Fear of large spaces


Overview - Agoraphobia - NHS

Agoraphobia is a fear of being in situations where escape might be difficult or that help wouldn't be available if things go wrong.

Many people assume agoraphobia is simply a fear of open spaces, but it's actually a more complex condition. Someone with agoraphobia may be scared of:

  • travelling on public transport
  • visiting a shopping centre
  • leaving home

If someone with agoraphobia finds themselves in a stressful situation, they'll usually experience the symptoms of a panic attack, such as:

  • rapid heartbeat
  • rapid breathing (hyperventilating)
  • feeling hot and sweaty
  • feeling sick

They'll avoid situations that cause anxiety and may only leave the house with a friend or partner. They'll order groceries online rather than going to the supermarket. This change in behaviour is known as avoidance.

Read more about the symptoms of agoraphobia.

What causes agoraphobia?

Agoraphobia usually develops as a complication of panic disorder, an anxiety disorder involving panic attacks and moments of intense fear. It can arise by associating panic attacks with the places or situations where they occurred and then avoiding them.

A minority of people with agoraphobia have no history of panic attacks. In these cases, their fear may be related to issues like a fear of crime, terrorism, illness, or being in an accident.

Traumatic events, such as bereavement, may contribute towards agoraphobia, as well as certain genes inherited from your parents.

Read more about the possible causes of agoraphobia.

Diagnosing agoraphobia

Speak to your GP if you think you may be affected by agoraphobia. It should be possible to arrange a telephone consultation if you don't feel ready to visit your GP in person.

Your GP will ask you to describe your symptoms, how often they occur, and in what situations. It's very important you tell them how you've been feeling and how your symptoms are affecting you.

Your GP may ask you the following questions:

  • Do you find leaving the house stressful?
  • Are there certain places or situations you have to avoid?
  • Do you have any avoidance strategies to help you cope with your symptoms, such as relying on others to shop for you?

It can sometimes be difficult to talk about your feelings, emotions, and personal life, but try not to feel anxious or embarrassed. Your GP needs to know as much as possible about your symptoms to make the correct diagnosis and recommend the most appropriate treatment.

Read more about diagnosing agoraphobia.

Treating agoraphobia

Lifestyle changes may help, including taking regular exercise, eating more healthily, and avoiding alcohol, drugs and drinks that contain caffeine, such as tea, coffee and cola.

Self-help techniques that can help during a panic attack include staying where you are, focusing on something that's non-threatening and visible, and slow, deep breathing.

If your agoraphobia fails to respond to these treatment methods see your GP.

You can also refer yourself directly for psychological therapies, including cognitive behavioural therapy (CBT), without seeing your GP.

Read more about psychological therapies on the NHS.

Medication may be recommended if self-help techniques and lifestyle changes aren't effective in controlling your symptoms. You'll usually be prescribed a course of selective serotonin reuptake inhibitors (SSRIs), which are also used to treat anxiety and depression.

In severe cases of agoraphobia, medication can be used in combination with other types of treatment, such as CBT and relaxation therapy.

Read more about treating agoraphobia.

Outlook

Around a third of people with agoraphobia eventually achieve a complete cure and remain free from symptoms.

Around half experience an improvement in symptoms, but they may have periods when their symptoms become more troublesome – for example, if they feel stressed.

Despite treatment, about 1 in 5 people with agoraphobia continue to experience troublesome symptoms.

How common is agoraphobia?

In the UK, up to 2 people in 100 have panic disorder. It's thought around a third will go on to develop agoraphobia.

Agoraphobia is twice as common in women as men. It usually starts between the ages of 18 and 35.

Page last reviewed: 18 December 2018
Next review due: 18 December 2021

Agoraphobia - Symptoms and causes

Overview

Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed. You fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd.

The anxiety is caused by fear that there's no easy way to escape or get help if the anxiety intensifies. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack and avoid the places where it may happen again.

People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. You may feel that you need a companion, such as a relative or friend, to go with you to public places. The fear can be so overwhelming that you may feel unable to leave your home.

Agoraphobia treatment can be challenging because it usually means confronting your fears. But with psychotherapy and medications, you can escape the trap of agoraphobia and live a more enjoyable life.

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Symptoms

Typical agoraphobia symptoms include fear of:

  • Leaving home alone
  • Crowds or waiting in line
  • Enclosed spaces, such as movie theaters, elevators or small stores
  • Open spaces, such as parking lots, bridges or malls
  • Using public transportation, such as a bus, plane or train

These situations cause anxiety because you fear you won't be able to escape or find help if you start to feel panicked or have other disabling or embarrassing symptoms.

