Agoraphobia can be defined as significant fear of situations such as using public transport (e.g buses, trains, planes), being in open spaces such as car parks and bridges, being in enclosed spaces such as movie cinemas and shops, standing in line or being in a crowd, and being outside of the home alone. The fear is related to a belief that it would not be possible to escape the situation or that help might not be available if panic-like symptoms occurred. While many people have some anxiety about being in some of these places, a person with Agoraphobia will try to avoid these situations, want someone with them if they have to endure them, or experience the situation with extreme anxiety.
Other common situations that people with Agoraphobia may find difficult include:
- Being a long way from home
- Going to concerts in stadiums or large venues
- Going anywhere new and unfamiliar
- Tunnels
- Elevators
Causes
Genetics and temperament
A family history of anxiety disorders increases the likelihood of children developing anxiety disorders, including Agoraphobia. This may be through genes, as well as through children learning through observing others being anxious about certain situations. An introverted temperament or personality style has been linked to an increased chance of developing an anxiety disorder, including Agoraphobia.
Parental factors
Punitive and controlling parenting styles have been linked to an increased chance of developing an anxiety disorder. Children of parents who have anxiety disorders are more likely to develop anxiety disorders, as their parents demonstrate or model high anxiety about certain situations. This can lead to the child developing anxiety about the same situation.
Thinking (cognitive) style
Certain styles of thinking have been linked with anxiety disorders. A “looming” cognitive (or thinking) style is a tendency to think about and pay attention to thoughts about upcoming dangers and risks. This thinking style has been linked to Agoraphobia.
Learning experiences and negative life events
Ongoing life stressors that cause anxiety are linked with the development of Agoraphobia. Agoraphobia usually appears after a person has started experiencing panic attacks.
Seeking help
If you experience high anxiety when outside the home and in public places, and the anxiety is significantly affecting your life, there are effective treatments available. You can seek help via:
Your GP. Your GP can refer you to a mental health professional, such as a psychologist or psychiatrist. Your GP is the best person to start with when looking for effective treatment for Agoraphobia
Like all anxiety disorders, Agoraphobia is highly treatable.
Treatment
Psychological therapies
People with anxiety disorders, including Agoraphobia, should be offered psychological therapies first, before medication. Cognitive behaviour therapy (CBT) has been developed for the treatment of Agoraphobia, and panic symptoms will also be focused on during treatment. CBT is a practical treatment, and involves teaching practical skills to deal with anxiety symptoms. CBT focuses on understanding the thoughts, feelings, and behaviours that keep anxiety going, and strategies to gain more control over symptoms. Often people with Agoraphobia will avoid situations they fear, or do things when in those situations to try to reduce their anxiety, such as making sure they have someone with them. However, these strategies often lead to increased anxiety over time. CBT helps people to begin to change these behaviours, and reduce their anxiety.
Online treatment programs for some anxiety disorders, including Agoraphobia, have recently been developed. Online treatment programs are based on CBT, and panic symptoms should also be targeted when treating Agoraphobia via the Internet. Online treatment programs may involve some contact with a therapist over the Internet.
Medication
A type of anti-depressant medication known as selective serotonin reuptake inhibitors (SSRI) has been found to be effective in treating Agoraphobia. Your GP or psychiatrist will need to prescribe this medication to you.
How family and friends can help
- Avoid telling the person with Agoraphobia to just “snap out of it”, or to get over it.
- Try to understand what situations the person with this disorder finds difficult
- Remember that although you might not find the situation hard, for the person with Agoraphobia, the fear of a particular social situation can be extremely intense
- Encourage the person with Agoraphobia to seek professional treatment, and to persist with it
