What is Agoraphobia?

Agoraphobia is frequently misunderstood as a condition where a person is deeply afraid of going outside into open spaces and therefore avoids leaving their home. In reality, agoraphobia is an intense fear or panic attack in response to being in places or situations where escape would be difficult, where it might be embarrassing to have to escape or leave or where help might not be available if something went wrong. Because of this, a person who struggles with agoraphobia symptoms may fear travelling on public transport, crossing bridges, travelling in lifts, flying or visiting crowded & enclosed areas. Because these feared situations often involve our primary means for getting from point A to point B as well as our common destinations, people with agoraphobia symptoms may find it very difficult to leave the house. They often feel comforted by being accompanied by someone familiar or by a pet.

How do we treat agoraphobia?

To help people work through their agoraphobia we focus on treating their anxiety, as it is the main driver behind the scenes. By using a combination of techniques derived from CBT, mindfulness and psychodynamic therapy. The focus of treatment is to help people effectively work through their catastrophic beliefs and perceptions so that they might be able to more accurately identify what actually is threatening from what is not. We also want to help people to sit with discomfort and watch their intense emotions and sensations from the outside looking in and also to focus their attention on what is okay in the world around them. Many people who struggle with agoraphobia will also need some help to improve their confidence, enhance their sense of self-efficacy, and develop self-trust to build resilience to cope with this stressful world.

What causes agoraphobia?

There is no one cause for agoraphobia and it’s possible that there are many different causes. It’s important to understand that despite their specific diagnostic label, all psychological conditions are various manifestations of fear or pain. When we go through difficult times in life we will very likely feel fear and/or pain. That is a normal response to difficulty and is, unfortunately, a normal part of our existence. Agoraphobia is one particular way that fear can manifest, usually when a person is going through a difficult time.

What is most common in the development of agoraphobia is that a person experiences a panic attack or very intense fear in a small public place where they feel intensely embarrassed and/or cannot get away. Following this, they develop a fear of panicking again in that space. To cope, they stay away from that space and similar ones altogether. While this helps to stop the panic attacks, unfortunately it teaches the brain to cope by way of avoidance and with time this generalises to other areas where we might feel fear. In time, we are avoiding pretty much anything that causes discomfort.

How does agoraphobia affect someone’s life?

Without working to understand the nature of our fearful thoughts and challenging ourselves to shift perspective and feel intense feelings, a person can become very withdrawn from the world, gradually developing agoraphobia. Everything begins to feel scary because we are no longer in the world, testing things out and having real experiences, but rather staying at home and imagining all the bad and scary things that could happen. Our minds get carried away and spin endless scary story after endless scary story. In this place, people often experience difficulties in their interpersonal relationships and professional life. This, in turn, hurts a person's self-confidence and self-efficacy, which can lead to feelings of depression. Agoraphobia can be hugely debilitating and difficult to work through but it’s important to know that people do recover with effective therapy.