How to Overcome Agoraphobia: Strategies to Get Back Outside
Anyone living with agoraphobia knows how debilitating it can be. Feeling stuck inside your home and being afraid to go outside makes it impossible to truly enjoy life to the fullest. Your career, relationships, and hobbies all take a hit when agoraphobia rears its ugly head.
Take heart, though - agoraphobia is a treatable condition. This article will help you learn more about agoraphobia and strategies you can use to comfortably get back outside.
What is Agoraphobia?
Agoraphobia is a mental health disorder that gets its name from the Greek word “agora.” An agora was a public meeting place that was normally full of people. It was a hub for social, religious, and commercial activities.
When combined with the word “phobia,” we can begin to understand the meaning behind agoraphobia - the intense fear of being in busy and/or public situations.
For people with agoraphobia, this fear is caused by the possibility of needing to escape or receive help and not being able to.
Why would someone fear not being able to flee? Well, it’s common for agoraphobia to co-occur with panic disorder.
Panic disorder involves experiencing recurrent panic attacks, which can include a racing heart, sweating, nausea, or even feeling like you’re about to die. If you can imagine what it would feel like to have a panic attack in a crowded area, you can begin to understand why a person could develop agoraphobia.
Additionally, people with agoraphobia may fear the humiliation that could occur if they needed to leave a public setting and couldn’t. This is common for people with emetophobia, which is the fear of vomiting. People with this condition often fear they’ll need to vomit in public without being able to get to a bathroom in time, leading to public ridicule.
According to the DSM-5, it’s common for people with agoraphobia to feel anxiety about using public transportation, being in public alone, visiting crowded areas, and being in open or enclosed spaces.
What Causes Agoraphobia?
There is no one cause of agoraphobia. Instead, it’s a combination of a person’s genetics, temperament, environment, and life experiences.
There’s a strong genetic component to agoraphobia. The DSM-5 states that the heritability of agoraphobia is 61%. This means that, when thinking about the cause of agoraphobia, 61% of it can be explained by genetics.
Additionally, the DSM-5 suggests that a person’s temperament can contribute to agoraphobia. Individuals who easily experience anxiety or a poor mood are more prone to agoraphobia. Extraversion has been shown to be linked to lower rates of agoraphobia.
The DSM-5 also states that a person’s upbringing can contribute to developing agoraphobia. People with agoraphobia often describe being brought up in overprotective home environments. Experiencing a traumatic event can also precede an agoraphobia diagnosis.
Can Agoraphobia Be Treated?
Whenever a client asks me this question, I’m excited that I get to tell them “Yes!” Agoraphobia is a treatable disorder that many people have already overcome.
The one caveat I’ll mention is that agoraphobia rarely remits on its own. Treatment is normally required for people to experience relief from agoraphobia.
Additionally, it may be necessary to pursue treatment even after a successful course of therapy. In some individuals, agoraphobia can be chronic and require lifelong maintenance. However, in my experience, agoraphobia is rarely as crippling when a person has a relapse compared to the first time they experience it.
How Do You Treat Agoraphobia?
You have options when it comes to treating agoraphobia. Let’s explore some of the most common ones below.
Exposure Therapy and Agoraphobia
One of the best ways to treat agoraphobia is with exposure therapy.
This type of therapy helps people gradually confront their fears through a series of “exposures.” Each exposure gets the person one step closer to conquering their fears.
There are three main types of exposures someone can participate in: in vitro, imaginal, and interoceptive. Let’s take a look at each of these kinds of exposures.
In Vitro Exposures - In vitro exposures are when someone confronts their fears head on. For someone with agoraphobia, this could include standing on their front porch for five minutes or going to a busy shopping mall.
Imaginal - As the name suggests, imaginal exposures include vividly imagining the feared scenario. A person with agoraphobia might imagine riding a crowded subway or having a panic attack in public.
Interoceptive - It’s common for someone with agoraphobia to fear the uncomfortable (yet harmless) physical sensations that occur during a panic attack. Interoceptive exposures help people get used to these sensations. A therapist using interoceptive exposures might direct their client to run in place for a minute to help them get used to the sensation of a racing heart.
In recent year, virtual reality exposure therapy (VRET) has become more and more popular. VRET involves wearing a VR headset that can display various scenarios relevant to someone’s phobia. For example, someone with social anxiety may view a scene of themselves standing on stage in front of a large audience.
