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How to deal with agoraphobia


Agoraphobia - Diagnosis and treatment

Diagnosis

Agoraphobia is diagnosed based on:

  • Symptoms.
  • In-depth interview with your health care provider or a mental health provider.
  • Physical exam to rule out other conditions that could be causing your symptoms.

Treatment

Agoraphobia treatment usually includes both psychotherapy — also called talk therapy — and medicine. It may take some time, but treatment can help you get better.

Talk therapy

Talk therapy involves working with a therapist to set goals and learn practical skills to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of talk therapy for anxiety disorders, including agoraphobia.

Cognitive behavioral therapy focuses on teaching you specific skills to better tolerate anxiety, directly challenge your worries and gradually return to the activities you've avoided because of anxiety. Cognitive behavioral therapy is usually a short-term treatment. Through this process, your symptoms improve as you build on your initial success.

You can learn:

  • What factors may trigger a panic attack or panic-like symptoms and what makes them worse.
  • How to cope with and tolerate symptoms of anxiety.
  • Ways to directly challenge your worries, such as whether bad things are actually likely to happen in social situations.
  • That anxiety gradually decreases and that feared outcomes tend not to happen if you remain in situations long enough to learn from them.
  • How to approach feared and avoided situations in a gradual, predictable, controllable and repetitive manner. Also known as exposure therapy, this is the most important part of treatment for agoraphobia.

If you have trouble leaving your home, you may wonder how you could possibly go to a therapist's office. Therapists who treat agoraphobia are aware of this problem.

If you feel homebound due to agoraphobia, look for a therapist who can help you find alternatives to office appointments, at least in the early part of treatment. The therapist may offer to see you first in your home or meet you in what you consider a safe place. Some therapists also may offer some sessions by video, over the phone or through email.

If the agoraphobia is so severe that you cannot access care, you might benefit from a more intensive hospital program that specializes in the treatment of anxiety. An intensive outpatient program usually involves going to a clinic or hospital for either a half or full day over a period of at least two weeks to work on skills to better manage your anxiety. In some cases, a residential program may be needed. This includes a stay in the hospital for a period of time while receiving treatment for severe anxiety.

You may want to take a trusted relative or friend to your appointment who can offer comfort, help and coaching, if needed.

Medicines

Certain types of antidepressants are often used to treat agoraphobia. Sometimes anti-anxiety medicines are used on a limited basis. Antidepressants are more effective than anti-anxiety medicines in the treatment of agoraphobia.

  • Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are used for the treatment of panic disorder with agoraphobia. Other types of antidepressants also may effectively treat agoraphobia. Antidepressants also are used for other mental health conditions, such as depression.
  • Anti-anxiety medicine. Anti-anxiety medicines called benzodiazepines are sedatives that, in limited situations, your health care provider may prescribe to relieve anxiety symptoms. Benzodiazepines are generally used only on a short-term basis for relieving anxiety that happens suddenly, also called acute anxiety. Because they can be habit-forming, these medicines are not a good choice if you've had long-term problems with anxiety or problems with alcohol or drug misuse.

It may take weeks for medicine to help manage symptoms. And you may have to try several different medicines before you find one that works best for you.

Both starting and ending a course of antidepressants can cause side effects that create uncomfortable physical sensations or even panic attack symptoms. For this reason, your health care provider likely will gradually increase your dose during treatment, and slowly decrease your dose when you're ready to stop taking medicine.

More Information

  • Cognitive behavioral therapy
  • Psychotherapy

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Alternative medicine

Certain dietary and herbal supplements claim to have calming benefits that reduce anxiety. Before you take any of these for agoraphobia, talk with your health care provider. Although these supplements are available without a prescription, they still pose possible health risks.

For example, the herbal supplement kava, also called kava kava, appeared to be a promising treatment for anxiety. But there have been reports of serious liver damage, even with short-term use. The Food and Drug Administration (FDA) has issued warnings but not banned sales in the United States. Avoid any product that contains kava until more-thorough safety studies are done, especially if you have liver problems or take medicines that affect your liver.

Coping and support

Living with agoraphobia can make life difficult and very limiting. Professional treatment can help you overcome this condition or manage it well so that you don't become a prisoner to your fears.

