Agoraphobia, which involves a fear of leaving the house, driving on freeways or other roads, being in lines or in the open, and similar situations, is a condition that provokes anxiety and panic attacks.

The uniquely debilitating characteristic of agoraphobia is that it is a self-perpetuating condition, often referred to as an “emotional and physical cage.” It effectively prevents the person experiencing it from doing the things that may bring healing—like taking a walk, taking a trip, etc.—because of the severity of the potential panic attacks when the person moves behind the boundaries of comfort.

The physiological symptoms of a panic attack can include the inability to breathe, a feeling of physical paralysis, blurred vision, or dizziness to the point of fainting when the person moves beyond these perceived boundaries.

If you struggle with agoraphobia, what can you do to help yourself overcome it?

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Recovery involves interventions on three fronts: (1) facing the panic, (2) implementing coping skills, and (3) addressing the underlying issues.

Facing the Panic

There is a catch-22 in recovery from agoraphobia: you must learn to endure the panic attacks in order to stop having them. This involves finding a goal that is bigger than your anxieties and that is worth enduring the extreme discomfort, like being able to go to dinner with your family, taking a vacation, etc. Think of this as your motivation to heal yourself. Please be assured that in following these strategies, the attacks are likely to become less frequent and less severe in time, eventually disappearing altogether.

As with any recovery process, it helps to locate yourself within your problems, envision yourself outside of them, and develop step-by-step strategies to make the transition.

To start the recovery process, think of yourself as being trapped inside a barbed-wire enclosure; your freedom resides on the outside of this enclosure. The idea is the barbed wire represents your panic attacks, the emotional and physical cage of your self-perceived “boundaries.” In essence, you need to climb over the barbed-wire fence to freedom—and this requires facing the barbs, or the panic attacks, in order to overcome their power.

Repetition is necessary in order to heal. Every day, it is important to take yourself on a trip to face your panic, endure your panic, and ultimately, overcome your panic.

Another useful metaphor to visualize is to think of yourself as a prisoner creating an escape plan. You will need to develop strategies for escaping your prison. It is like falling down a well and having to crawl back up over the jagged rocks to escape. As a prisoner with an escape plan, you know the journey will be a tough one, full of booby traps and pitfalls, but that your freedom lies beyond.

Please know progress will be slow but steady, and that sometimes you will stretch your boundaries, but sometimes they will feel like they are shrinking around you. But don’t be discouraged—this is all part of the process of healing.

To begin, set a small goal. Think of an activity you would like to try to participate in. An example is taking a trip to the library. If your destination is the library, you will have to endure the panic attack of driving or getting on the bus in order to travel there. However, once you arrive, if it is something you truly wanted to do and enjoy, your panic will likely subside, and you will likely feel better after you return home again.

Repetition is necessary in order to heal. Every day, it is important to take yourself on a trip to face your panic, endure your panic, and ultimately, overcome your panic.

Implementing Coping Skills

Coping skills may help you in the moment. Here are some tried strategies you can implement as the need arises. The point is to distract your mind from the anxiety.

Strategy 1: Counting

• In your mind, count to 11. Then count backward to two. Then count up to 12. Then backward to three, etc.
• Count items of certain things in the room by category; for instance, count everything you see that is orange. You can do this with a variety of categories.

Strategy 2: Locate Patterns

• Write lists or patterns on a piece of paper.
• Fold a piece of paper systematically.

Strategy 3: Accept Your Panic Attacks

• Do not “stoke” your panic by being afraid to have an attack; this will likely only prolong the attack.
• Learn to endure and accept the attacks. As you do this, they may become less severe and frequent.
• Realize “that which you resist, persists.”

Addressing Underlying Issues

A pivotal quality of agoraphobia to be aware of, one that may help you in your recovery, is the concept the condition provides a type of “reflection” for you. If you can see there are some situations in your life that exacerbate your panic attacks, you can look at these situations as indicators of areas in your life that need to be addressed.

