Agoraphobia: A Psychologists Guide On Agoraphobia

Agoraphobia is a fear of being in places or situations where it may be difficult or embarrassing to get out quickly or where you may have a panic attack and can’t get help. Agoraphobia is an illness has been around for thousands of years. The word “agoraphobia” is of Greek origin. “Agora” literally means “marketplace” and the widely used “phobia” means “fear” or “morbid fear”. Approximately 3.2 million adults in the US between the ages of 18 and 54, or about 2.2%, suffer from agoraphobia (1). Triggers for agoraphobia may include wide open spaces, crowds (social anxiety), or traveling (even short distances).

How to know if you suffer from Agoraphobia:

• Do you feel anxious that you will have a panic attack when in a situation from which escape is not possible or is difficult or embarrassing?
• Do you fear being alone?
• Do you fear of being in crowded places, such as in a shopping mall or sports stadium?
• In such situations do you suffer from intense fear, disorientation, rapid heartbeat, dizziness, or diarrhea?
• Do you avoid situations that provoke these reactions?
• Do you confine yourself to your home, experiencing difficulty traveling from this safe place?

What are the symptoms of Agoraphobia?

What causes agoraphobia?

Imbalance in vestibular system:

People with Agoraphobia are thought to suffer from problems with spatial orientation (2). Normal individuals maintain a balance of their orientation by combining information from their vestibular system (ear), their visual system and their proprioceptive (motion) sense.

It has been found that agoraphobics have weak vestibular function and therefore rely more on visual or tactile signals. This may cause them to get disoriented when visual signals are compromised as in wide open spaces or overwhelming as in crowds.

Other causes of Agoraphobia:

• Stressful environment
• Substance abuse.
• Long term use of tranquilizers and sleeping pills (When benzodiazepine dependence has been treated and after a period of abstinence, agoraphobia symptoms gradually subdue)
• It is now believed that agoraphobia develops as a complication of panic attacks.

You may develop agoraphobia when you begin to associate your panic attacks with one or more situations in which those attacks have occurred. Check out the amazing method which will explain you the complete details.

When should you seek medical help for agoraphobia?

Anxiety is a part of daily life, but if you have experienced the above symptoms and you find that these symptoms don’t go away quickly or easily, its time you consult a psychiatrist.

Consult a doctor if you feel:

• The symptoms of anxiety are intense and you may need medication.
• If the condition is affecting your personal, professional or social activities,
• If you feel depressed after the attacks and feel suicidal at times,
• If you are not able to function normally due to this problem

How is a diagnosis of Agoraphobia made?

Patients suffering from Agoraphobia do not seek help until the problem becomes devastating. They often report to the hospital with other medical or mental health problems such as feeling fearful and depressed. During the consultation the psychiatrist obtains a history and asks for relevant laboratory tests. The doctor may also carry out physical examination to rule out any medical causes for such anxiety. Following the consultation, you may be asked to take up psychological therapy or you may be started on medication.

Treatment for Agoraphobia:

Treating agoraphobia can involve both psychotherapy and some medications.

Psychotherapy options:

Cognitive-behavioral therapy:

CBT (Cognitive behavior therapy) involves a therapist working with the patient to understand how thoughts and feelings influence behavior(1).The goal is to change negative thought patterns that lead to the patient’s anxiety and replace them with positive and more realistic thoughts.

Cognitive therapy helps patients to limit cognitive distortions by teaching patients to record their worries, listing evidence that justifies or contradicts the extent of their concerns. Through CBT patients learn that “worrying about worry” worsens anxiety and they are taught to take a proactive approach to solve their problems instead of practicing avoidance or procrastination.

Exposure therapy:

This is a form of therapy where the patient is exposed to the objects of their fear in a safe, controlled environment. Through repeated exposures to the feared object or situation, the patient develops control over the situation and no longer feels threatened by any negative outcome.

Drugs:

Benzodiazepines

Benzodiazepines are used to provide short term relief to the patient, then can become addictive and habit forming and hence are not recommended for long term use. Many patients are started on Benzodiazepines and enrolled into CBT at the same time, the dose of Benzodiazepines is tapered off as the patient develops more control over his/her thoughts.