You also can take these steps to cope and care for yourself:

  • Follow your treatment plan. Keep therapy appointments. Talk regularly with your therapist. Practice and use skills learned in therapy. And take any medicines as directed.
  • Try not to avoid feared situations. It can be hard to go to places or be in situations that make you uncomfortable or that bring on symptoms of anxiety. But routinely practicing going to more and more places can make them less frightening and lower your anxiety. Family, friends and your therapist can help you work on this.
  • Learn calming skills. Working with your therapist, you can learn how to calm and soothe yourself. Meditation, yoga, massage and visualization are simple relaxation techniques that also may help. Practice these techniques when you aren't anxious or worried, and then put them into action during stressful situations.
  • Avoid alcohol and recreational drugs. Also limit or don't have caffeine. These substances can worsen your panic or anxiety symptoms.
  • Take care of yourself. Get enough sleep, be physically active every day, and eat a healthy diet, including lots of vegetables and fruits.
  • Join a support group. Joining a support group for people with anxiety disorders can help you connect with others facing similar challenges and share experiences.

Preparing for your appointment

If you have agoraphobia, you may be too afraid or embarrassed to go to your health care provider's office. Consider starting with a video visit or phone call, and then work out a plan to try to meet in person. You also can ask a trusted family member or friend to go with you to your appointment.

What you can do

To get ready for your appointment, make a list of:

  • Any symptoms you've been experiencing, and for how long.
  • Things you have stopped doing or are avoiding because of your fears.
  • Key personal information, especially any major stress or life changes that you had around the time your symptoms first started.
  • Medical information, including other physical or mental health conditions that you have.
  • All medicines, vitamins, herbs or other supplements you're taking, and the doses.
  • Questions to ask your health care provider or mental health provider so that you can make the most of your appointment.

Some basic questions to ask include:

  • What do you believe is causing my symptoms?
  • Are there any other possible causes?
  • How will you decide on my diagnosis?
  • Is my condition likely temporary or long term?
  • What type of treatment do you recommend?
  • I have other health problems. How best can I manage these together?
  • What is the risk of side effects from the medicine that you're recommending?
  • Are there options other than taking medicines?
  • How soon do you expect my symptoms to improve?
  • Should I see a mental health professional?
  • Are there any printed materials that I can have? What websites do you suggest?

Feel free to ask other questions during your appointment.

What to expect from your doctor

Your health care provider or mental health provider will likely ask you a number of questions, such as:

  • What symptoms do you have that concern you?
  • When did you first notice these symptoms?
  • When are your symptoms most likely to occur?
  • Does anything seem to make your symptoms better or worse?
  • Do you avoid any situations or places because you fear they'll cause symptoms?
  • How are your symptoms affecting your life and the people closest to you?
  • Have you been diagnosed with any medical conditions?
  • Have you been treated for other mental health conditions in the past? If yes, what treatment was most helpful?
  • Have you ever thought about harming yourself?
  • Do you drink alcohol or use recreational drugs? How often?

Be ready to answer questions so that you'll have time to talk about what's most important to you.

By Mayo Clinic Staff

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Treatment - Agoraphobia - NHS

A stepped approach is usually recommended for treating agoraphobia and any underlying panic disorder.

The steps are as follows:

  1. Find out more about your condition, the lifestyle changes you can make, and self-help techniques to help relieve symptoms.
  2. Enrol yourself on a guided self-help programme.
  3. Undertake more intensive treatments, such as cognitive behavioural therapy (CBT), or see if your symptoms can be controlled using medicine.

Self-help techniques and lifestyle changes

Learning more about agoraphobia and its association with panic disorder and panic attacks may help you control your symptoms better.

For example, there are techniques you can use during a panic attack to bring your emotions under control. 

Having more confidence in controlling your emotions may make you more confident coping with previously uncomfortable situations and environments.

