Agoraphobia Treatment
- Russell A. Hunter, PsyD
- Jun 22, 2018
- 11 min read
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
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
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)
How to Overcome Agoraphobia
1. Identify Unhelpful “If Then” Thinking
Your subconscious mind and your sympathetic nervous system will respond to the “If, Then” thinking of your conscious mind.
If your “If Then” thinking is focused on fear and anxiety, then you will experience fear and anxiety. If your “If Then” thinking is focused on a desired positive outcome or what you want, then you will feel less anxious.
Example: “If I go to the grocery store I will panic, pass out, and then I will be embarrassed” vs. “If I go to the grocery store I can buy my favorite food and I will get myself a reward for being brave.”
If you constantly focus on the possibility of danger, then your brain and body will prepare you for that danger. That means experiencing anxiety.
Begin identifying the positive outcome and experiences you want to have and deserve to have.
2. Transforming Your Beliefs
Profound and lasting changes happen when there is a shift in your beliefs.
The first step in self-transformation is to understand your beliefs about public situations, beliefs about yourself, and beliefs about your ability to cope.
You have developed beliefs about 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. If you believe that you have the ability to cope and stop a panic attack, then your thoughts, behavior, and feelings will reflect those beliefs.
Early experiences such as parents divorcing, death of a loved one, and any other stressful experiences could have instilled a sense of uncertainty and helplessness. These experiences contribute to the development of your beliefs and attitudes about yourself and about the world.
Just because you have a thought or a belief about something, it doesn’t make it true. Think about beliefs that people have that are not true such as “All blonds actually have more fun than brunettes.” These beliefs are not accurate or true. These are stereotypes.
Think about the stereotypes that you have about yourself and public places.
Your unhelpful beliefs and attitudes need to be identified and the truthfulness or accuracy of these beliefs need to be disputed.
Identify your beliefs about public places and beliefs about yourself
1. “At my core I am a person.”
2. “If I am someplace where I can’t escape then .”
3. “Being out of home and in public is dangerous because .”
Dispute your irrational beliefs by answering these questions
1. What is the evidence for this belief? What facts suggest this belief is 100% true all the time?
2. What evidence does not support this Belief? What facts or experiences suggest that this belief is not true all the time? Are there contradictory experiences?
3. How does this belief help me?
4. What would I tell a friend who had this belief?
Develop more accurate and helpful beliefs
Your new belief will be more accurate and realistic. It will not just be a positive or wishful belief.
For example: “I was able to escape and leave every place that I thought I could not escape from. This is evidenced by my being at home reading this right now.”
“Even though I felt very anxious in the movie theater, nothing bad has ever happened to me.”
“There was a time that I did not have this fear, so that means I can be fear free again.”
Your more helpful beliefs will be solidified when you test them out in public places and you actually have a positive experience while holding onto those beliefs.
3. Gradual Exposure
First imagining it (Imaginal exposure). You will get relaxed, close your eyes, and imagine the public place and the fear you have. You will identify all of your thoughts and beliefs about what would happen if you were there.
Second, you will learn to manage the symptoms of anxiety you experience while doing the imaginal exposure.
Finally, you will gradually venture out closer to the feared place and then you will learn to remain in the feared place until you completely manage the anxiety.
By repeatedly imagining and then remaining in the public place and at the same time learning to decrease your symptoms of anxiety and develop more balanced beliefs, you will become more desensitized to the fear.
4. Managing Anxiety
Feeling confident in your ability to manage the symptoms of anxiety will help with your fear of embarrassment and fear of panic attacks in public places.
Turn on Your Parasympathetic Nervous System
The parasympathetic nervous system is also called the “Rest and Digest” system. It produces a calm and relaxed feeling by:
Decreasing the heart rate
Dilating the blood vessels
Increasing salivation
Stimulating tear production
Stimulating the digestive system
Increasing a feeling of calm
Improves sexual arousal
The parasympathetic nervous system is activated by stimulating something called the vagus nerve. This nerve is very long and it runs from the hypothalamus in the brain to the chest, diaphragm, and intestines.
The vagus nerve can therefore be stimulated through diaphragmatic breathing, humming, and singing.
You can also turn on your parasympathetic nervous system with progressive muscle relaxation and by exposing yourself to cold temperatures.
Diaphragmatic Breathing Exercise
1. Inhale through your nose slowly by expanding from your belly first then fill your upper lungs for a count of 5.
2. Hold your breath for a count of 2.
3. Exhale slowly and forcefully through pursed lips for a count of 10.
4. Repeat this 5 to 10 times or do it for at least 1 minute
Progressive Muscle Relaxation
1. From a seated position begin by tensing your legs and buttocks for a count of 5, then relax.
2. Tense your abdomen for a count of 5, then relax for a count of five.
3. Tense your arms for a count of 5, then relax for a count of 5.
4. Shrug your shoulders to your ears and tense for a count of 5, then relax for a count of 5.
5. Press your tongue to the roof of your mount for a count of 5, then relax for a count of 5.
Tips: Let all of the tension release and flow out or your muscles. Exhale as you release the tension and relax. You should feel the muscles become loose and limp.
Focus on the difference between the tension and relaxation as this is the most important part of the exercise.
Exposure to Cold
Research indicates that your sympathetic (fight or flight) system slows down and your parasympathetic system increases when your body adjusts to cold temperatures (Makinen et. al. 2008).
It appears that any kind of cold exposure works such as drinking cold water, running hands under cold water, and splashing cold water on your face.
Take care of your physical health
Get regular exercise or physical activity to flush the stress hormones out of your body.
Get adequate sleep.
Eat a healthy diet and be mindful of your caffeine and alcohol intake.
For more information:
Please purchase my book “Attacking Panic: The Power to Be Calm” for more in depth information on how to stop panic attacks quickly and how to treat the root cause (Amygdala/Sympathetic Nervous System).
The book shows you how to go beyond just giving up control and allowing yourself to experience a panic attack.
The book has more powerful strategies that will short-circuit your fight or flight system, stop a panic attack very quickly, and even prevent a panic attack from occurring.
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