Seeking therapy is highly recommended, but in lieu of or in addition to therapy, it is most important for you to be self-aware of the connections between situations, events, and your panic attacks. These issues can be related to job, family, or other dynamics that might normally produce minor stress symptoms.

As part of the process of becoming self-aware, it is a good idea to keep a journal, one that records not only when you have attacks, but what happened in your life around the time you had the attack. What were you feeling? What feelings or memories did it trigger? As you work through these issues, in addition to progressively enduring your attacks, you may find your freedom once again.

Food Network chef Paula Deen is known for her bubbly personality, so many fans were shocked when she explained in her biography that she had agoraphobia for 20 years. Deen is hardly the only celebrity to experience this potentially debilitating condition, however. Kim Basinger and Woody Allen also reportedly have experienced it, and the father of modern psychiatry himself—Sigmund Freud—may have struggled with the issue as a young man.

In an increasingly busy, crowded, and connected world, anxiety can be overwhelming even for famous people, and agoraphobia will affect about 1.4 percent of the U.S. population at some point, with 40% of cases reported being “severe,” according to the National Institute of Mental Health.

What Is It?
Agoraphobia means “fear of the marketplace,” and is commonly associated with a shut-in lifestyle and social avoidance. However, agoraphobia is distinct from social phobia and characterized by a chronic fear of feeling anxiety or panic in a place where one is unable to escape or get help. For this reason, many people with agoraphobia are hesitant to leave their homes, unwilling to go out alone, or visit only familiar locations. Some people with the condition experience panic, generalized anxiety, and other issues classified as anxiety disorders.

Although everyone experiences anxiety in unfamiliar or social settings from time to time, people with agoraphobia experience overwhelming anxiety and panic on a regular basis. They might feel dizzy, restless, short of breath, or confused in unfamiliar settings. Agoraphobics are often fearful of feeling out of control, and the physical symptoms of anxiety can exacerbate this fear.

What Causes It?
Agoraphobia is typically a side effect of panic disorder. People who have had panic attacks in public settings may fear that they’ll have another panic attack and grow increasingly fearful of going out in public. Sometimes agoraphobia is caused by other circumstances, such as a traumatic event in a public place, social anxiety, or other mental health conditions that cause anxiety and panic. The disorder may be caused by a combination of genetic and environmental factors. Children of parents with panic disorder are more likely to develop agoraphobia; this could be due to either genetics or parental modeling.

How Is It Treated?
Because people with agoraphobia are often terrified of having panic attacks, one of the most important steps in treatment is giving the person a sense of control over his or her tendency to panic. Relaxation techniques can help many people regain a sense of control. Medication is also highly effective. Anti-anxiety medications and antidepressants can also help people with agoraphobia.

Sometimes agoraphobia causes so much fear that people refuse to leave their homes. People with severe agoraphobia sometimes need several months of progressive desensitization to fearful settings. For example, a person might start by walking outside, graduate to getting in the car, progress to driving to a parking lot, and ultimately master going to the grocery store. Most people with agoraphobia undergo some form of psychotherapy. Cognitive behavioral therapy can be especially helpful, and some people with the issue benefit from group therapy. Group members often share coping strategies and can help an agoraphobic feel less isolated; the group setting itself can also serve as a form of desensitization to unfamiliar people and settings.

References:

1. A.D.A.M. Editor Board. (2011, November 18). Panic disorder with agoraphobia. PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001921/
2. Agoraphobia among adults. (n.d.). NIMH RSS. Retrieved from http://www.nimh.nih.gov/statistics/1AGOR_ADULT.shtml
3. Agoraphobic celebrities. (n.d.). The Daily Beast. Retrieved from http://www.thedailybeast.com/galleries/2011/12/13/photos-paula-deen-kim-basinger-and-other-famous-people-with-agoraphobia.html
4. Mayo Clinic Staff. (2011, April 21). Agoraphobia. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/agoraphobia/DS00894
5. Moskin, J. (2007, February 28). From phobia to fame: A southern cook’s memoir. The New York Times. Retrieved from http://www.nytimes.com/2007/02/28/dining/28deen.html?pagewanted=all