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The Appalachian Thru-Hiker

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Friday, September 22, 2017

Hiking 2200 miles with agoraphobia: Mission impossible or miracle cure?


The truth is, I expect it can be a little bit of both, depending upon the characteristics of one’s particular agoraphobic tendencies, but I hope to make some surprising arguments in favor of such an undertaking.  Let’s face it: thru-hiking the roughly 2,200-mile Appalachian Trail is incredibly challenging for anyone, and five to seven years ago, when my panic attacks and agoraphobia were at an earlier stage, I might as well have tried long-jumping the rocky mountains.  There are, however, many benefits associated both with the endless hiking and lack of over-stimulation that could prove to be beneficial to an agoraphobic adventurer.

I feel I have neglected the agoraphobic aspect of my thru-hike in my writing, in part because the insulin-dependence is such a dangerous issue physically, and in part because I can only write so many articles per week.  I am also not above admitting that some evolutionary machismo deep down likely causes at least a degree of shame or embarrassment, particularly when the condition is so frequently portrayed by the loner rocking back and forth in the fetal position in a dark apartment, afraid of his or her own shadow.  The truth is, most of the agoraphobics I have conversed with and befriended – and there have been hundreds, from all over the US and beyond – have incredible strength.

panic attack buttonAfter receiving many questions from readers interested in the hiking or minimalist aspects of my writing asking what exactly agoraphobia is, and inquiries from others with agoraphobia as to when I was going to speak up, it is certainly time to raise the issue.  So first, what is agoraphobia?

This is a more complicated question than one would think, but I will try to be brief and to the point.  Panic disorder is condition associated with frequent, chronic panic attacks.1  About 1 in 3 people who suffer from panic disorder will also develop agoraphobia.  Unlike specific phobias, such as a fear of spiders or 24-hour news channels, agoraphobia is more generalized in that there is not one specific “thing” that one fears.  Instead, panic attacks become so frequent, and occur in so many locations and under so many different circumstances, that one begins to fear having panic attacks in most places, often anyplace outside of the home.  Panic attacks suck, and the mere fear of having a panic attack can eventually cause so much anxiety that it triggers one – the self-fulfilling prophecy.  While triggers can vary, things like public transportation, standing in lines, crowds, or being anywhere one might feel “stuck” or unable to escape in the event of a panic attack are fairly common.1

an agoraphobic's home baseSo how on earth does someone with such a condition come to the conclusion that it’s a good idea to go tromping out into the wilderness, miles away from home, from help, from any form of civilization?  On a personal level, this is largely influenced by the progression of my own agoraphobia and the particular triggers that cause problems for me.  I have moved constantly throughout my life, from the time I was a child – almost once a year on average.  For most agoraphobics, “home” is the safest, most comfortable place to be, and I am no exception.  The difference is in what home means to me.  Home for me is my “home base,” a place where I have space to myself and the comforts I need to feel… comfortable.  This includes hotel rooms, the homes of friends and family (as long as I have a bedroom or someplace semi-private), and yes, even a tent in the middle of nowhere.

I’d like to go beyond my own situation, though, and explain why hiking in general, and even a long hike like the Appalachian Trail, can be therapeutic for someone who has agoraphobia, and even go so far as to suggest that such a person has certain hidden strengths that will be invaluable on the trail.

First, let’s look at the aspect of walking or hiking in relation to agoraphobia.  This has always been somewhat of a Catch-22, because agoraphobics and others with an over-sensitivity to anxiety are less likely to engage in exercise.2 The matter is further complicated for agoraphobics who have difficulty leaving the home.  First, being stuck indoors does not present the best environment for being active.  Second, even though equipment such as treadmills or activities such as aerobics allow activity indoors, some of the most common symptoms of a panic attack are shortness of breath or hyperventilation, increased heart rate and blood pressure, and heart palpitations.1  Vigorous exercise can begin to mimic these symptoms and either cause an attack to occur, or at least cause enough discomfort to discourage one from the activity.