In addition:

  • Fear or anxiety almost always results from exposure to the situation
  • Your fear or anxiety is out of proportion to the actual danger of the situation
  • You avoid the situation, you need a companion to go with you, or you endure the situation but are extremely distressed
  • You experience significant distress or problems with social situations, work or other areas in your life because of the fear, anxiety or avoidance
  • Your phobia and avoidance usually lasts six months or longer
Panic disorder and agoraphobia

Some people have a panic disorder in addition to agoraphobia. Panic disorder is a type of anxiety disorder in which you experience sudden attacks of extreme fear that reach a peak within a few minutes and trigger intense physical symptoms (panic attacks). You might think that you're totally losing control, having a heart attack or even dying.

Fear of another panic attack can lead to avoiding similar circumstances or the place where it occurred in an attempt to prevent future panic attacks.

Signs and symptoms of a panic attack can include:

  • Rapid heart rate
  • Trouble breathing or a feeling of choking
  • Chest pain or pressure
  • Lightheadedness or dizziness
  • Feeling shaky, numb or tingling
  • Excessive sweating
  • Sudden flushing or chills
  • Upset stomach or diarrhea
  • Feeling a loss of control
  • Fear of dying
When to see a doctor

Agoraphobia can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands.

Don't let agoraphobia make your world smaller. Call your doctor if you have signs or symptoms listed above.

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Causes

Biology — including health conditions and genetics — temperament, environmental stress and learning experiences may all play a role in the development of agoraphobia.

Risk factors

Agoraphobia can begin in childhood, but usually starts in the late teen or early adult years — usually before age 35 — but older adults can also develop it. Women are diagnosed with agoraphobia more often than men are.

Risk factors for agoraphobia include:

  • Having panic disorder or other phobias
  • Responding to panic attacks with excessive fear and avoidance
  • Experiencing stressful life events, such as abuse, the death of a parent or being attacked
  • Having an anxious or nervous temperament
  • Having a blood relative with agoraphobia

Complications

Agoraphobia can greatly limit your life's activities. If your agoraphobia is severe, you may not even be able to leave your home. Without treatment, some people become housebound for years. You may not be able to visit with family and friends, go to school or work, run errands, or take part in other normal daily activities. You may become dependent on others for help.

Agoraphobia can also lead to or be associated with:

  • Depression
  • Alcohol or drug abuse
  • Other mental health disorders, including other anxiety disorders or personality disorders

Prevention

There's no sure way to prevent agoraphobia. However, anxiety tends to increase the more you avoid situations that you fear. If you start to have mild fears about going places that are safe, try to practice going to those places over and over again before your fear becomes overwhelming. If this is too hard to do on your own, ask a family member or friend to go with you, or seek professional help.

If you experience anxiety going places or have panic attacks, get treatment as soon as possible. Get help early to keep symptoms from getting worse. Anxiety, like many other mental health conditions, can be harder to treat if you wait.

By Mayo Clinic Staff

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What is agoraphobia and how people live with it

Alena Agadzhikova has agoraphobia: she is afraid to leave her apartment and find herself in an unfamiliar place. Alena decided to conduct an experiment by placing herself in uncomfortable conditions. PR manager Dasha Tikhomirova agreed to do the same.

Both girls kept diaries in the "here and now" format. Afisha publishes them along with a psychotherapist's commentary.

What is agoraphobia and where does it come from?

Dmitry Komarov

Psychotherapist at the Moscow clinic Mental Health Center

Agoraphobia is supposed to be the fear of open spaces. In fact, it is both the fear of not being able to immediately leave a place or situation, and the fear of being away from home. The discrepancies are due to the fact that at the time of the introduction of this term into psychiatry, there were no typical agoraphobia triggers for the modern world: public transport, passenger planes and shopping centers. Maybe in the time of Karl Westphal (a German psychiatrist and neurologist who lived in the 19th century, the author of many psychiatric terms. - Note ed. ), who first described agoraphobia, the open spaces of the piazzas were as unpleasant as our subways are now at rush hour. Agoraphobia is now commonly referred to as the fear and avoidance of independent movement outside the home (or other safe place).

The disorder arises from a predisposition to anxiety and psychological factors. The latter, according to the British Ministry of Health, include: sexual abuse (especially in childhood), bereavement, divorce, job loss, anorexia or bulimia, alcohol abuse, being in an unhappy relationship or in a relationship with an over-controlling partner. In national studies of various Western countries, figures from 1.3 to 3.5% of the prevalence of agoraphobia in the population appear. Anxiety disorders are diseases in the development of which a genetic predisposition factor plays a relatively large role, so their incidence is approximately the same in different countries of the world. Based on this, it can be assumed that in Russia, about one in 50 people is also subject to agoraphobia.