  • Stay where you are – try to resist the urge to run to a place of safety during a panic attack; if you're driving, pull over and park where it's safe to do so.
  • Focus – it's important for you to focus on something non-threatening and visible, such as the time passing on your watch, or items in a supermarket; remind yourself the frightening thoughts and sensations are a sign of panic and will eventually pass.
  • Breathe slowly and deeply – feelings of panic and anxiety can get worse if you breathe too quickly; try to focus on slow, deep breathing while counting slowly to 3 on each breath in and out.
  • Challenge your fear – try to work out what it is you fear and challenge it; you can achieve this by constantly reminding yourself that what you fear is not real and will pass.
  • Creative visualisation – during a panic attack, try to resist the urge to think negative thoughts, such as "disaster"; instead, think of a place or situation that makes you feel peaceful, relaxed or at ease: once you have this image in your mind, try to focus your attention on it.
  • Do not fight an attack – trying to fight the symptoms of a panic attack can often make things worse; instead, reassure yourself by accepting that although it may seem embarrassing and your symptoms may be difficult to deal with, the attack is not life threatening.

Making some lifestyle changes can also help. For example, ensure you:

  • take regular exercise – exercise can help relieve stress and tension and improve your mood
  • have a healthy diet – a healthy, balanced diet and weight can help maintain overall health
  • avoid using drugs and alcohol – they may provide short-term relief, but in the long term they can make symptoms worse
  • avoid drinks containing caffeine, such as tea, coffee or cola – caffeine has a stimulant effect and can make your symptoms worse

Psychological therapies

If your symptoms do not respond to self-help techniques and lifestyle changes, your GP may suggest trying a psychological therapy.

If you prefer, you can refer yourself directly for psychological therapies, such as cognitive behavioural therapy (CBT), without seeing your GP.

Find an NHS psychological therapies service (IAPT)

Read more about psychological therapies on the NHS.

Guided self-help

With guided self-help you work through a CBT-based workbook or computer course with the support of a therapist.

The therapist works with you to understand your problems and make positive changes in your life.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is based on the idea that unhelpful and unrealistic thinking leads to negative behaviour.

CBT aims to break this cycle and find new ways of thinking that can help you behave more positively. For example, many people with agoraphobia have the unrealistic thought that if they have a panic attack it will kill them.

The CBT therapist will try to encourage a more positive way of thinking – for example, although having a panic attack may be unpleasant, it is not fatal and will pass.

This shift in thinking can lead to more positive behaviour in terms of a person being more willing to confront situations that previously scared them.

CBT is usually combined with exposure therapy. Your therapist will set relatively modest goals at the start of treatment, such as going to your local corner shop.

As you become more confident, more challenging goals can be set, such as going to a large supermarket or having a meal in a busy restaurant.

A course of CBT usually consists of 12 to 15 weekly sessions, with each session lasting about an hour.

Video: psychological therapies for stress, anxiety and depression

Animated video explaining self-referral to psychological therapies services for stress, anxiety or depression.

Media last reviewed: 14 March 2022
Media review due: 14 March 2025

Applied relaxation

Applied relaxation is based on the premise that people with agoraphobia and related panic disorder have lost their ability to relax. The aim of applied relaxation is therefore to teach you how to relax.

This is achieved using a series of exercises designed to teach you how to:

  • spot the signs and feelings of tension
  • relax your muscles to relieve tension
  • use these techniques in stressful or everyday situations to prevent you feeling tense and panicky

As with CBT, a course of applied relaxation therapy consists of 12 to 15 weekly sessions, with each session lasting about an hour.

Medicine

Sometimes medicine can be used as a sole treatment for agoraphobia. In more severe cases, it can also be used in combination with CBT or applied relaxation therapy.

Selective serotonin reuptake inhibitors (SSRIs)

If medicine is recommended for you, you'll usually be prescribed a course of selective serotonin reuptake inhibitors (SSRIs).

SSRIs were originally developed to treat depression, but they've also proved effective for helping treat other mood disorders, such as anxiety, feelings of panic, and obsessional thoughts.

An SSRI called sertraline is usually recommended for people with agoraphobia. Side effects associated with sertraline include:

  • feeling sick
  • loss of sex drive (libido)
  • blurred vision
  • diarrhoea or constipation
  • feeling agitated or shaky
  • excessive sweating

These side effects should improve over time, although some can occasionally persist.

