Agoraphobia is a mental health condition that induces intense fear and anxiety in affected individuals when they face the possibility of being unable to escape from a triggering event or environment. It affects close to 1% of US adults with an even prevalence rate between males and females. Agoraphobia is a debilitating condition that often threatens to disrupt every aspect of a person’s life. Therefore, it is important to have access to health care professionals such as occupational therapists and mental health interventions. Let’s discuss agoraphobia and its treatment options in more detail.
What is Agoraphobia?
Agoraphobia occurs when someone is very afraid of or anxious about not being able to easily escape from a situation. Many persons wrongly think that agoraphobia is a fear of open spaces, but this is a more complex mental health condition. It involves a lot more than that and varies across individuals.
Approximately 1.3% of adult Americans experienced agoraphobia at some time in their lives. The levels of severity also vary from mild to serious impairment. Studies indicate that close to 41% of adults had serious agoraphobia impairment, and the remaining 59% experience mild to moderate impairment.
The DSM-5 classifies agoraphobia as a persistent and chronic condition if the individual doesn’t undergo treatment. Many people experience it as a lifelong health condition. But the good news is that treatment helps with managing the symptoms. Furthermore, roughly 50% of those with agoraphobia receive treatment and make a full recovery.
Agoraphobia Symptoms
Agoraphobia is a fear of certain situations that can be classified into five groups:
- Public transportation (of all kinds).
- Open spaces.
- Enclosed public spaces.
- Crowds or standing in line.
- Being outside the home (in general).
However, the fear (or anxiety) must occur in two out of five situations to be classified as agoraphobia. If a person fears a single situation, then a specific phobia is assigned as the diagnosis. Also, agoraphobia differs in terms of the consequences that are feared.
If an individual is scared because they don’t want to experience anxiety or panic, then it is agoraphobia. But if the person is scared because of other reasons, then it is most often a specific phobia.
Risk Factors and Accompanying Conditions
Agoraphobia has several risk factors such as:
- Panic disorder
- A younger age
- Being female
What causes agoraphobia? Biological, psychological, and environmental factors play a role. Studies have shown there are genetic/familial agoraphobia clusters. It is believed that agoraphobia is hereditary, although the environmental factors are most influential. One’s personality is also a factor. Agoraphobia is most often associated with introversion, anxiety sensitivity, and dependency.
Furthermore, agoraphobia is more likely to occur in the presence of other mental health conditions. These are called comorbidity rates (or correlations). Each comorbidity rate shows the likelihood that a person experiences agoraphobia and that specific condition:
- Anxiety disorders: 49 to 60 percent
- Depressive disorders: 33.1 to 52 percent
- Specific phobia: 73.7 to 75.2 percent
- Social phobia: 66.5 percent
- Generalized anxiety disorder: 15 to 31.9 percent
- Post-traumatic stress disorder: 24.2 to 39.6 percent
- Major depressive disorder: 38.5 to 48.7 percent
- Bipolar disorder: 15.5 to 33 percent
- Substance use disorders: 31.4 to 37.3 percent
Agoraphobia Treatment Options
There are several agoraphobia treatment options to explore:
Psychological Therapy
Cognitive-Behavioral Therapy (CBT) is the most notable method to treat agoraphobia.
CBT focuses on you becoming more aware of your thoughts to identify and challenge the negative and unrealistic thought patterns that generate negative behavior. For example, many persons with agoraphobia worry that a panic attack will lead to their death. Your therapist will work with you to discover new ways of thinking to help you behave more positively. This means that your therapist will help you to see that although a panic attack is an unpleasant experience, it is not fatal and it will pass.
This shift in thinking is critical for your success in therapy. As you shift your thinking, you are more likely to confront situations that previously scared you.
CBT is often combined with exposure therapy. Your therapist will set quite modest goals at the start of your treatment. This could be as simple as going to your local store at first. Then once you become more confident, you can attempt a more challenging goal such as going to a supermarket or having a meal in a busy restaurant.
