Agoraphobia: An Overview

What is agoraphobia? 

A common misconception regarding agoraphobia is the notion that it is a fear of open spaces. However, people with this anxiety disorder experience a dread of leaving the house due to the fear of an anxiety-provoking situation, including the fear of having a panic attack. People with agoraphobia often experience panic attacks, and leaving the house or going to places where help may not be immediately available can cause extreme worry. Places and situations that may cause anxiety in people with agoraphobia include shopping malls, large crowds, long lines, and open or enclosed spaces, depending on the person.

The root of agoraphobia is often the fear of having a panic attack in public, which is why some people may stay at home as much as possible and dread the thought of going outside. Some people with this condition may not experience a sense of safety in places that commonly gather crowds. The severity of the condition depends on the person. However, some people may ask a friend to accompany them outside of the house. Others might not leave the house at all. 

Risk factors: What causes agoraphobia?

Agoraphobia is typically the result of biological predisposition and environmental stressors. Below are possible risk factors that could lead to the manifestation of agoraphobia:

• Having an anxious or nervous nature
• Being previously diagnosed with panic disorder or other mental illnesses or phobias
• Having a relative diagnosed with agoraphobia
• Having a history of panic attacks
• Going through trauma, such as the death of a loved one or being a survivor of abuse

Symptoms and what to expect

Like any mental disorder or illness, symptoms of agoraphobia can depend on each individual’s unique experiences. However, common symptoms of the condition can include the following: 

Is agoraphobia the same as panic disorder?

There can be an overlap between panic disorder and agoraphobia. Panic disorder is defined as a tendency to experience an unforeseen attack of overwhelming anxiety, panic, and fear. Some people report that panic attacks make them think they’re about to die or that they’re quickly losing control of their lives and surroundings. Some individuals with agoraphobia also experience panic attacks, which can cause symptoms like: 

• Hyperventilating
• Chest pain
• Shaking
• Chills
• Excessive sweating
• Numbness or a tingling sensation
• Nausea and upset stomach
• Dizziness or lightheadedness
• Accelerated heartbeat
• Fear that they are dying

Impacts of agoraphobia on emotional and social well-being

Because people with agoraphobia may dread leaving the house, the condition can have adverse effects on their emotional and social well-being. Below are the potential consequences of agoraphobia, especially when untreated: 

• Being bound to one’s house or having a sense of being trapped inside one’s own home
• Becoming disconnected from society or believing you are an outcast in your community
• Inability to go to school or work
• Disconnection from family and friends
• Becoming dependent on others
• Developing or worsening symptoms of depression
• Becoming dependent on substances
• Developing additional mental disorders, especially anxiety disorders and personality disorders

Treatment options

Mental health professionals often recommend that people diagnosed with agoraphobia undergo therapy combined with medication. Psychotherapy is the most commonly used, specifically cognitive-behavioral therapy (CBT). 

Cognitive-behavioral therapy involves the client and a therapist or psychiatrist. On a regular basis, the two can meet to discuss the client’s unique circumstances, including events that worsen symptoms. After these challenges are identified, the therapist can work with the client to find coping mechanisms and exercises to prevent or reduce panic attacks, thus decreasing the amount of worry one has about having an attack in a public setting. Cognitive-behavioral therapy may also teach clients the following: 

• Coping mechanisms and ways to eradicate anxious feelings
• An understanding of what situations can cause panic attacks, as well as prevention methods for the situation and the attack itself
• Exposure therapy to desensitize fear via gradual exposure to increasingly stressful situations

Since agoraphobia is unique in that it can cause a person to become housebound, some therapists may be willing to be flexible in how they are contacted. Online therapists and psychiatrists can be contacted over the phone or through the computer. Often, the goal of therapy is to help the client get to a place where they are comfortable leaving the house to attend their sessions or participate in daily life. The therapist may help the client learn to leave the house on their terms, not only for therapy appointments.

Psychiatrists may prescribe antidepressants and anti-anxiety medications to a client with agoraphobia. Like other mental illnesses, it may take several attempts to find the medication, or combination of medications, that work. Some people may not respond to medication or want to take it. Medication can be taken in combination with therapy, but therapy on its own has also been found to be effective in treating agoraphobia for those who do not want to take medication or cannot. 

Selective serotonin reuptake inhibitors (SSRIs), types of antidepressants, may be prescribed to individuals with agoraphobia. These medications are used to treat the panic disorder that can accompany agoraphobia. SSRIs increase serotonin uptake in the brain, as serotonin may be lacking in people with depression and anxiety. 

Benzodiazepines may be prescribed to reduce anxiety in stressful environments. These medications are situational, as they are sedatives that can calm individuals when panicked or overwhelmed. However, benzodiazepines aren’t often prescribed to those who have a history of addiction, as it is possible to develop a dependency on them.

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional.

How to help

Agoraphobia, like most mental illnesses, is easier to recover from with the support of one’s family and friends. The condition can be difficult for some people to understand, as some individuals have an overlap of panic disorder and other possible mental illnesses. There can be commonalities between panic disorder and agoraphobia. However, understanding the difference between the two can be helpful for family members and loved ones. Below are steps loved ones can take to help someone with agoraphobia:

• Learn as much as possible about agoraphobia and panic disorder
• Encourage treatment without being overbearing or too pushy 
• Understand that the individual is trying their hardest
• Do not blame your loved one 
• Be supportive and remind them that they have a support system
• Accompany them to places that give them anxiety unless requested not to by a therapist or the individual themselves

Understanding panic attacks

Panic attacks can be extremely scary and may worsen or last longer when an individual is forced to work through them on their own. Every person is different regarding methods that help them calm down, so loved ones may benefit from establishing what does and doesn’t work for them. 

Some people may want to be held or hugged and reassured that they are safe and are going to be okay. However, some people may hate being touched during an attack and would like anyone around them to keep their distance. Below are several tips for loved ones to support a person who is having or is about to have a panic attack:

• Speak with them: Try to speak with the individual, but do not push communication. Some people may struggle to articulate how they feel or what they want during a panic attack.
• Be supportive: Remind the person that you are there to help and want them to be safe. They may benefit from being taken to a quieter place. However, communicate before touching a person or attempting to help them move locations. In addition, do not tell them their fear doesn’t make sense for the situation, as it can be very real for them. 
• Influence self-care: Try to influence your loved one to practice breathing exercises. Help them calm their breathing and heart rate by breathing slowly in through the nose and out through the mouth. If they’re struggling to do it on their own, do it yourself and encourage them to mimic your actions.
• Be present: Be present with the individual, letting them know you are available to support them. If they ask you to leave them alone, you might ask if they truly want to be alone. Respect their autonomy, but be close by in case they request your presence again.
• Avoid invalidating language: Try not to use phrases like “calm down” or “relax,” as doing so may be invalidating. It can also be counterproductive to ask why they are panicking, as some individuals might not know why. Even if the reasoning seems irrational to you, their fear is real. 
• Be patient: Panic attacks can range from seconds to over an hour, and it can be immensely terrifying for the person having it, as well as the person witnessing it.

Online therapy for agoraphobia

If you or someone you know is experiencing symptoms of agoraphobia, consider reaching out to a mental health professional through an online platform like BetterHelp. Online platforms can offer unique options and the ability to work with a therapist from home. In addition, clients can choose between phone, video, or live chat sessions. 

With evidence-based therapeutic methods like cognitive-behavioral therapy (CBT), online therapy can offer practical tools and strategies to manage symptoms and regain control over daily life. CBT offers effective strategies for managing agoraphobia by addressing negative thought patterns and gradually exposing individuals to feared situations in a controlled manner.