What is agoraphobia?

Cognitive behavioural therapist and author Pamela Myles-Hooton explains what agoraphobia is and how self-help can help you overcoming its distressing symptoms.

What is agoraphobia?

Agoraphobia is a fear of being in situations in which the person believes that escape may be difficult or that help will not be available if something goes wrong. Many people think that it is simply a fear of open spaces, but it isn’t: it’s more complicated than that. Agoraphobia actually translates from Greek as ‘fear of the marketplace’. Many people with agoraphobia find it difficult to use public transport, go shopping at the supermarket or shopping centre, or even leave home without being accompanied by someone they trust. If a person with agoraphobia finds themselves in a situation such as this, they may experience physical symptoms of panic, including racing heart (palpitations), rapid breathing (hyperventilating), feeling hot and sweaty, feeling sick, butterflies in the tummy and diarrhoea.

Symptoms of agoraphobia

People with agoraphobia will tend to avoid a wide range of situations (e.g. queues, public transport, large crowded shops, supermarkets, shopping centres, theatres, cinemas, etc.). In these situations, the person will commonly feel some or even all of the physical symptoms of anxiety and panic listed above (e.g. palpitations, hyperventilation, etc.). When the person is feeling this way, they will often fear that something bad is going to happen and might have upsetting thoughts such as ‘I’m going to faint’, ‘I’m going to have a heart attack’, ‘I’m going to stop breathing’, ‘I’m going to fall over’, etc.). Having these very unpleasant physical symptoms and frightening thoughts can lead to an increase in the person’s feelings of anxiety and panic. As a way of coping, many people use what we call safety behaviours, which tend to help the person to feel less anxious and might include things like always being accompanied when out, carrying medication, a bottle of water or even a good luck charm, or holding onto something like a trolley, or carrying an umbrella. Another coping strategy is escape. Many people with agoraphobia recount stories of when they abandoned their shopping trolley and quickly left the supermarket due to feelings of panic. 

To sum up, there are a number of symptoms of agoraphobia: feelings (anxiety and panic); physical symptoms (palpitations etc.); thoughts (‘I’m going to have a heart attack’ etc.); and behaviours (avoidance – not going places for fear of feeling anxious; safety behaviours – doing things or taking things with you to help reduce anxiety; and escape – leaving a situation when feeling panicky).

Consequences of agoraphobia

Agoraphobia can at times feel like a mental prison that limits your life. It may also have a number of consequences for your daily routines. You might have tried to overcome your agoraphobia before but not succeeded. It can be incredibly difficult! Loved ones may have offered you well-meaning advice that might not have helped, despite your best efforts to follow it. At this point, you might feel hopeless about your situation. Because of this, you will need to address your agoraphobia at a pace that is manageable for you, and in a way that should allow you to overcome it and begin living your life to the full.

What is cognitive behavioural therapy?

A set of techniques that have been proven to work for addressing your agoraphobia come from cognitive behavioural therapy, or CBT for short. The evidence supporting this approach comes from many research trials which are summarised in important scientific reviews. These reviews say that CBT is effective for lots of people who experience anxiety difficulties (including agoraphobia) and also depression. Of course, sometimes people with an anxiety disorder will become depressed as well due to the consequences of experiencing long-term anxiety and this is not uncommon in agoraphobia.

CBT can be provided in a number of ways including: face-to-face with a therapist, by telephone or using online technology; in a group setting with others also living with agoraphobia; or in a self-help format such as in a book. Sometimes you can get support while using self-help from a healthcare professional. A family member or friend can also act as a supporter. 

The use of CBT self-help books is often referred to as ‘low-intensity CBT’. It’s called ‘low intensity’ because there is a strong emphasis on the use of self-help materials rather than sessions with a therapist. It used to be thought that low-intensity CBT was only suitable for people with mild problems, but more recent research evidence supports this form of therapy for anyone suffering from anxiety and depression. This means, that no matter how severe or longstanding your agoraphobia is, a self-help book can help.