Agoraphobia Treatment in CardiffAgoraphobia treatment: Agoraphobia is an anxiety disorder and complex phobia in which the sufferer fears being in various situations that are considered difficult to leave. Having a panic attack in a situation and feeling trapped, embarrassed or isolated from help starts a sequence of fearful reactions that exacerbates the condition. Agoraphobia can also develop when you have experienced a trauma usually away from your home. You now live in fear of experiencing another trauma when you leave your home. With mild agoraphobia, you may be able to travel short distances to deal with “essential” matters. In the extreme progression of agoraphobia, you will struggle to leave your home.
Agoraphobia treatment: What situation does an agoraphobic fear?Someone suffering with agoraphobia will fear returning to any situations where you have previously experienced a panic attack or a trauma, typically open spaces and public places. This can include:
- Being in open spaces where help may not be readily available such as in open fields and countryside, around and at the top of hilly and mountainous landscapes.
- Being away from home in extreme weather conditions.
- Travelling in vehicles or on public transport where you are unable to control the journey e.g. when travelling on a train, bus, coach, ship, underground tube, airplane and even a taxi. Or travelling in a car with unfamiliar people whom you fear would be unsupportive if you had a panic attack.
- Social situations or crowded locations where you cannot see your “exit” or where your help may not be able to find you easily.
- Being in confined spaces that are difficult to escape or where the location has limited access points such as in forests, on bridges, in tunnels, walking amongst tall buildings and being stuck in traffic jams. It can also include inaccessible situations at a relative height or altitude e.g. being in a lift at the top of a multi-storey building, parking at the top of a multi-storey car park or using a cable car to travel between locations.
- Visiting a large shop or supermarket that has: narrow aisles, is very crowded, has queues at the service tills, has electronically operated doors or where the shop is so enormous that you may not be able to vacate it easily.
- Being left alone and feeling isolated (either at home or away from home), particularly from those whom you trust or whom you believe can help you.
- Travelling over or being close to other potential areas of danger such as bridges, heights, deep water etc.
- Progressively being further away from your safe place, (this is usually your home) and being away from people who are important to you.
- Having driving anxiety (or fear of losing control and having a panic attack whilst driving) and endangering yourself, your passengers, other drivers, pedestrians and damaging the vehicle. This can be experienced in numerous situations detailed in this section. For example when driving over bridges (heights) and deep water. The feeling of anxiety is also intensified with certain road types such as motorways with increased speed, motion, shorter reaction time, relative open/closed spaces, exposure to sudden gusts of wind, distance away from home, being stranded if the vehicle broke down etc.
- Having experienced a previous trauma or near-trauma, you believe that you may experience an actual trauma or another trauma when you leave your home. Traumas can include being attacked, doing something that may cause extreme humiliation such as having a severe attack of IBS or being (re) infected by a serious illness. Fear of contracting a serious illness is also known as health anxiety.
Agoraphobia treatment: What causes agoraphobia?Agoraphobia is caused by a number of biological and psychological factors, more notably as a complication of panic disorder. Panic disorder is an anxiety disorder characterised by panic attacks that are assumed to be spontaneous and a possible symptom of a more serious condition e.g. a heart attack. During the early development of panic attacks, you are in a state of high alert trying to look for causes of and solutions to your distress. You ignore the importance of your internal beliefs and the physiological meaning of these panic symptoms i.e. you are in a fearful state, but at this time, you just don’t know how you can end up feeling this way are why you feel this way. You (mistakenly) focus externally on your situation, location or activity and (incorrectly) give excessive importance to when these symptoms are alleviated (i.e. when you escape the situation and arrive home). The situation you were in when you felt anxious becomes the “cause” of your distress and your rapid escape home becomes the solution. Then, in order to control the frequency of panic attacks, you will avoid these situations in the future. The combination of your rapid retreat and avoidance convinces you that you are dealing with the situation in an effective way to minimise your immediate discomfort. However, these avoidant solutions are quick-fixes that make the long term situation worse as there are a diminishing number of situations in which you can feel safe from panic attacks. In addition to this, your hasty escape becomes automated and a “necessary” method of coping even when you anticipate feeling anxious. Progressively, as the condition grips you, you feel high anxiety when you are at home just imagining confronting the outside situations. Experiencing panic attacks in your “safe place” causes confusion as your remedial escape plan is now meaningless. Effectively, you are running away from your “own mind” and have exhausted your options to comfort it. At this advanced stage of the agoraphobia, you are probably housebound and experiencing a higher frequency of panic attacks. Other causes of agoraphobia can include:
- Experiencing trauma (e.g. violence) whilst away from your home. You live in fear of experiencing another similar trauma if you were to leave your home.
- Suffering major lifestyle traumas like bereavement, divorce and unemployment. These external events can cause a significant loss of confidence, feelings of guilt, worthlessness, embarrassment and shame. Some people feel vulnerable and exposed to judgement from others when you go through a major lifestyle event and are exposed to social situations.
- Having other anxiety disorders and phobias such as depression, generalised anxiety disorder, obsessive compulsive disorder (OCD), social phobia and claustrophobia.
- Suffering a history of abuse and control.
- Conditioned responses from a family background of agoraphobia. In some cases the background can include a “dependency culture” that stifles self-confidence.
- Problems with substance abuse.
- You have certain medical conditions such as suffering problems with balance (vertigo) and spatial awareness distortion issues. This affects how you perceive the proximity of people and objects. You feel disoriented and vertiginous when environmental features “look busy”, are too close, too far away or have a “descending” perspective when viewed from a height.
Agoraphobia treatment: What are the symptoms of agoraphobia?Physical symptoms: Since avoidance is the common strategy to minimise discomfort, the agoraphobic will rarely confront those situations that cause distress. When it is necessary to confront those situations however, the anxiety symptoms experienced are common to those when having a panic attack. Symptoms will include hyperventilation, rapid heartbeat, nausea, excessive sweating etc. Cognitive symptoms: The cognitive symptoms reflect the underlying belief system. For example, the agoraphobic with health anxiety will be convinced that your physical symptoms are connected to a serious illness. Whereas the agoraphobic with social anxiety will be believe that appearing out of control with a panic attack will draw attention and will feel humiliating. In addition to this, the agoraphobic with claustrophobia will judge that you will not be able to escape the situation particularly when experiencing a panic attack. Behavioural symptoms: The behavioural symptoms have been detailed in the section above entitled “Agoraphobia treatment: What situation does an agoraphobic fear?” and includes being in open spaces where help may not be readily available.
How is agoraphobia diagnosed?Agoraphobia is usually diagnosed by your doctor who will ask questions about your signs and symptoms, and your medical and family history. It is common to do some blood tests to dismiss any physical causes for your condition e.g. hyperthyroidism.
How is agoraphobia treated?Agoraphobia treatment can involve a specific or a combination of different interventions including:
- Self help techniques that help you understand agoraphobia and panic attacks. When you learn about these conditions, it may help you have more control over your symptoms. Lifestyle changes such as taking up regular exercise (initially performed in your home) can help you reduce symptoms of everyday-anxiety.
- Prescribed medication from your doctor such as SSRI’s (selective serotonin reuptake inhibitors), antidepressants or anti-anxiety medications can relieve some of your agoraphobia or panic attack symptoms.
- Therapy such as psychotherapy, Cognitive Behavioural Therapy (CBT), and Exposure therapy can be used to discuss your fears, change your thoughts and progressively challenge your behavioural symptoms.