Most people with agoraphobia begin with panic attacks in public places.

A panic attack for many is one of the worst emotional experiences of a lifetime.

The strongest fear is instantly associated in the brain with the place where this event occurred. When you visit it again, the deep parts of the brain responsible for the fear reaction (in particular, the amygdala) are activated again and further strengthen this conditioned reflex connection. In the future, fear can spread to other places similar to the first in some characteristics: for example, it becomes scary to be not only in the supermarket on the minus the first floor where the first panic attack occurred, but also in all public places where you need to go down to escalator. If a person knows what kind of sensations await him in such places, he begins to avoid them. It turns out that he actually avoids not public places, but his own emotional reactions and difficult to bear bodily sensations that arise there . Sometimes a person can have both claustrophobia (fear of enclosed spaces. - ed. note ) and agoraphobia. There are no contradictions here: a common place in these states is the fear that it is impossible to instantly get out of the situation and find yourself in a “safe” place. And both the crowd on the street and the closed elevator doors can prevent this.”

What happens if a person with agoraphobia confronts their fear?

Dasha Tikhomirova, 30 years old

PR manager. Has suffered from agoraphobia since the age of 9. The last three years is in a state of exacerbation. As part of the project, he decides to go down the subway.

Situation

Plan: take the subway two stops. I definitely won't do it anymore. One is not interesting, because I want to live the moment when the train stops, the doors open, and I don’t run out and go on. The last time I was on the subway was about a year and a half ago when I was trying to get out of my comfort zone and train myself. Before that, I had not been to the subway for about two more years. Agoraphobia began in me during an exacerbation of an anxiety-depressive disorder, which I have been suffering from for several years. In general, panic attacks have been with me all my life: they appeared and left, I felt bad on the subway or on the street, but I coped without medication, because there was no choice - I hid these conditions from relatives and friends, I was ashamed. Now I have been seeing a psychiatrist for three years now, I visit a cognitive-behavioral psychotherapist once a week, I drink a “cocktail” of antidepressants and tranquilizers.

© From the diary of Dasha Tikhomirova

Beginning

I usually start to feel anxiety about going outside as soon as I learn about the need for this action. This may be the decision to go to a cafe with a friend, the need to go to the doctor without her husband, and anything else. Anxiety increases on the eve of the event. This manifests itself in hyperventilation (frequent shallow breathing. - Note ed. ), stomach cramps, dizziness, pain in general in all muscles of the body, tachycardia. That's what happened this time as well.

When Alena invited me to participate in the experiment, I was horrified. I immediately began to choke, the muscles of my forearms cramped.

Then, as a rule, the same thought loops in the head, which is almost impossible to get rid of. Now this is a picture of how I cannot get out of a subway car during a panic attack. Such situations happened to me more than once, and they merge into one terrible scene at once. A panic attack sets in, I restrain it with all the methods known to me: I touch objects, listen to smells, count colors, stretch my feet. Fear drives me crazy and makes me depressed. It is at such moments that the desire to commit suicide escalates to a maximum.

© From the diary of Dasha Tikhomirova

Preparation

In order to deceive my brain, I developed a system of rituals that helps reduce anxiety to a level that allows me to step over the threshold of the house altogether. Here they are: wash your hair, style your hair beautifully, carefully choose clothes. Then I start putting on makeup. These are my ways of putting extra armor on my body to protect myself from the outside world. In addition, this is a rather meditative process that requires concentration. Anxiety has less space in the mind. In parallel, I think about all the options for the development of events and convince myself that none of them will lead to my death.

So, I carefully put on my make-up, dressed up, admired the new coat and pink shoes, checked if clonazepam (an antiepileptic drug, used by a doctor. - Note ed. ) was in place and whether it was enough (usually I wear a minimum three tablets, although a quarter or half is enough to relieve a panic attack). She said all the options: I have an attack, I'm shaking, I can't breathe, I grab onto all the surrounding objects, everyone is staring at me, it gets dark in my eyes, my legs buckle, I dream of losing consciousness, nothing helps, the train gets stuck in the tunnel, I feel even worse, clonazepam does not help. I run up to the car doors to run out, as soon as they start to open, my legs give way, I lie down and sob. I countered: “You know that you don’t die from a panic attack!” People around are not evil: they will either sympathize or not pay attention. Someone can offer help. It gets a little better.