If sertraline fails to improve your symptoms, you may be prescribed an alternative SSRI or a similar type of medicine known as serotonin-norepinephrine reuptake inhibitors (SNRIs).

The length of time you'll have to take an SSRI or SNRI for will vary depending on your response to treatment. Some people may have to take SSRIs for 6 to 12 months or more.

When you and your GP decide it's appropriate for you to stop taking SSRIs, you'll be weaned off them by slowly reducing your dosage. You should never stop taking your medicine unless your GP specifically advises you to.

Pregabalin

If you're unable to take SSRIs or SNRIs for medical reasons or you experience troublesome side effects, another medicine called pregabalin may be recommended. Dizziness and drowsiness are common side effects of pregabalin.

Read more about pregabalin.

Support groups

Charities like Mind and Anxiety Care UK are useful resources for information and advice about how to manage anxiety and phobias. They can also put you in touch with other people who've had similar experiences.

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?

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.

For many, a panic attack 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.” nine0003

What happens if a person with agoraphobia confronts their fear?

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. nine0003

Beginning

I usually become anxious about going out as soon as I know it is necessary. 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. nine0003

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

Further, 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. nine0003

Preparation

In order to fool my brain, I have developed a system of rituals that helps reduce anxiety to a level that allows you to even step over the threshold of the house. 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 over all the options for the development of events and convince myself that none of them will lead to my death. nine0003

So, I carefully put on makeup, 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’m starting 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. nine0003

Climax

I alone could not decide to accomplish this little feat, I asked my husband to take part in the 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 external 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). nine0003

Coming down. 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 cramped that it is almost impossible to walk. Breathing is impossible. Hands and feet are icy, palms are shaking, sticky with sweat. nine0003

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.

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. nine0003

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. nine0003

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. nine0003

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. nine0003

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. nine0003

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.

I am sitting in the airport lounge. 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: they took me to church, to a fortune-teller, once they took me 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. nine0003

Fear of fear, fear of this uncontrollable shaking, numb hands, growing 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. nine0003

Panic disorder was followed by OCD (an 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. nine0003

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. nine0003

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... Here I am borrowing money from friends, but from whom? Everybody sleeps. 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.

Worsening

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. nine0003

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. nine0014 But, unfortunately, I fainted only a few times and in other circumstances.

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. nine0003

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. nine0003

Did not 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.

First flight

On the eve of the first flight, I was shaken from the very 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.

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. nine0003

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

I remember a real incident from my childhood that reminds me 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. nine0003

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

Three weeks have passed 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. nine0003

Do you know how I spent the last ten days? "I" is ironic. 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. nine0013 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!" nine0003

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.

Can agoraphobia be overcome?

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. nine0003

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 CBT 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 guess I’m 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. nine0003

After some time, we encourage client to deliberately 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. nine0003

I metaphorically imagine agoraphobia as some kind of evil entity that tries to stay in the host organism as long as possible with the help of threats and cunning 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. nine0003

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.

Agoraphobia is - causes, symptoms, signs, stages, consequences, treatment

Agoraphobia: what does it mean, what are the main symptoms? nine0218

Agoraphobia is an anxiety-phobic disorder characterized by fear, panic attacks, anxiety due to being in such circumstances or places where there is no way to leave them now and unhindered.

Agoraphobia in translation means “fear of the market, shopping area”, that is, a large, crowded open space and similar situations, crowds, being away from home, etc. Anxiety-phobic disorder prevents a person from adhering to a normal lifestyle, limits him in work, personal life, leisure, since it is difficult for a person suffering from agoraphobia to leave the house. nine0003

A trip to the subway, a trip to the supermarket, to study is accompanied by increasing panic and an inability to soberly assess the environment. In people prone to panic attacks, agoraphobia is more likely to manifest as an accompanying symptom.

Fear of open spaces can also be manifested by other phobias, for example, fear of open doors, crowds of people. In combination with agoraphobia, an anxiety disorder can develop, manifested by a constant fear of being shamed, ridiculed in society, and a persistent anxiety disorder that is not associated with specific objects or situations. nine0003

Symptoms of agoraphobia

The phobia manifests itself unconsciously as a defense mechanism of the body. This disorder can be obtained in real life due to fear for something, fear of something related to people and emotional and psychological trauma, strong emotional upheavals.

