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How to get over agoraphobia


Agoraphobia - Diagnosis and treatment

Diagnosis

Agoraphobia is diagnosed based on:

  • Signs and symptoms
  • In-depth interview with your doctor or a mental health professional
  • Physical exam to rule out other conditions that could be causing your symptoms
  • Criteria for agoraphobia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatment

Agoraphobia treatment usually includes both psychotherapy and medication. It may take some time, but treatment can help you get better.

Psychotherapy

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

Generally a short-term treatment, 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. 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 the likelihood of bad things happening in social situations
  • That your anxiety gradually decreases if you remain in situations and that you can manage these symptoms until they do
  • How to change unwanted or unhealthy behaviors through desensitization, also called exposure therapy, to safely face the places and situations that cause fear and anxiety

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 well 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. He or she may offer to see you first in your home or meet you in what you consider a safe place (safe zone). Some therapists may also offer some sessions over the phone, through email, or using computer programs or other media.

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.

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

Medications

Certain types of antidepressants are often used to treat agoraphobia, and sometimes anti-anxiety drugs are used on a limited basis. Antidepressants are more effective than anti-anxiety medications 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 may also effectively treat agoraphobia.
  • Anti-anxiety medication. Anti-anxiety drugs called benzodiazepines are sedatives that, in limited circumstances, your doctor may prescribe to temporarily relieve anxiety symptoms. Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these drugs aren't a good choice if you've had long-term problems with anxiety or problems with alcohol or drug abuse.

It may take weeks for medication to relieve symptoms. And you may have to try several different medications 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 doctor likely will gradually increase your dose during treatment, and slowly decrease your dose when he or she feels you're ready to stop taking medication.

Alternative medicine

Certain dietary and herbal supplements claim to have calming and anti-anxiety benefits. Before you take any of these for agoraphobia, talk with your doctor. 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 has issued warnings but not banned sales in the United States. Avoid using any product that contains kava until more-rigorous safety studies are done, especially if you have liver problems or take medications that affect your liver.

More Information

  • Cognitive behavioral therapy
  • Psychotherapy

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Coping and support

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

You can also take these steps to cope and care for yourself when you have agoraphobia:

  • Stick to your treatment plan. Take medications as directed. Keep therapy appointments. Communicate regularly with your therapist. Consistency can make a big difference, especially when it comes to practicing skills and taking your medication.
  • Try not to avoid feared situations. It's hard to go to places or be in situations that make you uncomfortable or that bring on symptoms of anxiety. But practicing going to more and more places can make them less frightening and anxiety provoking. 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 avoid 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. Support groups for people with anxiety disorders can help you connect to 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 doctor's office. Consider starting with a phone call to your doctor or a mental health professional, or ask a trusted family member or friend to go with you to your appointment.

What you can do

To prepare 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 stress
  • Key personal information, especially any significant stress or life changes that you experienced around the time your symptoms first developed
  • Medical information, including other physical or mental health conditions that you have
  • All medications, vitamins, herbs or other supplements you're taking, and the dosages
  • Questions to ask your doctor so that you can make the most of your appointment

Some basic questions to ask your doctor may include:

  • What do you believe is causing my symptoms?
  • Are there any other possible causes?
  • How will you determine my diagnosis?
  • Is my condition likely temporary or long term (chronic)?
  • 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 medication you're recommending?
  • Are there options other than taking medications?
  • 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 recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

  • 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 trigger your 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 disorders 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?

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.

Agoraphobic Traveler: How to See the World When You’re Scared to Leave Home

  • Kate Palmer
  • BBC

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Image copyright Jacqui Kenny

Jackie Kenny has agoraphobia. This means that going to the supermarket can provoke a panic attack and fear of an impending disaster in her. According to her, her Instagram account helps her - with its help, she and people like her can explore the far corners of the world.

43-year-old Jackie uses Google Street View to take pictures of nuns in Peru and high-rise buildings in Russia in the other. She posts these photos to the 20,000 followers of her Agoraphobic Traveler account.

Since the age of 20 she has been afraid of crowded places and public transport, despite the fact that she lives in the center of London. However, according to her, the digital age has given her the opportunity to visit places that she would never have been able to see otherwise.