© From the diary of Dasha Tikhomirova

Details on the topic

What are panic attacks and how to get rid of them

What are panic attacks and how to get rid of them

Climax

I alone could not decide to accomplish this small feat, I asked take part in the husband's experiment. My husband is getting dressed, I am furious because it seems to me that he does it too slowly. When the inevitable is near, you want it to happen as soon as possible. We go out into the street, my husband tries to distract me with conversations on side topics. When he sees that it does not work, he starts asking questions so that I can express my feelings. He pronounces all the ways of salvation: we can go home at any moment, we will be very close to home, so it will not take much time. If it gets bad, bury yourself in me. We continue to walk: I am surprised how the road to the metro has changed (new paths, fences), the area in front of the metro (a mini-square with benches has been broken!), the entrance group (like fashionable).

© From the diary of Dasha Tikhomirova

Descending. I feel my leg muscles contract, it hurts to walk. I turn off consciousness, something like depersonalization sets in. It’s as if I’m watching from the side as the girl Dasha applies the ticket, stands on the platform. The train is coming. Once I enter it, it will be impossible to escape. I start crying (this is another tension-release mechanism recently discovered by accident). In front of the car doors, I say: "NO!" I take my husband by the arm, I feel that now I will collapse.

All muscles are so constricted that it is almost impossible to walk. Breathing is impossible. Hands and feet are icy, palms are shaking, sticky with sweat.

People squint, we quickly leave. I feel like I'm sweating through, right down to my beautiful blue coat. The scarf is pulled off, it is unbearable to feel something on the throat. I'm very hot, we're walking back down the street. It's cold outside, but I can't button up.

© From the diary of Dasha Tikhomirova

Finale

Walking is still very painful, you have to walk slowly. Gradually, the panic passes, and a feeling of devastation remains. I start to get cold, I wrap myself in a scarf, I overcome the rest of the way in silence, my sadness becomes somehow flat, I hate and despise myself. I try to feel sorry for myself, but it doesn't work. I feel ashamed in front of my husband.

When I get home, I immediately take off all my clothes, wash off my make-up, and get under the covers. It’s not easy to relax, I put clonazepam under my tongue. I feel nauseous, the muscles gradually relax, but continue to whine. My head hurts. Even drawn curtains let in too much light. I wrap myself up in a blanket very tightly, put on a mask over my eyes and fall into a viscous disturbing dream. When I wake up, I continue to feel nausea, headache, dizziness, anxiety returns, but drinking clonazepam again means falling asleep again. I'm trying to disperse, eat something, breathe. I turn on the Colombo series: I know all the episodes by heart, but nothing new comes out of watching in this state. "Colombo", "Poirot" and "Harry Potter" are stored on the computer in the "Eternal" folder - I turn them on randomly in any incomprehensible situation.

© From the diary of Dasha Tikhomirova

For the next two days I continue to experience headaches and muscle pain, it is difficult for me to concentrate, I feel moral devastation, frenzy. I cancel all the few things I do, eat, take care of myself, lie under the covers, correspond with the psychiatrist, note that this time I have gone much further than before (for example, often I just cancel the meeting after not coping with anxiety), praise myself for the fact that I learned to stop in time and decided to try it in general. I believe that everything will be fine.

Afterword

Actually, my life is not so terrible. I learned to build it by avoiding trigger situations. I almost never go to public places, but I can go to a concert or a restaurant if my husband is with me or not far away. I communicate with friends by inviting them to visit or coming to them. I go to the doctors by taxi. Previously, this was also difficult for me, but now I almost do not experience unbearable anxiety. I see progress in treatment and thank myself for every small step in overcoming myself and the disease.

© From the diary of Dasha Tikhomirova

Details on the topic

“I’ll tell you, they’ll fire you right away”: what it’s like to hide a mental disorder from colleagues

“I’ll tell you, they’ll fire you right away”: what it’s like to hide a mental disorder from colleagues

Alena Agadzhikova , 25 years old

Has suffered from agoraphobia since the age of 13. At the age of 20, there was an exacerbation with thoughts of suicide. She has been taking antidepressants and undergoing psychotherapy for five years. The last year is in a state of incomplete remission. As part of the project, it flies from Moscow to Prague.

13:00. Flight from Moscow to Prague

It's so gray outside that you don't want to live. I'm going in a taxi to Sheremetyevo. I'm horrified: I'm late for the flight, and my anxiety is going through the roof. I thought that after two flights in my life, in which I was naturally delighted with air pockets and felt as safe as possible, there would be no more fear. But he is.

