What you need to know about agoraphobia

Among many mental health conditions is agoraphobia, characterised by the fear of situations or places where help and escape are challenging to access. Such cases include crowded spaces, public transportation, or open spaces.

Severe diagnoses of agoraphobia could lead to a person refusing to leave home to avoid these situations altogether, which poses a challenge to everyday life. By learning more about this condition, we can grow to recognise the signs of agoraphobia and provide the appropriate support to those who need it.

People in their early twenties are at the greatest risk for developing agoraphobia, while the disorder rarely begins in those over 40. This phobia accounts for more than half of all anxiety disorders treated by mental health professionals.

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Agoraphobia is derived from the Greek term for "fear of the marketplace." People may develop agoraphobia after having a panic attack in a public place, or agoraphobia may come first, followed by a panic attack. Only about five per cent of people who have agoraphobia do not have panic attacks.

In most cases, agoraphobia is associated with increasing isolation as a person gives up activities outside the home, often including a job, or ventures out only when accompanied. Even with an escort, the person will constantly look for escape routes and may abruptly flee for home out of fear of having an attack.

Agoraphobia often leads to clinical depression, and chronic anxiety increases the risk of stress-related illnesses. Addictions may also develop because many seek relief from alcohol and substance abuse.

Agoraphobia, if untreated, usually waxes and wanes. In mild cases, it may disappear without treatment if you can bring yourself to go out despite your fear and anxiety—a process called habituation.

Self-help manuals can teach you to recognise the signals of an impending panic attack and how to avert it by changing your breathing and thought patterns. However, it's best to consult a mental health professional if you suffer from long-standing or confining agoraphobia.

1. Medications

Agoraphobia may be treated with various medications:

If you take medication for agoraphobia, use only as directed. Some drugs, such as Xanax, can be habit-forming if taken for a prolonged period.

2. Behaviour therapy

With the help of a therapist, patients deliberately seek, confront, and remain exposed to what frightens them. They start with the least frightening and progress to increasingly threatening situations until their fears gradually subside.

For example, someone afraid to stand in a supermarket checkout line may be instructed to envision being in such a situation. When the person can do this without feeling anxious, the next assignment is to go near the supermarket until the fear subsides. After that, the challenge is to take a few steps inside.

Eventually, the person is able to stand in line without difficulty. Behaviour therapy is effective for over 90 per cent of those who complete an entire course.

3. Biofeedback training

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With practice and guidance from a qualified professional, people can learn to recognise elements of their physiological arousal, such as rapid, shallow breathing and a racing heartbeat, and how to avoid a panic attack by controlling them.

4. Hypnosis

Medical hypnosis can reduce anxiety by teaching a person to visualise being in control in places that evoke discomfort or panic attacks.

For example, someone who fears travelling by bus is taught to imagine driving the vehicle. People with agoraphobia also learn to use self-hypnosis to reduce their anxiety about being in public places.

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Read more: How to talk about illness

Read more: How to support those with mental health issues