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Agoraphobia Treatment


Agoraphobia

Overview

Agoraphobia is an anxiety disorder in which people develop a fear of being in public places, and in some cases a fear of leaving their home.

You can overcome and conquer Agoraphobia by transforming your beliefs and taking gradual and powerful actions!

Below you will find information about Agoraphobia and how to overcome Agoraphobia.

Agoraphobia Definition

Agoraphobia is an anxiety disorder in which people develop a fear of being in public places, and in some cases a fear of leaving their home.

It is a fear of being in situations where the person believes that escape would be very difficult or where help might not be available.

Places such as theaters, parking lots, and buses are believed to be difficult to escape and cause extreme fear that often leads to a panic attack or feeling embarrassed.

These places are avoided partly because of the belief that they are unsafe and because these places can trigger very uncomfortable panic attacks or feelings of embarrassment.

People struggling with agoraphobia have a very difficult time feeling safe anywhere in public and they often need a friend or family member to accompany them anytime they venture outside of their home.

Agoraphobia usually develops after a person experiences anxiety, embarrassment, or a panic attack in a public place such as in a crowd or a shop. The public place is then labeled as dangerous and the person worries about experiencing anxiety in these places again. People will avoid these places that they believe will cause another panic attack.

Physically avoiding a situation and/or leaving a situation where anxiety and panic occur reinforces the belief that it is a dangerous situation.

Avoidance gives more power to the fear and the belief that public places are not safe.

How Many People Are Diagnosed with Agoraphobia

Among US Adults

Prevalence of Agoraphobia

​It is estimated that 0.9% of adults in the United States may have Agoraphobia during a given year. The prevalence for females is 0.9% and for males it is 0.8%. The lifetime rate of agoraphobia for U.S. adults is approximately 1.3%.

Among Adolescents

Prevalence of Agoraphobia

Approximately 2.4% of adolescents experienced agoraphobia during their lifetime. The prevalence was higher for girls than boys.

Symptoms

Symptoms of Agoraphobia include fear and avoidance of:

  • Using public transportation (e.g., automobiles, buses, trains)

  • Being in open spaces (e.g., parking lots, marketplaces, bridges)

  • Being in enclosed places (e.g., shops, theaters, cinemas)

  • Standing in line or being in a crowd

  • Being outside of the home alone

These situations cause anxiety because you fear that there is no easy escape and you will not find help if you have a panic attack or other embarrassing symptoms.

Your fear and belief that these situations are dangerous is out of proportion to any actual danger that these situations may pose.

You either actively avoid these situations, need to have a companion with you, or you endure intense fear and anxiety in these situations.

Agoraphobia with Panic Disorder

The fear of public places can cause intense anxiety that often leads to panic attacks. After experiencing a first panic attack, people fear experiencing the next one.

People will avoid situations that they believe will cause a panic attack. This can ultimately lead to Agoraphobia if you experience a panic attack in a public place, in a crowd, while using public transportation, or where escape seems difficult. The place is associated with extreme fear, anxiety, and the public place will be avoided.

Panic Disorder is an anxiety disorder that is diagnosed after experiencing symptoms of panic beyond one month.

A Panic attack is an abrupt wave of intense fear that reaches a peak within minutes and usually subsides within minutes.

Symptoms of a panic attack include:

  • Heart palpitations, pounding heart, or fast heart rate

  • Sweating

  • Trembling or shaking

  • Sensations of shortness of breath or smothering

  • Feelings of choking

  • Chest pain or discomfort

  • Nausea or abdominal distress

  • Feeling dizzy, unsteady, light-headed, or faint

  • Chills or heat sensations

  • Numbness or tingling sensations

  • Derealization (feelings of unreality) or depersonalization (being detached from oneself)

  • Fear of losing control or “going crazy”

  • Fear of dying

Complications

Agoraphobia can interfere with your ability to maintain social obligations, attend school, go to work, shop for groceries, and enjoy your life.

Many people become depressed and feel hopeless and helpless in reaction to this anxiety.

There is a potential for alcohol and benzodiazepine abuse and dependence.

Causes

Anxiety: Agoraphobia develops overtime after a person experiences anxiety, embarrassment, or a panic attack (also called an anxiety attack) in a public place such as in a crowd or a shop.

The public place is labeled as dangerous and is avoided due to the fear that this place will trigger another panic attack.

Avoidance: Avoidance is the major way that you feed the fear and develop agoraphobia. Of course, why would anyone want to approach an anxiety provoking situation or even stay in one?

Escaping and avoiding only temporarily reduces the anxiety.

