Agoraphobia is an anxiety disorder characterised by an individual being fearful of public or open spaces which may be difficult or embarrassing to escape or get away from. A person with agoraphobia will often distance themselves from situations such as crowds, large social interactions, marketplaces, shopping centres, trains, planes etc. Essentially a person with agoraphobia will try to not leave a place in which they perceive to be safe such as their home, and will try to avoid any place they perceive to be dangerous to them, or difficult to escape from. Although busy or crowded places may be frightening to a sufferer of agoraphobia, the situation does not have to necessarily be noisy or have lots of activity happening to be a fearful situation. People who suffer from agoraphobia will often also experience panic attacks in conjunction with their extreme anxiety. People who experience agoraphobia will often try to avoid places in which they have suffered a panic attack before in the fear that returning to the location could illicit another panic attack.
The symptoms of agoraphobia can include:
- A rise in anxiety when away from places of perceived safety
- Low self-esteem and confidence
- Increased anxiety in anticipation of having to leave a safe environment
- Breathlessness, dizziness, sweating, nausea, increased heart rate – all of which are common symptoms of anxiety
- Reluctance to leave familiar surroundings
- Fear of being embarrassed or humiliated
Agoraphobia can often be a very debilitating and difficult to overcome. It can greatly affect a person’s normal way of living as it may restrict them from going to public places or being able to go to their workplace. In extreme cases a person with agoraphobia can even become a prisoner in their own home as they may feel it is the only safe haven for them.
Treatment for agoraphobia is often long term and requires a sensitive approach by the therapist. Cognitive behavioural therapy (CBT) is often used to help teach a person with agoraphobia how to deal with difficult situations or public events.
CBT is generally employed in two different ways in the treatment of agoraphobia:
- Cognitive Therapy: helping change a person’s thinking patterns and attitudes towards a situation
- Behavioural Therapy: Helping change a person’s fear response by strategically and systematically supporting them to safely meet the feared situation and in turn allow them to learn new coping strategies
In addition to CBT, other approaches to treating agoraphobia include exposure therapy and Acceptance and Commitment Therapy. All treatment models generally share the common feature of systematic desensitisation.
Systematic desensitisation is useful in treating agoraphobia as it teaches the sufferer how to prevent or reduce the provocation of anxiety in the feared situation by gradually confronting the fear while the sufferer is in a relaxed state. This technique involves the individual to first identify what provokes anxiety in them, and then to imagine themselves in an anxiety triggering situation whilst at the same time learning how to relax (deep breathing, visualising peaceful and safe places, muscle relaxation). Over time this will desensitise them to the situation. This is repeated with various triggers of anxiety (varying in intensity) and over time the sufferer learns to ease into situations which illicit anxiety and eventually even enter a previously anxiety provoking situation with a sense of confidence and control.