Agoraphobia (A complete guide)

Agoraphobia

Agoraphobia is a fear of places or situations that are likely to trigger panic attack.

The person avoids places due to embarrassment, feelings of helplessness and getting trapped in anxiety situation. 

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Agoraphobia is an anxiety disorder characterized by a fear of certain environments and situations.

Best known as a fear of open spaces, agoraphobia is, in fact, a much broader condition. 

These people fear that will be get escaped in difficult situation and typically avoid going to places such as shopping malls, using public transport, cinemas, parking areas, being in crowded areas etc. 

People with panic disorder have high probability to develop agoraphobia but panic disorder can be with and without agoraphobia.

They become socially isolated due to restricted activities. A person’s professional and personal life is greatly affected by agoraphobia.

If left untreated it gets worse.

Entering a public place – or anticipating such a scenario – causes someone with agoraphobia to experience disproportionate feelings of fear.

This, in turn, manifests as distress, and sufferers often experience a panic attack or related symptoms, including breathing difficulties, a rapid heart rate and excessive sweating.

Who gets agoraphobia? Men or women?

Approximately 0.8 % of adults in U.S suffer from agoraphobia per year. Agoraphobia may develop at any age, however, it typically presents between the ages of 20 and 30.

Both women and men can be affected, although statistics show that the condition is more prevalent among women.

Research has shown that some stressful events increases risk for developing agoraphobia such as, death of loved one, being kidnapped, being abused or tortured. 

Symptoms 

  • Becoming isolated or detached
  • Feeling afraid of being alone
  • Overdependence on others
  • Being afraid of losing control in public
  • Avoiding places that may be difficult to escape from
  • Refusing to leave the house
  • Avoid open or enclosed spaces 
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Physical symptoms

  • Racing heart/palpitations
  • Excessive sweating
  • Feeling sick
  • Chest pain
  • Chocking 
  • Gastrointestinal discomfort or diarrhea
  • Feeling faint or dizzy
  • Trembling
  • Sudden chills 
  • Fear of dying
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Causes of Agoraphobia

Several factors are known to increase your risk of developing agoraphobia. These include having: 

  • depression
  • phobias, such as claustrophobia and social phobia
  • generalized anxiety disorder or obsessive compulsive disorder
  • trauma such as physical or sexual abuse
  • drug abuse 
  • a family history of agoraphobia

Here are Treatment Options for Agoraphobia 

Medication

A combination of antidepressants and antianxiety drugs are used to manage symptoms of agoraphobia. 

Antidepressants such as 

  • selective serotonin reuptake inhibitors (SSRIs) e.g paroxetine (Paxil) or fluoxetine (Prozac)
  • serotonin-norepinephrine reuptake inhibitors (SNRIs) e.g venlafaxine (Effexor) or duloxetine (Cymbalta)
  • tricyclic antidepressants, such as amitriptyline (Elavil) or nortriptyline (Pamelor)
  • anti-anxiety drugs, such as alprazolam (Xanax) or clonazepam (Klonopin)

Lifestyle Changes 

Lifestyles changes help reduce everyday anxiety. You may try:

  • exercising regularly to increase the production of happy chemicals in brain  
  • eating a healthy diet comprising of whole grains, vegetables, and proteins
  • practice deep breathing exercises to reduce anxiety 

Psycho-education

It is educating the client to provide insight about their problem, increase your knowledge about how the vicious cycle of panic attack continues to occur and is maintained. 

Psychoeducation could be provided with the help of diagrams, which explains how panic attack is triggered by something in our mind and brain perceives it as threat which in turn set off fight or flight reflex in the body.

The body changes are misinterpreted and perceived as a threat. This misinterpretation leads to more anxiety.

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Cognitive-behavioural therapy 

Cognitive behavioural therapy is a very good way to get rid of Agoraphobia.

Relaxation Exercise

In order to deal with muscle aches and pain relaxation exercise (Progressive Muscle Relaxation (PMR) is recommended using deep breathing.

It targets 16 muscles of body that get most effected by stress. Relaxation exercise produce calming and relaxing effect.

Body focus task

It helps you to identify the effect of thinking on symptom perception. The patients are asked to focus their attention to the tightness of muscles of neck and chest, arms, legs etc.

After few minutes, they began noticing the changes. Most patients fear that panic attack would occur as they feel tightness in muscles.

This increases patient’s perception about relation between bodily sensations and anxiety symptoms.

The patients realize that increased awareness to bodily sensations could lead to anxiety symptoms.

