In this post, we’re going to talk about Agoraphobia, some common misconceptions, and what kind of treatment works.
By the end of the video you’ll learn 5 steps to overcoming agoraphobia, and you’ll hear from someone who did it.
Imagine being bound by invisible chains every time you reach for your front door, your heart racing at the thought of stepping outside, or going to the store, crossing bridges, or being in an elevator or subway car. Terrifying thoughts of having a medical emergency in public keep you indoors or when you do leave the house, you’re white knuckling, terrified, but using every ounce of your willpower to get through activities that the average person would do without thinking. This is a daily reality for the approximately 5 million Americans living with agoraphobia.
What is Agoraphobia?
So first, a lot of people think that agoraphobia is fear of leaving the house, or fear of bridges or crowded places- and at first glance, that’s what it looks like. People with agoraphobia either avoid going to these places or they still go out, but the whole time they’re full of anxiety, terrified but forcing themselves to get out.
But here’s the thing, the more I listen to the experiences of people with Agoraphobia, it’s not the places that scare them, it’s not the mall or the bridge or the elevator. Drew Linsalata, former agoraphobia sufferer and host of The Anxious Truth podcast said “You’re not afraid of the outdoors or the highway, you’re afraid of what will happen when you are there. You’re afraid of how you might feel when you go into those places.”
- They are afraid they will have a panic attack
- They’re afraid they’ll have anxious feelings, pass out, and they won’t be able to deal with that.
- They’re afraid they’ll vomit or soil themselves, and they won’t be able to manage the embarrassment.
- They’re afraid that a panic or anxiety attack is actually a medical emergency, and if they aren’t with someone who will keep them safe, they won’t be able to handle it.
Agoraphobia is intense fear of becoming overwhelmed, anxious, or having physical sensations and not being able to escape or get help.
Symptoms and Examples
And so we’re already jumping into understanding Agoraphobia- because in order to control something that you can’t control- your feelings and sensations, you start avoiding situations. If we take a look at the anxiety cycle we learn that when you avoid something, it teaches your brain that what you avoided is actually dangerous, and that increases your anxiety.
And your world shrinks. Soon you can’t cross that bridge or go to that store, or drive by yourself anymore. And as you continue to avoid these situations, not only does your world shrink, but your anxiety grows. Some people with agoraphobia can’t even leave a room in their house, or their bed or their couch. And it’s not that you truly can’t do those things, physically you can, it’s that you’ve created a mental rule- a rule that says “IF these things make me feel anxious THEN it must be dangerous SO I have to avoid them.”
The more you try to prevent yourself from feeling anxious, the more you try to control your anxiety, the stronger agoraphobia becomes.
Treatment: Trigger vs. Cause.
This is really important. The key to overcoming agoraphobia is understanding the difference between a trigger and a cause.
The TRIGGER might be a sensation of anxiety in your body (a racing heart or rapid breathing) or it’s a thought like “What if I have a panic attack?” that can be triggered by sensations, or a place that you believe is unsafe- like a bridge. This is what starts off that initial feeling of fear, anxiety or discomfort. But the CAUSE is how we respond to those feelings. Agoraphobia is caused by something we do that feeds a cycle of avoidance which leads to more anxiety. There are two behaviors that cause agoraphobia- Trying to control, and trying to avoid.
- Trying to control sounds like: “I cannot allow myself to go to my kid’s concert, because I cannot allow myself to panic, I cannot allow myself to have panic symptoms.” Controlling might look like carefully arranging your schedule to avoid certain situations, or making sure someone comes with you when you go out, to control for an emergency. This mental rule “I have to control my panic attacks” feels safer in the short term, but your brain increases anxiety in the long run.
- OK, the second cause of Agoraphobia is Trying to avoid- “I once had a panic attack at the mall, that was horrible, I never want to have that again, so I can never go to the mall again.” But if you don’t have the skills to manage panic attacks, you’re just avoiding them, then you’re likely to have another at the grocery store or driving, and if your only skill is to just “Avoid more” then the number of places where you feel safe from panic is just going to shrink.