Phobia is often accompanied by other obsessive states: fear of closed spaces, fear of getting sick, obsessive fear of losing loved ones, control over oneself, anxiety caused by thoughts of death, etc. nine0003

An obsessive state is often accompanied by depression and panic attacks, as well as autonomic regulation disorders: a feeling of rapid heartbeat, lack of air, hot flashes or a feeling of trembling, cold throughout the body, a feeling of a foreign object in the throat and heaviness in the chest.

Many people who suffer from such an obsessive condition understand its strangeness and think that there will be nothing terrible when they leave the apartment. But a person cannot do anything with himself, since phobic states cover him every time, one has only to think about the need to go outside. nine0003

Causes of agoraphobia

Most often, phobias develop in adolescence, but they also occur in adults. The etiology of phobias can be a psycho-emotional trauma that is associated with people or situations that occurred outside the apartment (attack, accident, terrorist attack, etc.).

The disease can also be a consequence of panic disorder, manifested in the form of:

  • fear of fear. When a similar situation repeats, a person experiences a panic attack. As a result, there is a fear of a situation that he will avoid in every possible way, fearing repetition of panic attacks; nine0245
  • conditioned reflex. A person automatically begins to experience anxiety, phobias, panic, only approaching the place where this fear has already been experienced.

The patient, going out into the street, is faced with a strong attack of inexplicable anxiety, an incomprehensible feeling of an impending disaster. This condition is accompanied by a release of adrenaline, an increase in blood pressure, a person is able in such a situation to lose self-control, faint, start screaming, run away in an unknown direction. Over time, the number of factors provoking fear only increases, panic attacks become more frequent, the patient avoids leaving his apartment in every possible way. nine0003

A person with agoraphobia is often withdrawn, which hinders timely therapy, turns the treatment of anxiety disorder into a long and complicated process.

How to treat agoraphobia?

The treatment of agoraphobia includes several effective methods: psychotherapy, drugs for drug correction, a modern rehabilitation method of therapy through biofeedback.

Methods of individual psychotherapy are an important step in the fight against anxiety disorder. Cognitive-behavioral treatment allows you to realize that everything that happens to a person, his feelings and phobias at the moment of panic are the result of perception, and not the situation itself. The treatment also uses auto-training, suggestive psychotherapy (for example, non-directive hypnosis based on the technique of hypnotic suggestion and induction into a trance). Medications alleviate the clinical picture of the disease, but it is necessary to fight the causes of agoraphobia, with which psychotherapeutic techniques and biofeedback therapy will help get rid of. nine0003

Treatment by a psychotherapist is aimed at solving the following problems:

  • awareness of the underlying cause that causes anxiety, panic attack;
  • teaching a person skills to prevent or stop anxiety, panic;
  • mastering the skills of controlling breathing, heartbeat and other physiological indicators;
  • elimination of distortions in thoughts, development of positive thinking, the ability to adequately perceive the situation.

Medications can help alleviate the symptoms of pathology. Therapy for agoraphobia, depending on the patient's condition, may include psychotropic drugs to correct anxiety, muscle relaxants, analgesics and anti-anxiety pills to relieve phobias, panic attacks, as well as sedative pharmaceuticals.

How to deal with agoraphobia?

Agoraphobia is the result of psychological problems, the ignorance of which leads to social isolation, behavioral disorders, alcohol anosognosia and depression. Highly qualified specialists of the Verum expert clinic know how to defeat panic attacks, achieve stable remission, and overcome such an anxiety-phobic condition as agoraphobia. nine0003

Biofeedback treatment is an innovative non-pharmacological method for the treatment of mental disorders. By means of a computer program, the patient can be taught to control physiological parameters: heart rate, respiration, blood pressure, muscle relaxation. Such skills allow you to cope with panic, stress and anxiety in difficult situations, stop a panic attack in time.

The doctor chooses the therapy for each patient on an individual basis, taking into account the symptoms, time of onset, severity of the disease, age, gender of the patient, and concomitant diseases. Detailed recommendations on how to cope with a mental disorder will be provided by the attending physician.

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