People tend to think of agoraphobia as being a fear of public places and open spaces, but that’s not the whole story. Agoraphobia involves intense fear and anxiety of being in any place or situation where escape might be difficult or where help might not be available if things go wrong. Examples of feared situations include:
When in a feared place, people with agoraphobia become distressed and anxious and have an intense desire to get out. Consequently, feared situations are either avoided or tolerated with considerable fear. Agoraphobia can be very debilitating and restricting. Many sufferers may end up staying inside their home for most or all of the time, or they may only leave the house with a friend or partner.
Agoraphobia tends to develop as a complication of panic disorder. Agoraphobia typically results from the fear of panic attacks; one third of people who have panic disorder go on to develop agoraphobia.
Panic attacks can be scary. Besides experiencing feelings of overwhelming anxiety, people suffer unpleasant physical symptoms that are often mistaken for a heart attack. Agoraphobia begins when people begin to associate their panic attacks with the places or situations where they occurred. Consequently, they decide to avoid that place for fear that they will suffer another attack.
For example, someone who has had a panic attack in a shopping centre may begin avoiding shops in general; someone who has had a panic attack on a train may decide to avoid trains or other forms of transport. This can feed on itself. The person may decide to avoid one particular setting, then another related one, and so on, leading to increasingly restricted day-to-day activities.
In a small minority of cases, agoraphobia develops in people who have had no history of panic attacks. Here, the focus of fear tends to be on the potential occurrence of embarrassing panic-like symptoms rather than full panic attacks.
The UK-based National Institute for Clinical Excellence (NICE) confirms that cognitive behavioural therapy (CBT) is the psychological treatment of choice for panic disorder and agoraphobia, helping most people with agoraphobia to make significant and lasting improvements.
In therapy, we will address any underlying panic disorder. The physical symptoms of panic will be explored, as will the catastrophised fears that typically go hand in hand with panic disorder. Cognitive skills will help you to identify and change unhelpful thinking patterns that maintain anxiety.
Additionally, we will tackle the behavioural avoidance that is central to agoraphobia through a policy of graded exposure. This will help you gradually face up to feared situations. Remember: avoidance brings short-term relief but long-term anxiety; exposure brings short-term anxiety but lasting relief.