Agoraphobia is much more than "fear of open spaces". For people who suffer from it, the outside world can become a minefield: the supermarket, public transport, a crowded square, queueing at the pharmacy, or simply moving away from home can trigger unbearable anxiety. In the most severe cases, agoraphobia can confine the person to their own home for months or years. But the good news is that it can be overcome.
What is agoraphobia, really?
Agoraphobia is an anxiety disorder (not simply a specific phobia) characterized by an intense fear of being in situations or places from which escape would be difficult, or where help could not be obtained in case of a panic attack or anxious symptoms.
Contrary to popular belief, agoraphobia is not only a fear of open spaces. People with agoraphobia may fear:
• Crowds and large gatherings
• Public transport (subway, buses, trains)
• Shopping centres, supermarkets
• Queues and waiting rooms
• Bridges, tunnels, motorways
• Open spaces (squares, fields)
• Being alone outside the home
• Any place where they feel they "cannot escape"
The connection between agoraphobia and panic attacks
Agoraphobia and panic attacks are intimately linked. In most cases, the cycle works as follows:
Phase 1: The panic attack
The person experiences a first panic attack in a public place: the supermarket, the subway, a shop. The attack is so intense (racing heart, difficulty breathing, sense of impending death) that it creates a very strong memory associated with that place.
Phase 2: Fear of fear
After the first attack, the person develops "fear of fear": they don't fear the place itself so much as experiencing the panic sensations again. They begin to avoid the place where they had the attack. If it happened at the supermarket, they stop going.
Phase 3: The expansion of avoidance
Avoidance extends to similar places: "if it happened at the supermarket, it could also happen at the shop, at the shopping centre, at any store...". The circle of avoidance grows until the person may become confined to home, the only place where they feel "safe".
Symptoms of agoraphobia
Physical symptoms: Racing heart, hyperventilation, sweating, trembling, nausea, dizziness, muscle tension, sense of unreality, blurred vision, and, at the most intense moments, full panic attacks with a sense of imminent death.
Cognitive symptoms: "It's going to happen again", "I'm going to die", "I'll lose control", "I'll embarrass myself", "I won't be able to get out of here", "no one will help me". Constant hypervigilance of bodily sensations and of the available exits.
Safety behaviours: Always going out accompanied, carrying medication "just in case", always sitting near the door, memorizing escape routes, avoiding moving away from home, avoiding new places, limiting outings to known "safe" places.
Treatment of agoraphobia
Agoraphobia requires a comprehensive therapeutic approach but has a very positive prognosis:
Cognitive-behavioural therapy (CBT)
The gold-standard treatment. It works on two levels: restructuring the catastrophic thoughts that maintain the fear, and gradually exposing the person to the avoided places. Exposure is carried out very progressively, respecting the patient's pace.
Treatment of panic attacks
If agoraphobia is accompanied by panic attacks (which is very common), they need to be treated directly. Interoceptive techniques are taught (exposure to the bodily sensations of panic) along with emotional regulation to reduce fear of one's own reactions.
EMDR
EMDR is useful when agoraphobia began with a traumatic experience (a very intense panic attack, a public fainting, an unsafe situation). It allows the memory to be reprocessed and reduces the automatic fear response.
Online therapy: the ideal first step
Online therapy is especially valuable for agoraphobia: it allows treatment to begin from home, without needing to travel. As the person progresses, online sessions can be combined with progressive outings. For many people with severe agoraphobia, online therapy is the only possible first step.
Take the first step
If agoraphobia is closing the world to you, if you have stopped doing things you used to do normally, if the idea of leaving home generates anxiety, know that recovery is possible. From the practice in Igualada or through online therapy, we can begin to work together to recover your freedom. Contact me for a first informational consultation.