“What if the plane leaves and I stay at the airport? I will have a panic attack, I will lie on the ground, everything will go dark in my eyes, as it was once in the subway. Will have to call an ambulance. Don't care what people think! I don’t give a damn about the fact that at such moments my body becomes icy from the inside, and I almost can’t speak. ” Great thoughts! The most it is before the flight.

I see terminals somewhere in the distance. So maybe I won't be late. When I have such anxiety, my intestines weaken. This is probably the most socially disturbing thing for me. Lying in the middle of the crowd is still all right, but crap yourself... We are approaching. I am not late. Glory to Gagarin.

© From the diary of Alena Agadzhikova

I am sitting in the airport waiting room. I was not late, although I could. It seems that I need to listen to my mother more, even if she gets on my nerves with her catastrophizing. Behind the glass are airplanes. The condition, despite yesterday's gin, is quite tolerable. Probably worth saying thanks to phenazepam (drug, taken only as directed by a doctor. - Note ed. ) and herself. Two years ago, the mere thought that I would be flying in an airplane plunged me into a state of acute panic. Imagine that I am sitting here, drinking water without gas, and even one . .. Show me such a photo of me before, I would definitely say that this is photoshop. And angry: "I feel so bad that I can't fly anywhere, and you're kidding!"

Beginning

It all started at 10 years old. Then I started having panic attacks. Nobody knew what was happening to me: I was taken to church, to a fortune-teller, once I was taken to a district psychiatrist - he refused to accept "without taking into account", requested a bribe and prescribed "Novo-Passit" (a sedative of plant origin. - Note ed. ) . As a child, I didn’t know what was happening to me: just one night I suddenly started shaking, and it also seemed that my head was going numb. Further - as if in a fog: unbearable horror and fear. Fear of death? No, I was not afraid to die, I knew that I was not dying. Fear of losing control? More like the truth.

Fear of fear, fear of this uncontrollable shaking, numb hands, rising terror? Yes.

I recently had five CBT sessions. The psychiatrist said that panic disorder develops into agoraphobia most often in those alarmists who do not have a specific phobia. In other words, the fear of death, the fear of social condemnation, the fear of a stroke are things that are less likely to lead to the fact that you will be afraid to be far from home. But the feeling of the impossibility of experiencing this difficult state, concentration on it - this is exactly that.

© From the diary of Alena Agadzhikova

Panic disorder was followed by OCD (obsessive-compulsive disorder, in which a person has obsessive thoughts, memories, movements and actions, as well as various fears. - Note ed. ). For OCD - an anxiety-depressive disorder (a disease in which a person experiences both anxiety and depression without a clear dominance of one of the conditions. - Note ed. ). It's me now, examined by psychiatrists and undergoing psychotherapy, I know what's wrong with me. And then, ten years ago, information came in pieces and through the Internet.

My life underwent a major change when I suddenly became terribly afraid of being away from home. I remember at the age of 14 I stayed with my boyfriend on the other side of Moscow. It was night, neither he nor I had any money. He fell asleep, I didn't. And suddenly a familiar horror began to seize me, the back of my head began to go numb. It was cold outside, the lanterns were burning with a nasty yellow light. I became incredibly sad and scared. I thought: “What should I do if I want to go home right now? How can I get home RIGHT NOW, because the subway does not work, there are no buses, my parents will not understand me if I call and ask in a panic to pick me up. WHAT SHOULD I DO?" Panic thoughts began to come one after another. I was shaking. I was afraid to wake up the guy, because he, like me, did not know what was happening to me, so he would twist his finger at his temple.

I lay there unable to move, thinking of all sorts of crazy ways to get out of the house.

Here I imitate pain in my stomach and call an ambulance, but no, the ambulance will not take me home, but to the hospital. .. So I borrow money from friends, but from whom? Everyone is asleep. Yes, and how to explain what urgency is? Morning has come. I didn't get any sleep. All day long she walked in a fog, periodically plunging into panic attacks and gritting her teeth.

© From the diary of Alena Agadzhikova

Deterioration

Over time, these attacks became more frequent. It became difficult for me to travel out of town. Already on the bus, I began to think: “What if I want to get off the bus right now? I can't do that. And if I do, where should I go?" The image of me in an unfamiliar area, unable to move, firmly settled in my head. I began to avoid traveling anywhere. The next nightmare was the subway. A train stopping in a tunnel is the worst picture that has remained with me so far.