Distraction technique

Distract your mind away from anxiety provoking stimulus by counting backwards or engaging in any of your favorite activity. 

Questioning the Evidence

Therapist challenge patient’s beliefs by looking for evidence of the thoughts and the beliefs that they have regarding their illness such as hyperventilate could cause death.

Questioning the evidence against patients thoughts and beliefs helps in identifying cognitive errors mainly catastrophizing, overgeneralization, fortune telling, and arbitrary inference in people with agoraphobia. 

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Exploring the Counter Evidence

Therapist ask the evidences that why anything bad did not happened to you  if you were sure that panic attack could cause a catastrophe.

The therapist and client together review various situations to check whether you died due to shortness of breath.

In absence of evidence, counter evidences are generated and you realize that you cannot die because of anxiety.

You finally, reach to the conclusion that many people might experience hyperventilation but they never died.

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Panic diary

Panic diary helps you to keep a record of your panic tacks and enable you to reflect back that you pass through it safety without major injury or death.

Alternative positive thoughts or to answer the negative automatic thoughts are generated to develop positive concept that you can deal with your anxiety and can control it. 

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Behavioral Experiment

Behavioral experiments are used for challenging the belief and their misinterpretation by actively inducing behavioral panic sensations.

Therapist first identifies client’s misinterpretations that helped in symptom induction.

Patient imagines the situation as per instructions of therapist during symptom induction procedure; which states that you get through the situation safety.

Ratings of anxiety before and after the behavior experiment are recorded.

After careful discussion patient realizes reduction in his/her anxiety ratings; and that they could control their anxiety in actual situations as well. 

Hyperventilation task

In this process, vigorous breathing is induced until you had panic like symptoms of palpitations, shortness of breath and sweating.

You are asked to chest breath rapidly for 30-40 seconds and then, taking slow deep breaths in order to challenge the belief about shortness of breath, getting faint, having a heart attack or dying.

The ratings of anxiety after hyperventilation task are usually less which helps you to understand that how breathing process affects your feelings.

Exposure Response Prevention (ERP)

Your avoidance behaviors are managed by using ERP technique as homework for testing agoraphobia beliefs. Let’s say you have fear of closed spaces.

You are asked to sit alone in closed room for 5 minutes initially while being monitored by any family member.

Continuous practice of this exposure response prevention technique you fears gradually decrease in intensity.

Systematic desensitization 

This behavioral technique helps you to learn to regulate your stress level utilizing relaxation techniques to lower anxiety. 

A hierarchy of feared stimuli is made by patient and each stimulus is rated in their intensity of anxiety on 0 to 10 point rating scale.

With the help of imagery, therapist guides patient starting from least anxiety provoking stimulus then advancing to higher fear levels.

This is done in subsequent number of session. 

At starting sessions even imagining the anxiety provoking stimulus is very difficult.

But as sessions continue the patients realize that he effectively deal with these stimuli in imagination and could do similarly in real circumstances. 

Peer group support 

In-person and online support groups can be an encouraging for those who want to manage their anxiety about leaving their home, entering open or closed spaces.

Feel open to share your phobia with friends or family because they can be your strongest support system in managing your fears. 

Seek professional help 

If you have constant difficulty getting in open or crowded places and you avoid these places because of anxiety then, don’t hesitate to consult a mental health professional, psychologist or doctor. 

You manage your anxiety by avoiding these places but actually they reinforce your anxiety and trap you in its whirlpool.

Early treatment could help relieve your symptoms, give you a better chance of living and improved quality of life. 

Frequently asked questions (FAQ) 

Is fear of open, crowd places a mental disorder?

Yes it is known as agoraphobia; an anxiety disorder.

Agoraphobia involves a fear of open, close or crowded places that might cause feelings of helplessness or embarrassment.

People tend to avoid certain places due to their anxiety which affects their level of functioning, quality of life and cause distress.

How can we prevent agoraphobia?

Agoraphobia cannot be prevented but managed.

I you feel you start developing fear of open, closed, crowded places then don’t avoid them; try to go to those places to overcome your fear.

You can accompany a family member or friend. 

If still the symptoms prevail or get worse then seek professional help. 

Please feel free to comment on the content or ask any questions in the comments section below.

Agoraphobia (A complete guide)

Juanita Agboola

Juanita Agboola is the editor in chief of HFNE and an expert in mental health online. She has been writing about online behavior, mental health and psychology issues since 2012. All Guides are reviewed by our editorial team which constitutes various clinical psychologists, PhD and PsyD colleagues.