Many people think that people with agoraphobia can’t leave their house and are afraid of ‘the outside’. In fact, agoraphobia is much more nuanced and broad, with approximately 1.5% of people worldwide meeting criteria for its diagnosis. What to know about agoraphobia:
- While it is now its own diagnosis as of DSM-V-TR, it is helpful to think of it as typically related to Panic Disorder.
- Most patients with agoraphobia are concerned that if they leave an area they consider safe (like their house, or a certain distance from their house), or if they are trapped (physically or socially), it will lead to a catastrophic outcome (e.g., heart attack, going crazy, passing out, dying), and therefore try to avoid those places. When they are forced to be in a feared situation, it often triggers a panic attack and associated fear, causing them to try to avoid those situations even more in the future.
- Avoiding places and situations in of itself isn’t agoraphobia.
- Although it may look like agoraphobia, avoidance of specific situations (dating) or places (school) may be due to another issue:
- If I were previously assaulted on a date, I may have PTSD and avoid similar situations.
- If I am afraid of embarrassing myself in front of others at school, I may have Social Anxiety Disorder.
- Knowing the reason for the avoidance is important as it may change the approach to treatment. Understanding the underlying fear or avoidance is key.
- Although it may look like agoraphobia, avoidance of specific situations (dating) or places (school) may be due to another issue:
- It’s treatable.
- We utilize a 12 session protocol for the treatment of panic disorder with agoraphobia that can be done in weekly sessions (~3 months) or in a compressed format (~8 days). It’s based on an empirically supported treatment protocol developed as part of a National Institute of Mental Health grant that is now considered the benchmark for the treatment of panic disorder with agoraphobia.
- Relaxation and deep breathing don’t work.
- Many of our patients tell us that they’ve sought treatment previously that focused on trying to remain calm when panicking, or have tried anything from essential oils to hypnosis and found them to be ineffective, which makes sense: If I think being stuck in this meeting will lead to me passing out or having a heart attack, I’m not going to be able to ‘box breathe’ or use progressive muscle relaxation. It’s like asking me to calm down if there’s a mountain lion in the room.
Agoraphobia can feel scary and overwhelming, and in the moment the catastrophic outcomes feel real and imminent. In treatment, the focus becomes learning that the intense physical and emotional feelings are due to the automatic thinking patterns, as opposed to realistic outcomes. Treatment is highly effective and with good outcomes when using research approaches tailored to you.