The quintessence of a situation that cannot be influenced. I was lucky to get both claustrophobia (fear of closed spaces) and agoraphobia. Every time a train gets stuck in a tunnel, I sit for three or four minutes, and then I start thrashing about. I imagine how I break the windows, how I get out. It becomes hard to breathe, there is a feeling that my own horror will eventually drive me crazy. My dream when the train stops in the tunnel is to faint and wake up when it is already at the station. But, unfortunately, I fainted only a few times and in other circumstances.

© From the diary of Alena Agadzhikova

At the age of 20, I started treatment - antidepressants, therapy. If I had started it earlier, at least four years, much could have been avoided. It would be easier to overcome the same agoraphobia. My social capital would be even greater, the number of accumulated impressions too. But right now it's a sin to complain.

Boarding begins.

I try to take a deep breath and realize what work has been done over all these years.

15:25. I'm on the plane

We took off. I smile and fall asleep. This is my third flight in my life and the first in the evening. It's so great that there is no light in the cabin and you can see the glow of the blue horizon of clouds - like Kuindzhi in the picture. It feels like all the problems have remained below, under the clouds, and I am cradled in a warm cradle. Something that, as it seemed to me for many years, can drive me crazy, gives a feeling of happiness and peace. I feel light and relaxed. I can not continue to write, a strong drowsiness attacked. I'll sleep.

© From Alena Agadzhikova's diary

I didn't sleep. We are flying over Vilnius. I would like to visit Vilnius. And everywhere, since now I can fly.

How did it happen that I started flying? My beloved person moved to Prague. My best friend has been living there for the eighth year now. And so I won a grant covering flights, accommodation and study for a month in Prague. I, in fact, had no internal choice: either now or never.

Details on topic

“Touching buttons is a real torture for me”: how people with phobias live

“Touching buttons is a real torture for me”: how people with phobias live

First flight

On the eve of the first flight, I was shaking since the morning . Parents followed. Most of all, I was afraid of waiting. The flight itself is not very good, I am not afraid of heights and death. I will die and die. Now it seems to me that death from a fall is far from the worst option. It's beautiful, and in the chest everything will go to the end. But then I was shaking because I was afraid of panic at the moment of waiting, fear of fear. A tranquilizer and awareness of what was happening helped me. Here I am registering. Here is passport control. Here I am laying things out at customs. And here - wow - I'm in the green corridor. It made me laugh that this is technically a "nowhere" zone. I prepared myself for the worst: "Land the plane, call the paramedics" . But - as is almost always the case - my catastrophe was overdone. Yes, I was shocked, yes, I felt anxious. But all this is at the level of tolerable. I think it was largely because the people I loved met me in another country.

© From the diary of Alena Agadzhikova

My worst recurring dream looks like this. I find myself in a foreign country where everyone speaks an incomprehensible language. I don’t know where to go, and when I try to ask passers-by, only a wheeze comes out of my mouth. Those around me shun me, and I sit down on the ground and cry as the waves of horror roll over me again and again.

In my dream I want to go home. The house is my apartment. My bed.

I remember a real incident from my childhood, reminiscent of this dream. One day my mother took me to the market and quickly went ahead. I looked at the bright counters and lost sight of her. I started looking around, I felt dizzy, I wanted to call my mother, but for some reason I became afraid and ashamed to open my mouth. An unforgettable feeling in the worst sense of the word: a five-year-old child lost in the whirlwind of the market. When my mother saw me in the crowd, she pulled off her jacket by the sleeve and loudly, harshly scolded me. So she expressed fear.

© From the diary of Alena Agadzhikova

18:15.

Prague

We sat down. I like it when people clap for the pilot, even if many people think it's ridiculous, they say, thank you for being alive. And I rejoice in this fact. Even in the cockpit it is very beautiful and the control of the aircraft seems to me some kind of impossible action. Pilots are cooler than gods - so why don't they clap?

End of the journey. Return flight

It has been three weeks since I last opened this text. During this time, a lot has happened. Outside the window - minus 54 degrees. I'm flying to Moscow. During takeoff, it seemed to me that something bad was going to happen. This is my fourth flight. In the past, I was very proud of the fact that I like air pockets and pitching. This time I was almost thrown into a panic because we failed in the second minute of takeoff. I felt dizzy, sweat appeared on my forehead, then the plane somehow spun and spun, and the magnificent clouds outside the window did not calm me down a bit. In one second, I imagined that I was losing control of myself: that I was starting to cry, I was hysterical, or I was silent like a fish. I'm not afraid that others will see it. This state itself is terrible: cold, I am locked in my own body and I can hardly speak. And people with their anxious faces scare even more.