Your CBT treatment may consist of 12 to 15 weekly sessions, with each one being at least an hour in duration. There are other treatment options as well:
Applied Relaxation
Applied relaxation is another technique that is based on the idea that people with agoraphobia and related panic disorders would have lost their ability to relax. Therefore, the purpose of applied relaxation is to teach you how to relax:
- Identify the signs and feelings of tension
- Relax your muscles to alleviate tension
- Use these techniques in stressful situations to prevent feeling tense and panicked
Just as with CBT, an applied relaxation therapy consists of 12 to 15 weekly 1-hour sessions.
Guided Self-Help
This approach means working through a CBT-based workbook or computer course with your therapist’s support. The therapist will also help you understand your problems and make positive life changes.
This process often follows a stepwise process
- Learn more about your condition, beneficial lifestyle changes, techniques that you can undertake to feel better.
- Discover the appropriate treatments and medications that can help you.
- Learn more about agoraphobia and the related association with panic disorder and panic attacks to learn how to better control your symptoms.
- Have greater confidence in managing your emotions and better able to deal with previously uncomfortable situations.
These useful lifestyle changes include:
- Exercise regularly to relieve stress and tension and lift your mood.
- Follow a healthy diet to alleviate symptoms of panic and anxiety.
- Avoid drug and alcohol use to provide short-term and long-term relief.
- Avoid drinking tea, coffee, and cola, as the caffeine could make your symptoms worse.
Tips to manage a panic attack:
- Remain where you are. Yes, it’s tempting to try to run to a safe place, but resist the urge. If you are driving, then pull over and park in a safe location.
- Don’t fight an attack because doing so can make it worse. Reassure yourself that you will be alright and that your panic attack is not life-threatening.
- Focus on something non-threatening and visible. This can be the time passing or looking at items in a supermarket.
- Slowly breathe in and out. Taking these deep breaths will help to keep you calm. Breathe in and out while slowly counting to three on each breath.
- Challenge your fear with logic. Keep reminding yourself that this fear is not real and that your panic attack will pass.
- Practise creative visualization. During a panic attack, resist the urge to think negatively. Instead, picture a place or situation that makes you feel relaxed, peaceful, and at ease. Once you have this imagery in mind, focus on that to calm yourself.
The Role of Medications in Treating Agoraphobia
Medications can also be used to treat agoraphobia. Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs) help to manage feelings of panic, anxiety, and obsessional thoughts.
A popular SSRI called sertraline is often recommended for individuals with agoraphobia. However, some of the side-effects include:
- Feeling ill, blurred vision, excessive sweating
- A loss of libido (sex drive)
- Blurred vision, feeling agitated, or shaky
- Diarrhea or constipation
The side effects should improve with time, but a few of them could persist. If SSRI doesn’t work, then you may be prescribed serotonin-norepinephrine reuptake inhibitors (SNRIs).
You may have to take SSRIs or SNRIs for 6 to 12 months or more. It all depends on your response to treatment. When you and your doctor decide that you should stop taking these medicines, then you will be gradually weaned off them.
Can an Occupational Therapist Help With Agoraphobia?
An occupational therapist can help you manage your agoraphobia and minimize its impact on your daily life. If an occupational therapist is trained in CBT, then they can also assist you to change all dysfunctional thought patterns to better ones and change your behavior. They will help you discover how much the condition affects your ability to engage in daily life activities. Occupational therapy helps you develop a schedule to live a full life.
How to Help Someone With Agoraphobia
How can you assist a loved one with agoraphobia? You can:
- Learn more about agoraphobia and panic disorder
- Build trust and be supportive of your loved one
- Not force or hasten their recovery process
- Not think that they are being manipulative
- Not see your loved one as being weak
Can Agoraphobia be Treated?
Agoraphobia can be treated with a combination of treatment options deemed suitable by your medical team. Many health specialists will review your symptoms, make the appropriate diagnosis, and develop a custom treatment plan for your recovery which may include occupational therapy.
Do You Need Occupational Therapy?
We have considered the role of occupational therapists and mental health interventions to treat agoraphobia. If you are close to Shelton, CT, then visit Moving With Hope. We have many skilled medical professionals including occupational therapists, and we will partner with your existing medical team to give you exceptional healthcare. We invite you to contact us today to begin the journey to a better, healthier future.