Agoraphobia causes people to suffer anxiety about being in places or situations from which it might be difficult or embarrassing to escape, such as being in a room full of people or in an elevator. In some cases, panic attacks can become so debilitating that the person may develop agoraphobia because they fear another panic attack. In extreme cases, a person with agoraphobia may be afraid to leave their house.
What is Agoraphobia?
Agoraphobia is an anxiety disorder in which an individual fears and avoids places or situations that might cause panic and make one feel trapped or helpless. A person having agoraphobia fears an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd.
People with agoraphobia often have difficulty feeling safe in any public place, especially where crowds gather. One might think that they need someone such as a relative or friend, to go with them to public places review here. The fear can be so overwhelming that they might feel unable to leave their own home.
The anxiety of agoraphobia is caused by fear and there’s no easy way to escape or get help if the anxiety intensifies. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack and avoid the places where it may happen again.
Agoraphobia treatment can be challenging because it usually means confronting one’s fears. But with psychotherapy and medications, an individual can escape the trap of agoraphobia and live a healthy life.
What are the Causes of Agoraphobia?
The exact causes of agoraphobia are not known, but there are a number of risk factors that may increase the risk of developing this condition. These include:
- Depression
- Having another anxiety disorder, such as generalized anxiety disorder or social anxiety disorder
- Any other phobia such as social phobia
- A family history of agoraphobia
- A history of abuse or trauma
- Brain chemistry
Learned associations can also play a role in the development of agoraphobia. Experiencing a panic attack in a certain situation or setting can lead to a fear that such a reaction will occur again in the future.
What are the Symptoms of Agoraphobia?
Symptoms of agoraphobia may include:
- Being afraid of leaving home
- Being afraid of open spaces, bridges, or shopping centres
- Fear of enclosed spaces or buildings
- Fear of leaving home or being in social situations alone
- Fear of losing control in a public place
- Fear of places where escape might be difficult
- Fear of public transportation
These kinds of situations almost always trigger an anxiety response that is out of proportion to the actual danger presented by the situation.
Some people have a panic disorder in addition to agoraphobia. Panic disorder is a type of anxiety disorder in which you experience sudden attacks of extreme fear that reach a peak within a few minutes and trigger intense physical symptoms that is panic attacks. One might think that one is totally losing control, having a heart attack or even dying. Fear of another panic attack can lead to avoiding similar circumstances or the place where it occurred in an attempt to prevent future panic attacks.
Panic attacks often precede the onset of agoraphobia. When forced to endure a feared situation, a person may experience a panic attack that causes symptoms including:
- Chest pain
- Chills or hot flashes
- Diarrhoea
- Dizziness
- Feelings of choking
- Feelings of unreality
- Nausea
- Numbness
- Rapid heartbeat
- Shortness of breath
- Sweating and Trembling
- Tingling sensations
What can be the diagnosis of Agoraphobia?
To get the diagnosis of agoraphobia, a healthcare provider will assess the symptoms of an individual and check for any underlying medical conditions that might be causing those symptoms. The person may be asked about his or her medical history and about the nature, duration, and severity of the anxiety symptoms.
In order to be diagnosed with agoraphobia, one must:
- Have marked fear in at least two different situations, such as open spaces, crowded areas, or public transportation
- Having an agoraphobic situation almost always provokes an anxiety response
- Have a fear that is out of proportion to the threat
- Exhibit avoidance behaviours or distress that disrupts your normal routines, work, school, and relationships
- Experience these symptoms for at least six months
How To Prepare For The Appointment?
If one has agoraphobia, one might be too afraid or embarrassed to go to the doctor’s office. One can consider starting with a phone call to the doctor or a mental health professional, or ask a trusted family member or friend to go with them to the appointment.
One can prepare for the appointment and make a list of:
Any symptoms one has been experiencing, and for how long
Things one has stopped doing or are avoiding because of the stress
Key personal information, especially any significant stress or life changes that the person experienced around the time your symptoms first developed
Medical information, including other physical or mental health conditions that one has
All medications, vitamins, herbs or other supplements one is taking, and the dosages
Questions to ask the doctor so that one can make the most of your appointment
How Agoraphobia Is Treated?
If a person does develop agoraphobia with panic disorder, symptoms typically begin to occur within the first year that the person starts having recurring and persistent panic attacks. Agoraphobia can get worse if left untreated.
For the best outcomes in managing agoraphobia and panic symptoms, it is important to seek treatment as soon as symptoms arise. Treatment options typically include a combination of both medication and psychotherapy. The individual should seek help from the healthcare provider and follow expert advice.
Psychotherapy
Psychotherapy involves working with a therapist to set goals and learn practical skills to reduce your anxiety symptoms. Cognitive behavioural therapy is one of the most effective forms of psychotherapy for anxiety disorders, including agoraphobia.
Generally, a short-term treatment, cognitive behavioural therapy focuses on teaching specific skills to better tolerate anxiety, directly challenge our worries and gradually return to the activities we have avoided because of anxiety. Through this process, our symptoms improve as we build on our initial success.