Both of these responses, controlling and avoiding, send a message to your brain that those feelings or sensations are actually dangerous, and that increases our anxiety levels. So what feels good in the short term, what feels safe- retreating to smaller and smaller areas, your neighborhood, your home, your bed, actually causes the symptoms of agoraphobia. It wasn’t the anxiety, it’s your response to the anxiety that causes agoraphobia.
“What’s happening is that your brain made a faulty connection, it thought that feeling uncomfortable meant you were in danger, and you went along with it, you agreed with it, you left the situation, and that rewarded your brain, which strengthened your fear.”
Thoughts that Contribute to Agoraphobia
There are a bunch of anxious thoughts that contribute to agoraphobia,
- Believing that “If I feel anxious, it’s going to be a disaster”
- “I can only go out if I don’t feel anxious”
- Surely, the worst, awfulest most terrible things are likely to happen. (aka catastrophizing)
- Everyone is looking at me, judging me, no one will help me.
- It would be terrible if I had a panic attack, I have to guarantee that I won’t have one.
- The belief that panic attacks are actually dangerous, people often believe that they are having a heart attack or stroke, when they are having extreme anxiety symptoms. But panic attacks are actually safe. (Check out my playlist on Panic attacks)
- And, fundamentally, the belief that feeling anxiety is dangerous or bad
But fighting your thoughts is most likely not going to be helpful.
We often get stuck in a loop of trying to control our thinking first, and then change how we feel, so that we can act differently. As in “I’ll leave the house when I don’t feel so anxious”. But this doesn’t usually work. We can’t think our way out of agoraphobia.
The only way out of this is to reprogram your brain, to SHOW it that things that feel uncomfortable aren’t actually dangerous, and the way to show your brain this is through experiences- by getting out there.
So we have to do something uncomfortable, and sit with it, not retreat, not avoid, not control, and your brain will learn by experience that you are safe, even when you’re having that feeling. You can do this really gently.
Exposure Therapy
So let’s talk about the treatment approach that helps people overcome agoraphobia- it’s called exposure therapy.
Usually the thought of exposure therapy makes people feel really anxious, because it sounds overwhelming, but there is a way to do this really gently. Now, I recently made a video about me using exposure therapy on myself and my fear of falling, and the biggest holdup most people have, myself included, is that you immediately think of the scariest scenario and imagine that’s where to start exposure therapy–you have to immediately jump into the deep end of that fear.
You don’t. Let’s learn how to swim in the kiddie pool first.
As I describe in my other video, I was avoiding learning how to lead climb because I was afraid of taking large falls. But with my fear of falling, I started by taking 2 inch falls, then 6 inch falls, then 1 foot falls, and each time, I grew less scared and more proud of myself. Eventually I was taking 10-15 foot falls and I got more and more comfortable with it. With Agoraphobia, it’s similar.
The entire goal of exposure therapy isn’t to just do scary stuff, it’s to actually change your relationship with discomfort. We avoid anxiety because it’s uncomfortable, but anxiety isn’t dangerous. So we’re going to practice in tiny doses how to stop avoiding that discomfort.
The 5 Steps to overcoming Agoraphobia
(1)The first step is to just take a moment and get really clear on why this matters to you? What do you really want your life to be like? Who would you connect with if you didn’t let anxiety control you? Where would you go? What would your day be like? Pause this video and write this down, or comment below. Because more important than decreasing anxiety is actually moving in the direction of the life that you care about. How will you feel about yourself when you overcome these fears?
(2)Now that you know the WHY, the next step is to create an exposure hierarchy, write down a list of a bunch of triggers, and then rank them on a scale from 0-10 for how much anxiety you feel.
It’s important to come up with a bunch of things that are a 2, 3, or 4 on the scale because that’s where we start.
So maybe it’s leaving your bed and spending 5 minutes in the kitchen or sitting on your front porch, or walking to the end of the driveway or around the block, you make your list and find out what are the 2-4’s on your list.
