Agoraphobia

Agoraphobia

In this article we’ll look at the symptoms, causes and treatments for agoraphobia

Agoraphobia

Agoraphobia is a complex phobia that is more than just a fear of open spaces. People with agoraphobia may feel anxious in situations that they perceive to be unsafe with no easy way to escape. Read our article below for more information about agoraphobia.

What are the symptoms of agoraphobia?

The severity of agoraphobia varies from person to person. While one person with severe agoraphobia may be unable to leave the house, someone with mild agoraphobia may be able to travel short distances without problems.

Because agoraphobia is an anxiety disorder, its symptoms can be physical, psychological, and behavioural.

Common physical symptoms can include:

  • rapid heartbeat
  • rapid breathing (hyperventilating)
  • feeling hot and sweaty
  • feeling sick
  • chest pain
  • difficulty swallowing (dysphagia)
  • diarrhoea
  • trembling
  • dizziness
  • ringing in the ears (tinnitus)
  • feeling faint

Common psychological symptoms may include fear that:

  • a panic attack will make you look stupid or feel embarrassed in front of other people
  • a panic attack will be life threatening – for example, you may be worried your heart will stop or you'll be unable to breathe
  • you would be unable to escape from a place or situation if you were to have a panic attack
  • you're losing your sanity
  • you may lose control in public
  • you may tremble and blush in front of people
  • people may stare at you

Common behavioural symptoms may include:

  • avoiding situations that could lead to panic attacks, such as crowded places, public transport and queues
  • being housebound – not being able to leave the house for long periods of time
  • needing to be with someone you trust when going anywhere
  • avoiding being far away from home

What causes agoraphobia?

As with many mental health conditions, the cause of agoraphobia isn’t fully understood. It is believed that it’s caused by a combination of genetic and environmental factors. [1]

Agoraphobia often runs in families. It can also develop as a result of a stressful or traumatic event, like the death of a parent or being attacked.

Research has also suggested there is a link between agoraphobia and spatial awareness. A disproportionate number of agoraphobics have a weak vestibular system (the system that controls balance and eye movements), meaning they rely more on what they can see. This means that they may become disorientated in wide open spaces or overwhelmed in crowds. [2][3][4]

Chronic use of tranquilizers and sleeping pills (like benzodiazepines) has also been linked to the onset of agoraphobia. [5] However, it appears that agoraphobia caused by benzodiazepines normally goes away within the first year of assisted withdrawal. [6] Similarly, alcohol use disorders and smoking tobacco has been linked to developing agoraphobia. [7]

How is agoraphobia treated?

If you are worried that you may have agoraphobia, speak with your GP. If you’re unable to visit your GP in person, you should be able to arrange a telephone consultation.

Your GP will usually recommend a stepwise approach to manage agoraphobia. These steps are:

  • Find out more about your condition, the lifestyle changes you can make, and self-help techniques to help relieve symptoms
  • Enrol yourself on a guided self-help programme
  • Undertake more intensive treatments, such as cognitive behavioural therapy (CBT), or see if your symptoms can be controlled using medication

Self-help techniques and lifestyle changes

Agoraphobia is associated with panic attacks, meaning you can use techniques meant to bring your emotions under control during a panic attack. Feeling more confident in your ability to control your emotions may mean you feel more able to cope with previously uncomfortable situations and environments.

These techniques are:

  • Stay where you are – try to resist the urge to run to a place of safety during a panic attack. If you're driving, pull over and park where it's safe to do so.
  • Focus – it's important for you to focus on something non-threatening and visible, such as the time passing on your watch, or items in a supermarket. Remind yourself the frightening thoughts and sensations are a sign of panic and will eventually pass.
  • Breathe slowly and deeply – feelings of panic and anxiety can get worse if you breathe too quickly. Try to focus on slow, deep breathing while counting slowly to 3 on each breath in and out.
  • Challenge your fear – try to work out what it is you fear and challenge it. You can achieve this by constantly reminding yourself that what you fear isn't real and will pass.
  • Creative visualisation – during a panic attack, try to resist the urge to think negative thoughts. Instead, think of a place or situation that makes you feel peaceful, relaxed or at ease. Once you have this image in your mind, try to focus your attention on it.
  • Don't fight an attack – trying to fight the symptoms of a panic attack can often make things worse. Instead, reassure yourself by accepting that, although it may seem embarrassing and your symptoms may be difficult to deal with, the attack isn't life threatening.

