Night fell. We lit a fire, watched the flames, and whittled walking sticks. After giving the fire the Smokey Bear treatment, we climbed into our sleeping bags.

Now came the part with the least distraction. I worried about having a panic attack in the night, far from our car and the places I usually thought of as safe.

A long night in the tent

10:45 p.m.: already awake

I checked my watch and discovered I had slept for only an hour. My wife’s breathing suggested I was the only conscious person in the tent.

I wasn’t too cold yet. I wasn’t anxious yet. I focused on my breathing and hoped I could get back to sleep before the thought that this whole trip had been a horrible mistake gained much ground.

12:15 a.m.: the thoughts picked up speed

I woke again, with no obvious culprit. The temperature had dropped enough to notice, especially around my face and feet. I added the compression sack from my sleeping bag around my toes and pulled on another sweatshirt.

Then came the familiar pressure in my chest. An urgency.

My thoughts weren’t racing. They were accelerating to a comfortable trot.

Was the dropping temperature dangerous or just uncomfortable? Should I build a fire? Add more insulation? Were my toes numb or warming up? What was the wind chill? How much colder would it get?

I promised myself I would get up at five and make a fire. Five hours away.

1:00 a.m.: “cold”

My sleeping intervals were getting shorter. This time, my wife was awake too. When I asked how she was coping, she answered with one flat word.

“Cold.”

She begrudgingly left the tent to answer the call of nature, then returned to our small bubble of warm(er) air.

I wondered whether she was silently wishing herself back into our bed, unburdened by her partner’s need to drag the two of us into this challenge. I was too ashamed to ask, and she loved me too much for me to trust her answer.

We cuddled closer. I counted breaths.

2:00 a.m.: trying to work out what I was feeling

The wind picked up and rattled the rain cover. My toes were colder. I wrapped the sack around my feet with a down-insulated jacket.

I seemed to have endless layering options for my torso. I would have given my kingdom for warmer toes, or for the comfort of believing cold was the only sensation I had to deal with.

How long would help take to arrive? How long would it take us to reach help? Could the rangers drive this far? Could we find our way back in the dark? Was it more dangerous to leave or stay?

And underneath all of that: why had I dragged my wife through this?

I kept trying to name what I was feeling. Anxiety. Cold. Anxiety about the cold. Learning to cope with agoraphobia had left me suspicious of my sensations and motivations. I had become very practiced at finding reasons to avoid distress, and now I questioned which reasons to trust.

Editor’s note: This describes Sam’s uncertainty that night. Exposure therapy does not require ignoring cold-weather hazards, securing shelter inadequately, or treating new physical symptoms as anxiety. Practical safety and appropriate medical care still matter.

3:15 a.m.: the horror-movie intermission

The urge to pee, which I had been ignoring since midnight, became difficult to negotiate with. I reluctantly left the tent and the body heat we had managed to collect.

Then I made the mistake of pointing my flashlight down a trail into the woods.

The high-intensity light against the trees could have come straight from any number of horror movies my wife and I had watched. My imagination supplied a deranged murderer, a supernatural entity, a mythical beast, and several other possibilities the park brochure had neglected to mention.

I returned to the tent, grateful for the change in temperature.

3:45 a.m.: so close, so cold

The wind had become a series of severe gusts separated by unsettling calm. I worried we might lose the rain fly.

I kept renegotiating the time I could start the fire. One more hour. Perhaps earlier. Anything to give the night an end I could picture.

5:40 a.m.: I slept through it

I slept through my own fire-starting time.

I was beside myself with joy at the thought of a roaring fire and warm feet.

Morning, and other people who had been cold

Outside the tent, we found one of the most colorful sunrises I have ever seen. Pink, blue, orange, and purple striped the sky above the hill to the east.

I was tempted to imagine it as a reward for getting through the night, though I don’t believe the sky works that way.

We moved around to warm our feet and gathered wood. I broke logs down before the park’s quiet hours ended at eight, emboldened by an entirely unreasonable sense of entitlement after the night we had had.

We had stayed. I had felt anxious, but I hadn’t had the nocturnal panic attack I feared.

Meeting Bear

On my second trip to the community woodpile, I exchanged greetings and personal Midwestern observations with the other campers.

“It sure was cold,” we agreed.

“Quite cold,” some ventured. “And that wind,” we added agreeably.

Everyone seemed to have had a difficult night. One fellow, whom I’ll call Bear, had managed a particularly immersive version.

Like me, he had enthusiastically booked without checking the forecast. Unlike me, he had opted for a hammock instead of a tent.

He stood by that decision until roughly three in the morning, when a nasty gust tipped him onto the forest floor.

I felt sorry for him. His night was probably worse than mine.

Maybe.

Back at our tent, we picked at our rations and considered our next move. The car was still across the valley, on the other side of that “challenging” hike.

We enjoyed the fire for a couple more hours, packed our gear, and started home with our newly whittled walking sticks.

This time, the woods and river greeted us like friends. A breeze patted our backs as we climbed the last hill. Sunlight glinted off a windshield in the distance.

We had made it. I had made it.

What the trip changed for me

After that trip, I continued working with my therapist. Camping had given me an experience to build on, but it had not made agoraphobia disappear.

At the time I wrote this account, treatment had helped me manage the condition and make my life less limited. I was still working on it.

I had spent years letting the possibility of panic decide what I could do. For one difficult night and the morning that followed, I had managed to do something I wanted to do while that fear was still there.