© From the diary of Alena Agadzhikova

Do you know how I spent the last ten days? "I" is irony. Lying at a friend's house because I broke my leg. What I feared most of all, not traveling until 25 years old, happened - I seriously injured myself in a foreign country. If my loved one and best friend were not in Prague, I don’t know what state my psyche would be in, even though I drink an antidepressant. On the seventh day I had a panic attack. Nightmares began to occur: now I can’t fly away from the country, here I am lying and silent, before my eyes there are terrible pictures, some figures with gouged out eyes. I plunge into my own panic, nothing distracts me, I feel insane and losing control. And again this feeling of being locked in the body. Perhaps this is where agoraphobia and claustrophobia are similar: a deep-seated feeling of being unable to do anything. Moreover, the impossibility is not real, but internal, phobic.

Adrian (Alyona's favorite person, to whom she flew to Prague. - Note ed. ) is sitting next to him in the plane and drawing. Outside the window is a bright sun and curly clouds. In the morning, my mother sent photos of the frozen trees of South Butovo and signed: "Beauty!"

All I dream about is to enter my clean house in the middle of an icy country, throw away my crutches, crawl under the covers and watch Homeland until I feel comfortable and at home again.

Is this progress? Definitely. Can you travel if you have agoraphobia? Of course. Whether you are 20, 30, 40 or 50 years old. It won't be easy, but the very fact that "it will be" will help to move away from the feeling of uncontrollable inevitability.

© From the diary of Alena Agadzhikova

Is it possible to overcome agoraphobia?

Dmitry Komarov

Psychotherapist at the Moscow clinic Mental Health Center

Agoraphobia can take on a progressive character, over time taking away more and more freedom from a person, compressing his comfort zone to the limits of an apartment. This can happen when a person unquestioningly obeys orders dictated by fear. Unfortunately, doctors' appointments in state medical institutions often have a disabling effect. The average psychoneurologist in a polyclinic or PND is most likely to prescribe phenazepam for anxiety disorder, which relieves panic attacks situationally, but in the long term causes addiction and becomes another form of avoidance.

Since agoraphobia is almost always a consequence of panic attacks and serves as a means of avoiding them, treatment should be aimed at coping with panic disorder. The first line of therapy, according to international recommendations (American Psychiatric Association and British National Health Service), should be one of the following methods: cognitive behavioral therapy or a course of taking an antidepressant of the SSRI group (selective serotonin reuptake inhibitors. - Note ed. ). Considering that cognitive behavioral therapy provides a more stable effect and requires only short-term work (8-12 sessions), we at the clinic recommend this option to most clients.

Let me tell you a little about the content of psychotherapy. Cognitive theory considers a panic attack primarily as a consequence of an incorrect assessment of bodily symptoms: "If my pulse is more than 130, then something is wrong with the heart"; “I feel dizzy, so I can lose consciousness”, “The world around me looks strange - I must be going crazy”, etc. At the first stage of work, we identify these erroneous interpretations and replace them with more rational ones, teaching the client basics of normal physiology. This allows you to neutralize a significant part of the experiences.

After some time, we encourage client to intentionally evoke fear and experience it in the safe environment of a therapy session. This is the key moment of treatment. A person who decides on exposure (intentional immersion in fear) forever changes his attitude towards panic attacks. He learns new knowledge: that unpleasant bodily symptoms are not a threat, that a panic attack should not be fought in any way, it does not need to be saved from it, because it passes by itself. And after that, we actually work with agoraphobia. After going through the first exposures, the client already understands that the panic attack is actually not as bad as it seemed before; at this stage, he is already ready to conduct sessions outside the office, in public places that frighten him - first accompanied by a therapist, then on his own.

I metaphorically imagine agoraphobia as some kind of evil entity, trying with the help of threats and cunning to stay as long as possible in the host's organism like a parasite.

Since lies and manipulation are her main weapons, it is unlikely that she will be able to outmaneuver her with the help of any tricks: she reads your intentions three steps ahead. Only one remedy is effective: stubborn, systematic disobedience to her demands. You can make this task easier for yourself: find, for example, through some forum on anxiety disorders, a person in your city with a similar problem and train in independent exposure together. You can challenge each other with visiting various public places. Mutual face-to-face support from someone who knows firsthand about your difficulties is powerful medicine.

A loved one with agoraphobia needs to find a certain balance: on the one hand, give him enough emotional care, on the other hand, try to less indulge his avoidance. The gradual, jointly planned rejection of ubiquitous accompaniment and the transition to independent travel outside the home is an essential component of psychotherapy.

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Agoraphobia - fear of open spaces

In agoraphobia, overwhelming anxiety can occur both in the midst of a crowd (or in a place that is difficult to leave without attracting outside attention) and in a completely deserted area.