Thru-hiking with AgoraphobiaThis is distressing, because walking has been found to decrease levels of anxiety.3  The good news, however, is that walking, and even hiking at a moderate pace, tends to be a less strenuous exercise with less chance of heart palpitations and other symptoms.  While exercise in general has long been known to reduce symptoms of anxiety and depression, low-impact exercise such as yoga, walking or hiking are also effective.4

If there’s one thing a thru-hiker does, it’s hiking.  Hiking uphill, hiking downhill, hiking to fetch water, hiking off trail to use the “bathroom.”  The thing is, walking only improves anxiety symptoms temporarily.3  In studies3, individuals who begin walking a few days a week see symptom improvement, but a month later, once they’ve stopped, anxiety levels have returned to normal.  Hint: on the Appalachian Trail, the walking does not stop.  What we are talking about here is 5-6 months of consecutive days with a significant reduction in anxiety symptoms just from the hiking.

In addition to psychological research, neuroscientists have been studying the effect of walking on the amygdala part of the brain in rats.  The amygdala is the part of the brain commonly associated with the “fight or flight” response very much related to panic attacks.  Not only does walking reduce anxiety, but neuroscientists have been able to detect both lower levels of anxiety-related behaviors and changes in neuron activity in the amygdala of rats given space to walk versus being caged.5  Perhaps further research will reveal that walking is not only an alleviation of anxiety symptoms, but also initiates change in our “fight or flight” response, helping to reduce panic attacks.  Imagine six straight months of having this reduced level of anxiety.  What might happen?  Could your body forget what those higher levels anxiety feel like?  I don’t know, but I intend to find out.

So far, all I’ve shown is that walking can help reduce anxiety.  So why not just take a walk around your neighborhood every morning?  It’s not the same thing.  Particularly in more urban areas, but even in small cities and towns, walking can pose problems for someone with agoraphobia that cancel out any therapeutic benefits.  There could be crowds of people, buses rushing by, people yelling in the street, and the occasional confusing flash mob of high school drama geeks.  Walking in more secluded areas, such as nature trails, are a much different experience.

multitasking

Yes, this is a real product. Scary.

The fact is, many of the things that raise anxiety and stress levels in people, agoraphobic or otherwise, simply don’t exist on the trail.  Multitasking is known to raise stress levels6, and my plan for multitasking on the trail doesn’t go much farther than maybe whistling a tune as I trudge on.  As I wrote in my very first article, it was the stress of a complicated life that inspired me to make this the year I thru-hike the AT.  I have also described the book I plan to write while I am on the trail during quiet evenings spent under the stars.  One of the significant focuses of my book is how an increasingly complicated, fast-paced culture has increased the prevalence of anxiety and depression, and that living more simply significantly reduces these symptoms.

The Appalachian Trail is about solitude.  While you will definitely run into other hikers, this will mostly be in passing or at night at shelters.  For agoraphobics like myself for whom social interaction is a big trigger, there is good news as well.  Anxiety related to social interactions tend to lessen with familiarity.  There are not many things in life that build familiarity faster than hiking across a mountain ridge during a lightning storm or spending a rainy night in a shelter with a leaky roof.  On the trail, everyone is more or less in the same boat, and many hikers find themselves congregating with individuals they would never cross paths with in their normal lives.  There are situations along the trail which could pose a problem for someone with agoraphobia, such as packed lean-to shelters or hostiles where a dozen hikers sleep on summer camp-style bunk-beds, but this is easily avoided by simply pitching your tent.  That being said, I suspect that even myself, for whom the idea of sharing sleeping quarters with a dozen others is nightmarish, will begin to see this as less of an issue as I progress along the trail.

hungry black bearSpeaking of hiking over mountain ridges through a lightning storm, I believe there is an advantage to be had on the trail by those for whom panic attacks and anxiety are routine, particularly when faced with many of the inevitable challenges, catastrophes or frightening experiences which are bound to occur along a thru-hike.  Let me try to explain, especially to non-agoraphobics.  At the very root of panic attacks and agoraphobia is a misconfiguration of the “fight or flight” response.  If I’m Christmas shopping in a Walmart on Black Friday and suddenly feel surrounded by a myriad of shopping carts and sale-crazed shoppers, my “fight or flight” response sets off as if I’m in a life or death situation.  There is a part of my reptilian brain that doesn’t understand the difference between being in a busy store and turning a corner of the trail to meet a hungry-looking black bear.  In my own experience, which has involved many situations which should have initiated this “fight or flight” response, I have found that I tend to react either the same, or in most cases, more calm than in crowded stores or endless lines.  There are only so many times that this fear response can be activated needlessly before it becomes routine.  This is where someone with agoraphobia may have the opportunity to shine on the trail.

