The following article describes how to overcome agoraphobia and the various approaches to treatment.
Agoraphobia is defined by significant fear prompted by situations like using public transport, being in large or enclosed spaces, being in large crowds or being outside of the home.
Agoraphobia may develop as a complication of panic disorder and may be comorbid with other anxiety, depressive or substance abuse disorders.
There are several approaches to treatment for agoraphobia which are similar to treatment for other phobias.
Treatment can include changes in lifestyle, psychoeducation, self-help materials and programs, psychological therapies, and medication.
The most prevalent treatment is exposure-based treatment and exposure-based treatment alongside Cognitive Behavioural Therapy (CBT) seems to have the best outcomes.
Changes in lifestyle can impact our mental wellbeing and help decrease anxiety as well as symptoms of phobias like agoraphobia.
These can be engaging in regular exercise, eating a varied and balanced diet, avoiding the consumption of alcohol and caffeine or the use of drugs.
We may find it difficult to exercise when we are feeling unwell, and it may require more effort to get some daily movement, but exercise can aid in alleviating stress and contribute to improvement in mood. Try some stretching, go for a walk or engage in any movement that you previously enjoyed.
A poor diet, whether it is not eating enough, eating too much or not eating nutritious foods can impact energy levels and sleep which in turn affects our mood. Eating a varied diet of foods you enjoy and are nutritious can help improve your mood.
Drugs and alcohol may offer short term relief from the anxiety but may contribute to a worsening of symptoms in the long term. Hence try to avoid using them when you are feeling anxious.
Finally, caffeine acts as a stimulant and can make symptoms worse so avoiding caffeinated drinks can also be helpful.
Agoraphobia is linked to panic disorder so learning how to cope with a panic attack may help you feel more in control of your symptoms.
This in turn can help you feel confident about controlling your response to a previously uncomfortable situation or environment.
Self-help techniques that can aid you during a panic attack
Staying where you are when you are experiencing a panic attack. Often individuals may want to leave the situation or run to a place of safety but resisting this urge can be beneficial in the long term.
Focusing on something that is visible and non-threatening, this may be an item of clothing you are wearing, or an object in a store, whilst reminding yourself that the thoughts and feelings you are experiencing are symptoms of panic and will eventually pass.
Remembering to breathe. Panic can affect our breathing and we may start to take shallow and short breaths which in turn can exacerbate the feelings of anxiety and panic. Reminding yourself to take slow and deep breaths can also help reduce the feelings of panic.
Try to understand what it is you fear and challenge it. In phobias the fearful response is significantly greater than the actual danger. Remind yourself that the fear is not real and that it will pass.
During panic attacks an individual may experience negative thoughts hence visualizing a space where you feel relaxed and at peace can be helpful. Reflect on what this place is for you and keep that image in your mind.
If symptoms persist after engaging in lifestyle changes and self-help tools psychological therapies may be employed.
Your GP can refer you for psychological therapies or if you live in England and are over 18 years of age you can refer yourself to Improving Access to Psychological Therapies (IAPT) services.
IAPT offers talking therapies, such as cognitive behavioural therapy (CBT), counselling, other therapies, and guided self-help.
Or book an appointment with a psychologist at Mindler where we utilize a blended iCBT approach.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is based on the idea that our thoughts, feelings, behaviours and physical symptoms are all linked. When we feel particularly anxious or low in mood we may experience increased negative and unhelpful thoughts which consequently impact our behaviours.
CBT can aid in understanding the problem and what is contributing to it, finding, and engaging in helpful alternative thoughts and behaviours.
Examples of negative thoughts that someone with agoraphobia may have could be that they will have a panic attack if they leave their home, or that their panic attack will be fatal.
CBT can help with changing the negative thought to a more helpful alternative like “I’ve been to the supermarket in the past and nothing has happened” or “Although panic attacks are unpleasant, they are not fatal and they adverse feelings pass”.
The change in thinking can lead to the individual being better able to challenge situations that were previously uncomfortable.
Desensitization is a technique to cope with agoraphobia that involves the use of the imagination to overcome the triggers linked with the fears and panic attacks. Desensitization works by gradually imaging themselves in situations that typically trigger panic attacks or anxiety, while learning how to relax through their emotions and fears using relaxation and breathing techniques. By learning to relax through visualizations, the person will be able to reduce the anxiety, the panic and the avoidance behaviors.
The focus of exposure therapy is to change the reaction to the situation.
Exposure therapy involves understanding the thoughts, feelings and physical symptoms that arise when you are exposed to the route of the phobia and how to manage the anxiety.
The process involves progressively and gradually exposing the individual to the previously avoided situation or environment.
As exposure is gradual one may start with a moderate goal of going for a walk around the block and then going to the local corner shop. The more confident the individual becomes the more challenging tasks may be set like going to a big supermarket.
Medication may also be prescribed for treatment of agoraphobia. A course of selective serotonin reuptake inhibitors (SSRIs) is usually prescribed which are also used to treat depression and anxiety.
Medication can also be used alongside other types of treatment, such as CBT and exposure-based treatment.
Agoraphobia treatment can also be found through local charities such as Mind and Anxiety UK. Charities can also bring you in touch with other people that have experienced similar distress in the form of support groups. References: Bridley, A. & Daffin, L.W. Jr. (2018). Essentials of Abnormal Psychology, 1st Edition. Fisher, L. M. & Wilson, T. G. (1985). A study of the psychology of agoraphobia, Behaviour Research and Therapy, Volume 23, Issue 2, Pages 97-107, ISSN 0005-7967. https://doi.org/10.1016/0005-7967(85)90018-X.