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Agoraphobia is the condition of feeling extreme anxiety about finding oneself in places or situations where, if a panic attack occurred, escape would be difficult, help might not be available and the individual would feel highly embarrassed. Agoraphobia is experienced by people who have full-on panic attacks and those who have panic-like symptoms without panic attacks. Panic attacks are not required for the diagnosis of agoraphobia.
If you’re feeling trapped by agoraphobia, you’re experiencing one of the classic symptoms of this anxiety disorder. For many individuals, that fear alone — especially unexpected panic attacks — leads to the avoidance of people, places and situations until they the person is virtually homebound.
Unexpected panic attacks are referred to as uncued and seem to occur without any cause. People report they “come out of the blue.” These types of panic attacks might be the most troublesome, since individuals feel highly vulnerable at all times. Many individuals experiencing their first panic attack go to the emergency room, convinced they are having a heart attack and that they will die. Other times there is a strong sense that they will go crazy. Uncued panic attacks often lead people to high degrees of avoidance, making daily living difficult. Over time these unexpected panic attacks become situationally bound or predisposed, although unexpected panic attacks may still occur.
Situational panic attacks are considered cued because they invariably happen at a set location or environment. The trigger in situational panic attacks might be a person, place or thing. Someone with social phobias might have a panic attack before public speaking. An individual with a specific phobia to tunnels might have a panic attack if forced into that environment. If an individual has experienced one or more traumas at a certain location, say a hospital, nursing home or funeral home, and then senses panic attack symptoms at those locations, the panic is said to be cued or specific to that situation. In these circumstances, people will usually avoid those situations if possible, but doing so may extract a high cost to their lives.
Situationally predisposed panic attacks are similar to situational panic attacks, but the panic attacks are unpredictable. At times an individual might experience panic in a certain place/situation, and at times not. Researchers do not have a clear understanding of the mechanisms behind the irregular nature of these panic attacks.
Panic often makes individuals with agoraphobia feel crazy and out of control, and they fear that others see them this way. To manage this fear, individuals often close themselves off to the world. They may avoid being alone outside the home, driving by themselves, being in a crowd, or traveling via public transportation. They may not be able to work. This pervasive avoidance is what characterizes agoraphobia from other disorders.
Without treatment, panic disorder and agoraphobia often become worse over time. Some individuals awaken in the middle of the night with panic attacks, demonstrating the futility of avoidance as a protective strategy. For those feeling trapped by agoraphobia, just traveling to treatment might present a challenge. However, avoidance is simply a Band-Aid solution that comes with its own set of problems. Treatment is the only way out of the trap of agoraphobia.
The most commonly available treatments for panic disorder are based on cognitive-behavioral therapy (CBT), delivered in a group therapy setting. Many studies support the use of CBT to reduce panic symptoms, and CBT is highly preferred over medication treatment.
Other types of psychological treatment include panic control therapy (PCT), acceptance and commitment therapy (ACT), sensation focused intensive treatment (SFIT) family and group therapy, and finally medication. Panic control therapy -- along with some others -- includes a component of exposure and asking individuals to recreate their physical panic symptoms (such as dizziness and shortness of breath) in a controlled environment. As people learn to tolerate these unpleasant physical sensations, they become more able to manage their panic symptoms. The other therapies combine elements of both CBT and exposure.
When seeking treatment, ask about the modality used and if treatment is delivered individually or in a group format. Groups provide many benefits, and some treatment centers will combine individual and group treatment.