Antidepressants

Short dose of TCAs are used to reduce severity of anxiety and frequency of episodes. TCA’s provide a long term solution for treatment of Agoraohobia. Amitryptiline is a a popular TCA for the treatment of Agoraphobia.

Monoamine oxidase inhibitors have also been used to treat Agoraphobia, but they are usually used as last line of treatment due to their side effect profile and associated dietary restrictions.

SSRIs

SSRI’s are the most preferred drugs in treatment of Agoraphobia.

Paroxetine or fluoxetine have been the first line of treatment for Agoraphobia and they have proven to be very effective. Escitalopram is another drug that appears to be effective in the treatment of Agoraphobia.

Finally, it depends on the individual as to which medicine works best. For further details on this, please take spare a moment and check the Linden method which will be really useful for you to understand Agoraphobia.

Self help

Patients suffering from Agoraphobia feel like they have become an emotional and physical “cripple” due to a disorder over which they have little or no control. Here’s a list of helpful strategies to cope with Agoraphobia:

• Practice gradual exposure to events that cause anxiety, taking baby steps is the key to overcoming this problem.
• Try and maintain a supportive and trustworthy group of people around you.
• Discover your dreams and desires outside the agoraphobic fear s and pursue them, take up distance learning programs that will empower you to pursue your dreams.
• Thanks to the magic of the Internet, today there are many blogs, posting sites, on-line chat programs where you can meet fellow agoraphobics and communicate your fears and worries.
• Watch your diet and exercise, limit the intake of caffeine and other stimulants.
• Taking up to a yoga program can help you with your breathing and help you in centering your energy
• Learn everything you can about Agoraphobia so you are prepared to handle any panic attacks.
• Have high friendly and positive people around you, this can help you with your mood and overall sense of wellbeing.

Relaxation Technique:

Practice proper breathing. Breathing properly is most important if you are suffering from anxiety disorders like Agoraphobia. If you breath with your mouth open and your chest raises as you breath in and falls as you breath out then you are not doing it right! The proper way of breathing is belly breathing. You need to breath in through the nose and your belly should rise with each inhale and fall with each exhale.

The best way to practice this is to lie down on a couch or bed and with one hand on your belly breath in and out. Make sure your belly pushes your hand up when you inhale and comes back down when you exhale. Now, the key here is to make sure that your breathing is very slow.

Hold each breath for 3 seconds and then slowly exhale. Wait for 3 seconds and do it again. Practice this few times a day for at least 5 minutes or longer. Ideally you need to practice this to the point where it just becomes a subconscious habit. Practice it during all your regular activities, like cooking, watching television, talking to friends etc. Practice, practice, practice and with time you will notice that your anxiety levels decrease automatically.

Once you have mastered this technique, you can add some visualization to it , while laying on your couch or bed and breathing properly, close your eyes and visualize something that makes you feel happy or calm. Make the visualization as clear as possible, feel the sights, sounds and energy of the place.

Next imagine yourself actually, doing this activity that causes anxiety. Imagine taking the first step and see yourself going through with it without any trouble. After a few trials you will be able to visualize going through the activity, just keep going as long as you feel comfortable. The most famous method is indeed linden-method

Remembering the whole time to continue to breath properly. Do this as often as possible. This is going to take a lot of practice and patience but with repeated effort, it can improve your quality of living tremendously.

If you’re suffering from Agoraphobia and would like to take control of your anxiety without medications, then please feel free to spare a minute and refer to the most famous technique of agoraphobia  which will explain you the complete details.

Do provide us with your valuable comments which will help us improve our information.

References:

1. Phobia Fear Release. “Percentage Of Americans With Phobias”. http://www.phobia-fear-release.com/percentage-of-americans-with-phobias.html. Retrieved 2010-04-07.)
2. Yardley, L; Britton, J; Lear, S; Bird, J; Luxon, LM (1995 May). “Relationship between balance system function and agoraphobic avoidance.”. Behav Res Ther. 33 (4): 435–9. doi:10.1016/0005-7967(94)00060-W. PMID 7755529 : 7755529.)