Avoidance also confirms and maintains the belief that the situation is dangerous. You might not have a panic attack by avoiding a particular place but you have also reinforced that whatever you just avoided is dangerous.

Avoidance becomes a viscous cycle

  • The more you avoid situations that trigger anxiety, embarrassment, and panic attacks, the more fearful those situations become.

  • The more fearful those situations become, the worse your anxiety and panic attacks become.

  • The worse your panic attacks become, the more you avoid those situations.

Risk Factors

Although rare, Agoraphobia can begin in childhood but the overall average age when Agoraphobia usually starts is 17 years. Most people develop this fear before the age of 35 with women being twice as a likely as men to experience agoraphobia.

Temperament: Individuals with temperaments that are naturally introverted, withdrawn, or who believe that symptoms of anxiety are harmful are associated with agoraphobia.

Environment: Stressful or traumatic events in childhood such as parents divorcing, death of a loved one, or being mugged or attacked are associated with a greater risk for experiencing agoraphobia.

You may have also adopted beliefs from your parents that you apply to yourself, other people, and the world. Your current beliefs influence how you think, how you behave, and how you feel.

If you believe that the world is basically a dangerous place, then your thoughts, behavior, and feelings will follow and lead you to fear and avoid those places that you believe are dangerous.

Genetics: At 61%, agoraphobia has the strongest association with genetics and risk for inheriting it than other phobias.

Treatment

If you believe you could have Agoraphobia it will be helpful and important to seek consultation with a mental health professional to first verify the diagnosis and then receive appropriate treatment.

Treatment often consists of a combination of medication and psychotherapy. Medication helps take the edge off the physical symptoms of anxiety and psychotherapy helps to challenge irrational thinking and beliefs that lead to the anxiety and avoidance.

Treatment can begin in the home if you are afraid to leave your home. For treatment to ultimately be successful, however, you will need to gradually expose yourself to the outside world.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a well-researched and highly effective form of talk therapy that focuses on learning more helpful ways of thinking and behaving.

You learn different ways of responding to the symptoms of agoraphobia and to your feelings of anxiety.

CBT helps challenge and change unhelpful beliefs that cause anxiety by restructuring your automatic thinking.

CBT sessions also provide education on the symptoms of agoraphobia and how to manage the emotional and physical symptoms of anxiety such as how to stop a panic attack.

Cognitive Restructuring

Cognitive restructuring is used to identify and dispute unhelpful, automatic, and irrational thinking so that you can create highly effective thoughts with the power to alter your emotions and behavior.

An example of an irrational thought is “What if I can’t escape from that place. I’ll panic and lose control.”

We develop beliefs about ourselves, other people, and the world. These beliefs influence how we think.

If you believe that the world is basically a dangerous place, then your thoughts will follow. If you believe that you are defective and not a capable person, then your thoughts will reflect those beliefs.

It is not the public place that causes the anxiety, it’s your thinking and beliefs that cause the fear and anxiety.

Exposure Therapy

Exposure therapy, also known as prolonged exposure, is a form of CBT.

As with most anxiety disorders, in order to learn how to overcome the symptoms of anxiety and to know that you can cope with anxiety and master the symptoms, you need to have the experience of successfully managing the symptoms.

This often means exposing yourself to the thoughts, images, and the public places that trigger the fear, and then applying the coping strategies until the thoughts, images, and public places no longer produce the same level of fear.

Exposure therapy gradually exposes people to the feared place.

Medication

Please consult with your primary care physician or a psychiatrist regarding the use of any medication.

Medication can help reduce the symptoms of anxiety that occur in public situations that you have been avoiding such as school, work, and any other necessary public location.

Commonly prescribed medications include benzodiazepines and anti-depressants.

Benzodiazepines are quick acting sedatives that are generally safe and effective for short term use. However, the long term use of benzodiazepines is associated with the risk of developing tolerance, dependence, and possible other adverse effects.

Commonly prescribed benzodiazepines are:

  • Alprazolam (Xanax)

  • Lorazepam (Ativan)

  • Diazepam (Valium)

  • Clonazepam (Klonopin)

Anti-depressant medications are also effective at reducing symptoms of anxiety on a daily basis. This helps dampen the physical and emotional effects of anxiety and increases a person’s capacity to cope with stressful situations.

Commonly prescribed anti-depressants are:

  • Citalopram (Celexa)

  • Escitalopram (Lexapro)

  • Sertraline (Zoloft)

  • Paroxetine (Paxil)

  • Fluoxetine (Prozac)