Some lifestyle changes that may help are:

  • Take regular exercise – exercise can help relieve stress and tension and improve your mood
  • Have a healthy diet – a poor diet can make the symptoms of panic and anxiety worse
  • Avoid using drugs and alcohol – they may provide short-term relief, but in the long term they can make symptoms worse
  • Avoid drinks containing caffeine – such as tea, coffee or cola. Caffeine has a stimulant effect and can make your symptoms worse

Psychological therapies

If self-help techniques and lifestyle changes don’t seem to be working, your GP may suggest trying therapy. You can also refer yourself for therapy without talking to your GP.

Guided self-help

Guided self-help means you work through a CBT-based workbook or computer course while being supported by a therapist. The therapist will work with you to understand your problems and make positive changes in your life.

Cognitive Behavioural Therapy (CBT)

CBT is based on the idea that negative thinking leads to negative behaviours and aims to break this cycle by finding new ways of thinking. These new ways of thinking will mean that you behave more positively. CBT is often combined with exposure therapy. This means your therapist will set modest goals like going to the local corner shop. As you become more confident, more challenging goals will be set to raise your confidence. A course of CBT usually consists of 12 to 15 weekly sessions, with each session lasting about an hour.

Applied relaxation

Applied relaxation is based on the idea that people with agoraphobia have lost the ability to relax. The aim of applied relaxation is to teach you how to relax. Your therapist will go through a series of exercises with you, designed to teach you how to: spot the signs and feelings of tension, relax your muscles to relieve tension, and use these techniques in stressful situations to prevent you feeling tense or panicked. Similarly to CBT, a course of applied relaxation therapy usually consists of 12 to 15 weekly sessions, with each session lasting about an hour.

Medication

In some cases, medication may be used as a sole treatment for agoraphobia. However, in more severe cases, it can also be used in combination with CBT or applied relaxation therapy.

Selective serotonin reuptake inhibitors (SSRIs)

If it Is thought that medication will help you, you’ll usually be recommended a course of SSRIs. SSRIs were originally developed to treat depression, but have been found to be effective for treating other mood disorders like anxiety, feelings of panic, or obsessional thoughts. The length of time you’ll need to take an SSRI will vary depending on your response to them. Some people may have to take SSRIs for 6 – 12 months or more. When you and your GP decide you’re ready to stop taking your medication, your dosage will slowly be reduced until it is stopped completely. Never stop taking your medication without consulting your GP first.

Pregabalin

If you’re unable to take SSRIs for medical reasons or because you experience side effects, pregabalin may be recommended.

Benzodiazepines

If you experience a sever flare up of panic-related symptoms, you may be prescribed a short course of benzodiazepines. These tranquilisers can reduce anxiety, but it isn’t recommended to take them for longer than 2 weeks as they can be addictive.


[1] https://archive.org/details/diagnosticstatis0005unse/page/217

[2] https://pubmed.ncbi.nlm.nih.gov/7755529/

[3] https://pubmed.ncbi.nlm.nih.gov/8599398/#:~:text=RESULTS%3A%20Vestibular%20abnormalities%20were%20common,but%20not%20during%2C%20panic%20attacks.

[4] https://pubmed.ncbi.nlm.nih.gov/9178344/

[5] https://books.google.co.uk/books?id=wnIBEQKQi7IC&redir_esc=y

[6] https://www.benzo.org.uk/ashbzoc.htm#:~:text=The%20outcome%2010%20months%20to,onto%20benzodiazepine%20use%20after%20withdrawal.

[7] https://pubmed.ncbi.nlm.nih.gov/17592911/

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