This is not to say that I am suggesting that everyone with agoraphobia should immediately buy a plane ticket to Georgia and head out to the nearest REI to stock up on gear.  I have been walking for mental health reasons for years, and I have hiked, camped and backpacked since I was a kid.  Taking walks on a nature trail or even spending a weekend camping to get away from the stress of modern life could be an excellent start, and exactly what I’ve done in recent years when stress became overwhelming.  But it’s something to think about.  With the right preparation, anyone who can walk 5 miles with a pack on their back can thru-hike the AT.  It may be a very slow start, but once you’ve been hiking for one week, and then one month, you are going to have such a drastic physical transformation it won’t matter as much what shape you were in when you started.  I tend to agree with veteran thru-hiker Zach Davis’s (author of Appalachian Trials: A Psychological and Emotional Guide To Thru-Hike the Appalachian Trail) position that a successful thru-hike is far more psychological than physical, at least in terms of finishing the thru-hike and more importantly, enjoying the experience.

Finally, successfully thru-hiking the Appalachian Trail is unquestionably a life-changing experience, and there is no telling what internal changes might occur after completing one.  Most people who thru-hike come off of the end of the trail a changed person, and for someone with agoraphobia, who knows what those changes may be.  Even if the panic attacks continue and there is no “magic cure,” there is no question that completing such a daunting task will fill anyone with a sense of power and accomplishment.  If nothing else, it should make continuing to tackle the difficulties of life head-on easier.  After spending six months living in the woods, trudging through snow, rain, hunger, and fatigue, cold nights and hot days, having your food stolen by bears or taking a ride into town for supplies with someone on mushrooms, not to mention the endlessly aching muscles and roughly TEN MILLION steps, can Walmart on Black Friday really seem as daunting?

I think not.

 

References

1DSM-IV. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC.

2Moshier, S. J., Hearon, B. A., Calkins, A. W., Szuhany, K. L., Utschig, A. C., Smits, J. A., . . . Otto, M. W. (2013). Clarifying the link between distress intolerance and exercise: Elevated anxiety sensitivity predicts less vigorous exercise. Cognitive Therapy and Research, 37(3), 476-482. doi:http://dx.doi.org/10.1007/s10608-012-9489-9

3Lancer, R. (2005). The effect of aerobic exercise on obsessive compulsive disorder, anxiety, and depression (Order No. 3161769). Available from ProQuest Psychology Journals.

4 Zuroff D, Schwarz JC. Effects of transcendental meditation and muscle relaxation on trait anxiety, maladjustment, locus of control, and drug use. Journal of Consulting and Clinical Psychology 1978; 46, 2: 264-271.

5Urakawa, S., Takamoto, K., Hori, E., Sakai, N., Ono, T., & Nishijo, H. (2013). Rearing in enriched environment increases parvalbumin-positive small neurons in the amygdala and decreases anxiety-like behavior of male rats. BMC Neuroscience, 14, 13. doi:http://dx.doi.org/10.1186/1471-2202-14-13

6Paridon, H. M., & Kaufmann, M. (2010). Multitasking in work-related situations and its relevance for occupational health and safety: Effects on performance, subjective strain and physiological parameters. Europe’s Journal of Psychology, 6(4), 110. doi:http://dx.doi.org/10.5964/ejop.v6i4.226

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About Kevin McCourt

Kevin McCourt is an entrepreneur, writer, and reformed geek who challenged agoraphobia and insulin-dependent diabetes by thru-hiking the entire 2200-mile Appalachian Trail in 2016. He is currently working on his first non-fiction book, a philosophical and scientific look at how modern life became so complicated and the persuasive influences that created the world we live in today. He currently lives in Ocean View, DE and wherever his tent is set up.

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