(3)Now we’ll do some gentle exposures
Drew said that for him, one of his first steps was to leave the bed and spend 5 minutes in the kitchen.
(The Anxious Truth) You sit in the kitchen and allow all that anxiety to happen without trying to stop it. It takes courage, and when you don’t run, you go towards the things you fear, you’re feeding the fear center in your brain positive experiences (you have a panic attack, but nothing bad happens) I tolerated this, I didn’t give into it, but I was ok, and you do this over and over and the message starts to sink in.
You’re feeding your brain the experiences it needs to rewire itself, to learn that it is safe to go out.
You learn to have a new relationship with discomfort.
“You need to break your fear connection- fear of the sensations in your own body
Start small, get ready to go out, maybe you’ll have a panic attack while putting on your shoes- learn to put your shoes on while having a panic attack. It’s not dangerous.
And you can do this with any situation that you would normally avoid or control
Being home alone
Leaving a room
Needing someone to go with you
You might think “I’m going to be doing exposures forever!” but you only have to overcome one fear- fear of anxiety and the sensations that go with it”
“I may have a panic attack tomorrow, but I will never be agoraphobic again, because I’m not afraid of my panic attack anymore”
Not only will you get better at feeling, and get really good at feeling some anxiety without avoiding or controlling, your anxiety will go down with time too.
(4)Practice each exposure step repeatedly until your confidence goes up before moving to the next step. This process is known as “habituation.” This is how we break the anxiety cycle, each time you face your fears (and you don’t die) your brain learns ‘Phew, that was actually safe. I felt all anxious, but those sensations didn’t injure me. I drove on the highway and everything was fine”. And your brain decreases your anxiety because it learns that you are totally capable of having feelings and being ok, you are a good driver. And over time you’re going to feel more comfortable in those situations.
(5) Stay consistent with your exposures. It’s normal to experience some anxiety during exposures, but it should be manageable and decrease over time with repeated practice. And of course, celebrate and share each accomplishment. It can be helpful to keep a journal or log so that you can notice your progress.
Two pitfalls that can interfere with Exposure therapy
Now, it’s important as we do this, that we don’t get too focused on our feelings “Did I feel anxious or not??” It’s more important to focus on our actions and our values- I care about visiting my grandkids, did I visit them? I want to take care of my yard. Did I go out in the front yard today? Drop the struggle against your emotions and channel your energy towards what you really care about.
Now exposure therapy is really effective when done correctly, but there are some things called “Safety Behaviors” that can stop us from truly overcoming agoraphobia. These are things like making sure you’re always with a family member, or that you always have someone on the phone, or using benzodiazepines or alcohol or drugs. These safety behaviors are part of the control we talked about earlier, which end up contributing to the cause of agoraphobia. If you use a safety behavior while doing an exposure, it tells your brain “The only reason I could handle that was because I had Bob with me”. This reaffirms to your brain that you’re not actually capable or safe, so your brain keeps your anxiety levels high. Do your best to let go of control and instead make space for your feelings, this is how you’ll discover your true sense of strength. It’s ok to use a support person in the initial stages of exposure therapy, but don’t rely on them forever.
Medication and Therapy
In addition to doing the work on your own, working in therapy with someone who is skilled in exposure therapy can be really beneficial in overcoming agoraphobia. Antidepressants like prozac, and zoloft for example can also be helpful, so you can work with a doctor to explore your options. Benzodiazepines can make you feel less anxious in the moment, but they won’t help you develop the skills to manage agoraphobia in the long run.
And of course, anything you can do to improve your general mental health can help. Reduce your overall stress and anxiety and add in lifestyle changes, like exercise, nutrition, self-care, and social support.
Summary
So that’s agoraphobia in a nutshell, you really can learn to stop letting fear and panic and anxiety run your life, little by little you can show your brain that you can feel the fear and do it anyway, and in the long run, your brain will learn it doesn’t need to give you so much anxiety after all.
Check out the course, Break the Anxiety Cycle in 30 Days below.