A person can learn:
What factors may trigger a panic attack or panic-like symptoms and what makes them worse
How to cope with and tolerate symptoms of anxiety
Ways to directly challenge our worries, such as the likelihood of bad things happening in social situations
That our anxiety gradually decreases if we remain in situations and that we can manage these symptoms until they do
How to change unwanted or unhealthy behaviours through desensitization, also called exposure therapy, to safely face the places and situations that cause fear and anxiety
The therapeutic approach may include some systematic desensitization, in which the person gradually confronts avoided situations with the support and guidance of their therapist. Some research has shown that integrating exposure therapy with psychodynamic treatment has been beneficial in panic disorder with agoraphobia. Many times, the person will fare better in facing their fears if accompanied by a trusted friend.
If one still has trouble leaving home, one may wonder how one could possibly go to a therapist’s office. Therapists who treat agoraphobia are well aware of this problem. If one feels homebound due to agoraphobia, one can look for a therapist who can help to find alternatives to office appointments, at least in the early part of treatment. He or she may offer to see the person first in our home or meet you in what you consider a safe place (safe zone). Some therapists may also offer some sessions over the phone, through email, or using computer programs or other media.
If the agoraphobia is so severe that one cannot access care, one might benefit from a more intensive hospital program that specializes in the treatment of anxiety.
One may want to take a trusted relative or friend to the appointment who can offer comfort, help and coaching, if needed.
Medications
Medications may also be prescribed to help manage certain symptoms of agoraphobia. Certain types of antidepressants are often used to treat agoraphobia, and sometimes anti-anxiety drugs are used on a limited basis. Antidepressants are more effective than anti-anxiety medications in the treatment of agoraphobia. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) and Zoloft (sertraline); selective serotonin-norepinephrine inhibitors (SNRIs) such as Effexor (venlafaxine); and tricyclic antidepressants (TCAs) such as Tofranil (imipramine) and Anafranil (clomipramine). Anti-anxiety medications, such as Klonopin (clonazepam) and Xanax (alprazolam). However, an individual should always seek the advice of medical professionals before taking any drug.
Anti-anxiety drugs called benzodiazepines are sedatives that, in limited circumstances, the doctor may prescribe to temporarily relieve anxiety symptoms. Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these drugs aren’t a good choice if one has long-term problems with anxiety or problems with alcohol or drug abuse. It may take weeks for medication to relieve symptoms.
Both starting and ending a course of antidepressants can cause side effects that create uncomfortable physical sensations or even panic attack symptoms. For this reason, the doctor likely will gradually increase the dose during treatment, and slowly decrease the dose when he or she feels the patient is ready to stop taking medication.
Alternative Medicine
Certain dietary and herbal supplements claim to have calming and anti-anxiety benefits. Before the patient takes any of these for agoraphobia, taking doctor’s permission is required. Although these supplements are available without a prescription, they still pose possible health risks.
For example, the herbal supplement kava appeared to be a promising treatment for anxiety, but there have been reports of serious liver damage, even with short-term use. The Food and Drug Administration has issued warnings.
Self-Care Tips For Managing Symptoms
Some helpful strategies for people with agoraphobia include:
- seeking help and following the resulting treatment plan
- practicing relaxation techniques
- getting regular exercise and having a healthful diet
- avoiding drinks that contain alcohol or caffeine, including sodas
- avoiding recreational drugs
How to Cope up With Agoraphobia?
Living with agoraphobia can make life difficult. Professional treatment can help one overcome this disorder or manage it effectively so that the patient does not become a prisoner to their own fears. In addition to seeking help from a mental health professional, there are also lifestyle changes that can help an individual to better manage the symptoms of agoraphobia. These include:
- Sticking to the treatment plan: Take medications as directed. Keep therapy appointments. Communicate regularly with the therapist. Consistency can make a big difference, especially when it comes to practicing skills and taking proper medication.
- Trying not to avoid feared situations: It’s hard to go to places or be in situations that make one uncomfortable or that bring on symptoms of anxiety. But practicing going to more and more places can make them less frightening and anxiety provoking. Family, friends and your therapist can help an individual work on this.
- Learning calming skills: Working with the therapist, one can learn how to calm and soothe yourself. Meditation, yoga, massage and visualization are simple relaxation techniques that also may help. Practice these techniques when the patient is not anxious or worried, and then put them into action during stressful situations. Practising stress management techniques, such as deep breathing, visualization, and progressive muscle relaxation to help reduce anxiety.
- Avoiding alcohol and recreational drugs: Limit or avoid caffeine. These substances can worsen your panic or anxiety symptoms.
- Taking care of yourself: Get enough sleep, be physically active every day, and eat a healthy diet, including lots of vegetables and fruits. Eating a healthy and nutritious diet can reduce the phobia.
- Joining a support group: Support groups for people with anxiety disorders can help one connect to others facing similar challenges and share experiences.
Through the support of family and friends and professional help, a person with agoraphobia can manage their condition. With medication and psychotherapy, a person with agoraphobia can expect to eventually experience fewer panic attacks, fewer avoidance behaviours, and a return to a more independent, enjoyable and active life.
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