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Feb 13

Agoraphobia: stop your avoidance behavior while you can

Start by taking a walk around the block to overcome agoraphobia.

Start by taking a walk around the block to overcome agoraphobia.

As I’ve mentioned before, I’ve struggled with agoraphobia for the past couple months. If you’re not familiar with agoraphobia, it’s the fear of being in situations where escape is difficult. Agoraphobia is typically lumped together with panic disorder because it usually begins with panic attacks (with your PD diagnosis, you’ll get a label of “with agoraphobia” or “without agoraphobia”). The rationale is simple: you have a panic attack in a particular situation, it scares you, so you start avoiding that situation. Over time, you may have so many panic attacks in so many different settings that you’re pretty much scared of going anywhere. At its extreme form, agoraphobia may prevent you from ever leaving your home (although I want to emphasize that agoraphobia is not simply a fear of leaving the house).

We all avoid things to a certain extent. Whether it’s shopping, going to the gym, attending social gatherings, or getting behind the wheel of a car, there’s probably something that makes you uncomfortable that you avoid when possible. That certainly doesn’t make you agoraphobic. It’s only once you’ve started altering your behavior in destructive or otherwise dramatic ways to avoid things that you may consider yourself agoraphobic. Trust me, it’s not pleasant.

How can you prevent agoraphobia? There are no surprises here – if you catch your avoidance behavior early enough, you may be able to prevent agoraphobia from setting in. It’s important to keep note of your anxiety triggers and watch for signs of panic attacks. If you do have a panic attack while you’re out somewhere, try not to run. Use coping techniques to overcome the panic attack without avoiding the situation. If you’re having your first panic attack or if you’re in a situation that is particularly scary for you, it may be hard to stay put. Running away is of course your initial instinct when you panic (hence the term “fight-or-flight”). If you have to run, make sure you come back to that situation when you’re more calm. Avoidant behavior is a way of training your brain to fear things. Let’s say you have a panic attack in the mall. If you run out of the mall as soon as the panic attack begins, your brain will interpret your surroundings as dangerous since it is in a state of hypervigilance and is looking for any cues that may signal danger.

My quick and easy advice: Don’t let your brain learn to associate external cues with internal anxiety. Unfortunately, that is much easier said than done. I know how hard it is to remain in situations that cause anxiety. But take it from me: it’s much worse to end up stuck at home, scared to venture outside.

How is agoraphobia treated? The primary method of treatment is exposure therapy. Yep, it’s not any more complicated than you’d think. Exposure therapy involves exposing you to the feared situations and encouraging you to stay there until your initial anxiety abates. At first, you may have supportive people there like spouses or close friends to help you, but eventually you should be able to face the situations on your own. The idea here is to undergo graduated exposure, where you develop a hierarchy of feared situations and start with the least scary, rather than flooding, where you would jump right into the deep end and face your most feared situation. Flooding can actually be harmful and just further enforce your agoraphobia.

For my agoraphobia exposure plan, I started by taking my dog for a walk around the neighborhood. I realized pretty quickly that I had just built up my fears in my head, and I was not actually afraid to leave the house after all. So, I decided to take it a step further and leave the house for a therapy appointment. It was a little scarier because I had to stay in one place, but I knew it was for my benefit in the end so I managed to get through it. The third thing was going to get a haircut, which was a bit of a leap. I find haircuts quite awkward on a good day, so with the added threat of a looming panic attack in the mix, I thought it was a recipe for disaster. I got through the appointment without a panic attack (and with a nice new ‘do). It was a great accomplishment, but left me feeling exhausted (even though I never quite reached the panic attack threshold, I wanted to run out of that hair salon the entire time I was there). Over the past week, I’ve managed to go out for dinner, join a gym and workout in public several times, and sit through two anxiety group sessions. Even just a month ago I never thought I’d be able to do any of that without having a panic attack. The exposure therapy really works well if you can stick to it.

If you’re having troubles with the exposure, maybe take it a little bit slower. I was lucky because my agoraphobia is quite the recent development, so I didn’t have too much trouble re-training my brain to feel comfortable in potentially inescapable situations. For many people, their agoraphobia has gone on for years, and thus can be quite difficult to overcome. If you fall into this category, then take things slow. Start by going out around the block with a loved one. Keep doing this for a couple weeks, at least until it no longer elicits a strong anxiety response. It may take months, but it will be worth it in the end when you have the freedom and control to engage in a variety of activities at your leisure. It’s worth noting that exposure therapy will not necessarily “get rid” of your anxiety. There may be situations that will always cause you some anxiety. Treating your agoraphobia will not eliminate your anxiety, but rather will allow you to regain control of your life.

If you want a more detailed overview of exposure therapy, I will be doing a longer post on the subject in the coming weeks. For now, it’s suffice to say that exposure is the only tried-and-true method for overcoming agoraphobia without medication. (If you are interested in medication, antidepressants and benzodiazepines can be of great help in your exposure plan. The only problem is the potential interference with the associative learning that you’re trying to overcome. Psychoactive medications can interfere with normal memory processes and interrupt the effectiveness of the exposure therapy – your brain may fail to learn that there’s nothing to fear. Talk to a doctor to weigh the pros and cons of medication.)

How have you overcome your agoraphobia? As always, I would love to hear your story. Leave me a line!

photo by: kevin dooley
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