"I go to any place that feels even a little magical to me," she says.

Image copyright, Google

Image caption,

Children playing near the Atacama Desert in Chile

Jackie was diagnosed with agoraphobia in 2009. Now, with the help of an Internet service, she selects the most remote and slightly gloomy places on the planet and photographs them. According to Jackie, she likes wherever there is a sense of "another world."

"There is a sense of isolation in these pictures, but also color and hope," she says. "The pictures I take reflect my feelings, and the agoraphobia is part of it. "

However, the feelings she experiences while traveling in this way to distant lands contrast sharply with what she feels in everyday situations.

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Going to the local supermarket is a nightmare for her and says she hasn't used the subway for 10 years.

"I start to panic - my palms are sweaty, my heart rate is racing, my feet feel like they're off the floor," she says.

Photo copyright, Google

Photo caption,

Bus stop in Belgorod region, Russia

Jackie first experienced a panic attack at age 23 while living in Australia at work in the middle of a busy day.

"No one explained to me what it was, and I felt like I was dying," she says. "Afterwards, the doctor said that I must have eaten something wrong for lunch."

"He blamed the black bean sauce - no one then said that the problem could be mental," she adds.

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Hidden disease

Before Jackie started this project in 2016, she was able to hide her symptoms from everyone except her family.

She ran a digital marketing company, but she only went to meetings at her office, which was two minutes' walk from her home.

According to her, finding and publishing these pictures helped her to come to terms with her agoraphobia, which for a long time made her angry.

"Before I had this anxiety, my dream was to be a photographer," says Jackie. "I resigned myself to the fact that it would never happen. "

"Now I realized that the disease does not define me as a person, but is part of me," she says.

Image copyright, Google

Image caption,

A tree in Senegal

But does posting pictures online really help her health?

Jackie admits she doubted spending hours on end surfing the internet was a good thing to do.

But she said it gave her confidence and helped her to speak openly about her condition and come to terms with it.

"It wasn't until I started posting these photos that I moved beyond my family circle and very close friends," she says.

"Before, no one knew [about me]," continues Jackie. "Now people from all over the world share similar difficulties with me, it's amazing."

Photo copyright, Google

Photo caption,

Multi-storey building in Russia

According to her, many people mistakenly consider agoraphobia to be a fear of open spaces - in fact, anxiety can occur in people in completely different conditions.

She was contacted by an agoraphobic journalist suffering from a crowded newsroom, as well as photographers who are afraid to travel to shoot.

"Quite a few young women have asked me for advice," says Jackie.

"Everyone has their own difficulties, and I'm starting to understand that now," she adds.

Image copyright, Google

Image caption,

A dog chases a Google car in Arequipa, Peru

Jackie is now treating her anxiety with cognitive behavioral therapy, which aims to change the way a person thinks, and recently even went to a wedding to sister in New Zealand.

"I went through therapy that made me very nervous and didn't sleep for three months," she says.

But in the end, she was helped by a psychologist who forced her to face her worst fears.

“I pretended to bang my head on the plane door trying to get out of it,” she says. “I realized how ridiculous the situation really was, and we laughed together. I'm going to get through this."

It wasn't easy, but she said the trip gave her hope.

"I try to do these things," says Jackie. "There are times when I realize I can't, and I go home. But I know I'm only making things worse for myself."

What is agoraphobia?

Photo credit, Reuters

  • Agoraphobes may be afraid of being alone in situations where they feel locked in or moving away from a "safe" place
  • The disorder mostly occurs between 18 and 35 years of age and is twice as common in women than men
  • Many agoraphobes are afraid of panic attacks that others can see or anxiety attacks
  • Anxiety can occur in long lines, crowded places or in open spaces

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 marketplaces 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.”

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.

Beginning

I usually become anxious about going out as soon as I know I need to do so. 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.

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 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 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 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.

Climax

I alone could not decide to accomplish this little feat, I asked my husband to participate 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).

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.

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.

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.

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.

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.

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: 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, 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.

Panic disorder was followed by OCD (an obsessive-compulsive disorder in which a person has intrusive 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.

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.

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.

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.

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.

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.

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.

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. 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.

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.

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 to outplay 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.

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