How to handle agoraphobia?

Agoraphobia is usually defined as an anxiety disorder. It involves strong anxiety attacks that are usually felt while being in open spaces, like city squares and streets. The anxiety specific to agoraphobia is provoked by feelings of helplessness and losing control due to inability to navigate with confidence in an open space. It is considered to be a special type of social phobia and the name is derived from the Greek work “agora,” which means “public square,” and “phobia,” which means “fear.”

The person who suffers from agoraphobia usually avoids crowded public spaces, small enclosed spaces (e.g. elevators) but also large open spaces (e.g. parking lots), because they can trigger high levels of anxiety. The fear which is generated in those situations is associated with a lack of control, humiliation and embarrassment. After a certain period of time, the additional problem becomes “the fear of fear”—being out in the open, the agoraphobic person anxiously expects another panic attack, which then triggers more anxiety, so this behavioral pattern constitutes a vicious cycle from which the agoraphobic person cannot escape.

Early signs of agoraphobia may include social withdrawal and isolation, staying at home most of the time during the day, needing to have company when leaving home (even for short walks or going to the supermarket), or mild signs of panic attacks which might proliferate in the future (rapid heart rate, sweating, trembling, cold hands, dizziness, chest pain, stomach pain and nausea, fear of dying).

The fear usually accumulates over the years and it is considered that the disorder develops as a result of environmental and genetic factors. Psychotherapy is used as a treatment for agoraphobia. For a person who suffers from agoraphobia, it is beneficial to find the meaning of symptoms in the framework of the person’s unique autobiography. In narrative psychotherapy, for example, elaboration of the life story, insights about major events, and “connecting the dots” i.e. finding meaning in the integration of separate life events is one of the main focuses. Some other therapeutic modalities, like CBT (cognitive-behavioral therapy), are more focused on the alleviation of symptoms and less focused on persons’ autobiographies. No matter what the specific personal reasons for the development of the disorder are, all people who struggle with agoraphobia have one thing in common: Strong feelings of losing control while being in public spaces, especially in unfamiliar environments. The fear can be generalized, but also focused on specific areas (of the city) where it was experienced, or even types of transportation (e.g. buses).

The main prevention techniques are focused on staying rooted and in control. Clients can also learn many useful breathing/relaxation and mindfulness techniques, which emphasize detachment and observing body reactions, not being identified with emotions that might arise, and staying in the present moment, accepting whatever the present moment may bring. Also, identifying thoughts that “trigger” panic attacks and can cause strong negative emotions might be of tremendous help during the psychotherapeutic treatment. Learning how to cope with these symptoms usually leads to better tolerance of anxiety, which in return lowers or diminishes anxiety levels.

When needed, medical doctors can prescribe specific treatments for agoraphobia, like antidepressants and anti-anxiety medicines. Sometimes it takes weeks for the medication to have an effect. However, one cannot only rely on prescribed medications to make an improvement in his/her life. Prevention and self-help are very much needed and desirable on the path to recovery. Self-help strategies include learning about anxiety, deeper understanding of agoraphobia and developing coping mechanisms and psychological resources for dealing with symptoms of agoraphobia.