Panic attacks are treated by a psychotherapist.
Most people are afraid of government institutions. In these situations, psychological and psychotherapeutic assistance centers offer their support. The treatment of panic attacks in Moscow is carried out by the DAR center, which has been operating since 1989 years old

Cost of treatment

Name of service Cost
Repeated treatment session* 4000 ₽
Initial consultation + treatment session 6000 ₽

Usually, such fear gradually grows and becomes more complicated, leading to a limitation of the social activity of the agoraphobe. As a result, he can simply withdraw, like a snail in its shell, being afraid even to go out to the store. Therefore, the fear of open space requires the mandatory medical assistance of a psychotherapist.

Possible causes of agoraphobia

Often agoraphobia is one of the accompanying symptoms of various neuropsychiatric and somatic diseases. For example, a person with visual impairment or vestibular insufficiency experiences discomfort among the crowd, while in a store or in other similar situations. It is also difficult for him to navigate in an open and unfamiliar space. The resulting feeling of insecurity and anxiety becomes the cause of self-restraint when leaving the house.

Fear of a large space often appears in emotionally labile and anxious people, with schizoid and asthenic personality disorder, bipolar affective or anxiety-phobic disorders. It can also develop after neurological diseases that lead to movement disorders and external changes. At the same time, a person is afraid to seem ridiculous, absurd or helpless in the eyes of society.

Agoraphobia may accompany panic attacks and generalized anxiety disorder. At the same time, the first vivid episode of anxiety with abundant somatovegetative symptoms contributes to the formation of pathological associations. After that, the person will begin to avoid the place where he first experienced a panic attack. Subsequently, the fear spreads to other situations, because of which there is a fear of space and being in a crowd.

Manifestations of agoraphobia

The main symptom of fear of open space is attacks of severe anxiety (often reaching the level of panic) with vegetative and somatic manifestations. They absorb the attention of a person and make him avoid provoking situations. Some time after the first appearance of this disorder, there is a fear of a recurrence of a panic attack. Because of this, the symptoms of the phobia will increase in anticipation of leaving the house, with memories and ideas about dangerous places.

With agoraphobia, a person develops an individual comfort zone, the size of which is determined by the degree of severity of fear. Some people with a fear of open spaces may go to work, socialize with friends, and take walks while avoiding squares, crowded malls, and deserted parks. Others, on the other hand, find themselves unable to leave the house for several days, since even the thought of having to leave their safe home leads to pronounced anxiety.

An attack of fear is accompanied by the appearance of palpitations, discomfort in the limbs, rapid breathing, spasmodic pains and abdominal pain with urge to urinate and defecate. A change in the productivity of gas exchange in the lungs leads to a violation of the ratio of carbon dioxide and oxygen in the blood. The brain reacts especially strongly to this, which leads to dizziness, disorientation, increased feelings of danger and anxiety. The whole body tenses up, sweat is intensely secreted, and blood pressure may rise.

Agoraphobia is often greatly relieved in the presence of familiar people. For example, accompanied by loved ones, a person with a fear of open space may be in an uncomfortable place for him and at the same time experience only slight anxiety.

How to get rid of agoraphobia

The use of drug therapy alone for the treatment of fear of open spaces is unpromising, although in the initial stages, a doctor may prescribe sedatives (sedatives) and certain antidepressants to alleviate the condition. They help to reduce the overall level of anxiety. But if we confine ourselves to only this method of treatment, shortly after the withdrawal of drugs, fear attacks will resume with the same force, which is explained by the preservation of internal mechanisms for the formation of a phobia. It is possible to get rid of fear with the help of psychotherapy.

Treatment of agoraphobia may require the use of several psychotherapeutic approaches. A competent and experienced doctor combines them, helping to control panic attacks and gradually eliminating the cause of anxiety. Specialists of the "DAR" center use exactly this approach and individually select a psychotherapy scheme.

The treatment of agoraphobia is usually based on rational and cognitive-behavioral psychotherapy, supplemented by various relaxation techniques. A person with a fear of open space is taught controlled breathing, special exercises to relax the body, auto-training and visualization. In some cases, the doctor uses classical or Ericksonian hypnosis to quickly reduce the severity of panic attacks. And long-term therapy can be supplemented with psychoanalysis and other psychotherapeutic methods.

To make an appointment with a specialist of the DAR psychotherapeutic center, you can use a special form or contact the administrator yourself by calling the numbers that are presented at the top of the page.

The article was written under the supervision of Dr. Vorontsov A.L.

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