The term Agoraphobia was first coined by German psychiatrist, Carl (Vestfarl) Westphal.
The term is derived from Greek with the joining of two words, ‘agora’, and ‘phobos’.
The Agora was the marketplace in ancient Greece and the word ‘phobos’ was considered to
be an aversion or fear.
Therefore, Agoraphobia can be roughly translated to a fear of the marketplace or a fear of
open spaces.
In the modern world, Agoraphobia is understood as an anxiety disorder characterised by a
fear and avoidance of any place or situation that a person believes may lead to increased
anxiety, loss of control, and most commonly a panic attack.
For this reason, Agoraphobia is sometimes referred to as ‘The Fear of Fear’.
Common places or situations people experiencing agoraphobia tend to be fearful of and often
avoid, include supermarkets, malls, crowds, public transport, heavy traffic, and elevators.
Panic attacks are sudden episodes of fear that trigger intense physiological reactions
in the body, including nausea, dizziness, heart palpitations, and feelings of losing
self-control, going crazy, or dying.
Over time an individual may develop panic disorder, particularly if the person does
not understand what is going on, believes that they are in real danger, and does not
possess the necessary skills to know how to manage panic attacks.
Panic Disorder is characterised by abrupt and seemingly random panic attacks, in which
the sufferer becomes consumed with fear of a recurring attack.
Agoraphobia typically develops after the onset of panic disorder arising from fear of places
and situations that the person believes may trigger another attack.
Panic attacks trick the individual into believing they are in danger and therefore the person
believes that they must protect themselves at all costs.
For a person experiencing Agoraphobia, avoidance of particular settings and circumstances becomes
their coping mechanism of choice, and in extreme cases, individuals may become housebound,
as their home may be perceived as the only truly safe place.
The problem with avoidance is that the costs far outweigh the benefits.
The benefit of avoidance is that the person can feel more secure and may not experience
heightened levels of anxiety in their ‘safe space’.
However, the costs of avoidance to the individual are immense.
They may begin avoiding many activities and places that they used to really enjoy, and
they may break off relationships with family and friends.
It may get the point of being housebound, with the individual no longer being able to
work and overall, experiencing a dramatic loss in their quality of life for prolonged
periods of time.
Safety behaviours are subtle avoidance behaviours that a person engages in to feel more secure
and to prevent fears from eventuating.
Safety Behaviours many include:
Only going places if a trusted family member or friend comes along
Staying close to the exits of establishments or on public transport
Going to stores only near opening or closing hours to avoid crowds
and carrying around a ‘lucky charm’.
These behaviours help to reduce anxiety in the short term but serve to maintain and reinforce
agoraphobia over the long term.
For example, if we engage in a safety behaviour and our fears do not eventuate then we tell
ourselves it was because of the safety behaviour.
Therefore, the individual continues to engage in the safety behaviour and prevents themselves
from testing to see whether their fears would eventuate in the absence of these actions.
Despite what you may believe or what you may have heard, Agoraphobia is a condition that
responds well to treatment.
Treatment includes cognitive behavioural therapy, psychoeducation, learning how to appropriately
respond to panic attacks, and exposure therapy.
It is imperative that the individual learns the connection between worry and anxiety,
and how to respond to panic attacks in a neutral manner.
Panic attacks are deceptive in nature.
They trick you into believing you are in real danger, and therefore your instinct will be
to run, duck for cover, and go into protection mode.
But it is an illusion.
Whilst the physiological sensations and symptoms are very real, you are not in any real danger.
Responding to panic attacks in a systematic and under-reactive way reduces the intensity
of panic like symptoms over time.
Exposure therapy, also known as graded exposure or systematic desensitisation, is used to
incrementally expose yourself to the sensations and symptoms of anxiety and panic that arise
when in particular environments and situations.
The idea is to float with the anxiety and panic and learn to gradually increase your
tolerance towards feared sensations and panic like symptoms.
A fear hierarchy can be developed with your therapist to begin exposing yourself to the
least threatening environment first and slowly stepping things up at your own pace until
you are back to living your life in the way that you desire.