One of the advantages of VRET is that allows people to experience a variety of exposures without having to leave their home. For someone with agoraphobia, this can be a helpful step toward getting back outside.
EMDR and Agoraphobia
Eye movement desensitization and reprocessing (EMDR) is one of the most popular types of therapy available today (you can read more about it here). EMDR was originally developed to treat PTSD, but some research that suggests EMDR can help reduce agoraphobia symptoms.
For example, one study from 2013 found that EMDR was just as effective at treating panic disorder and agoraphobia as cognitive behavioral therapy. Another case study from 2021 describes using EMDR to help a 33-year-old woman reduce her panic attacks and agoraphobia, results that were maintained a year from treatment.
Because exposure therapy involves confronting fears directly, EMDR can be a good option for people who want relief from agoraphobia but are hesitant to leave their home.
Medications That Help With Agoraphobia
The most common medication used to treat agoraphobia is a type of prescription antidepressant called selective serotonin reuptake inhibitors (SSRIs). There are lots of SSRIs available - some common ones are Prozac (fluoxetine), Lexapro (escitalopram), and Zoloft (sertraline). It normally takes several weeks for SSRIs to help reduce symptoms, so it’s important that you consistently take them as prescribed.
Another class of medication that can help with agoraphobia is benzodiazepines. “Benzos,” as they’re frequently called, are fast acting and provide immediate relief from anxiety and panic. However, they can be addictive, so most prescribers recommend taking them sparingly.
One of them concerns I often hear from clients is that they don’t want to become dependent on medication. While some people need medication to help them function long-term, it’s common to take an antidepressant for a short period before tapering off of it. Research suggests that a combination of medication and therapy is most effective at treating agoraphobia, so talk with you doctor if you think medication might be a good option for you.
Ways to Treat Agoraphobia at Home
*I’ll give a brief caveat here that information in this section shouldn’t be taken as medical advice and that you should always consult with a doctor or mental health provider before attempting to treat agoraphobia.
One of the cool things about treating agoraphobia is that you can start to take steps toward your recovery today!
Remember exposure therapy? (If you skipped that section, go back and read it now!)
While it’s always best to seek exposure therapy from a licensed mental health professional, you can still start practicing exposures on your own. Here’s how to get started.
Create a List of Exposures
The first step in exposure therapy is to create a list of exposures to participate in. This list should start with easier exposures first before working your way up to more difficult ones.
Not sure how to get started? Ask yourself this question - What situation would trigger your agoraphobia the most? Maybe it’s riding a bus during rush hour or trying to eat a meal in a busy restaurant. Whatever it is, list this situation as the most difficult exposure you’ll participate in. It will be the exposure you’re working toward by accomplishing all the easier exposures before it.
After identifying your most difficult exposure, start working backward, listing scenarios that are easier than the one before it. Remember that you can use in vitro, imaginal, and interoceptive exposures.
Stick to These Exposure Guidelines
Now that you have your list of exposures ready, it’s time to start practicing them. Here are a few helpful guidelines when it comes to practicing exposures.
First, it’s important to start slowly with exposures that feel somewhat easy. Having success during an exposure can build your confidence to practice more challenging ones.
However, it’s also important that exposures feel challenging. If they don’t, you’re simply wasting your time.
An exposure is considered successful once your discomfort starts to subside. Ideally, you’ll be able to practice the exposure until you feel half as distressed as you did when your anxiety was at its highest.
For example, let’s imagine one of your exposures was sitting on your front porch. Say your anxiety peaks at an 8 out of 10 before it starts to come down. You should try to stay in the exposure until your anxiety reaches a 4 or lower.
Practice, Practice, Practice
I always tell clients that you get more out of exposure therapy the more you put into it.
Exposures are most effective when you practice them repeatedly in a variety of settings. Doing so helps your brain get used to lots of different scenarios and gives you more confidence to get back outside.
Feeling overwhelmed about trying exposures at home? Don’t worry! Practicing exposures is fairly simple once you get the hang of it. You can click here to download a worksheet that can help you get started. You can also click here to see a list of 10 exposure examples for agoraphobia.
I also thought it would be worth mentioning that, despite it showing some promising results for treating agoraphobia, EMDR isn’t a type of therapy you should try to do on yourself.
Living With Agoraphobia: A Real Life Example
Many people struggling with agoraphobia find it comforting to read about real people who have overcome this disorder. Here’s my story about how I overcame panic attacks and agoraphobia.
I had my first panic attack when I was in my early 20s. It came out of nowhere when I was at a busy shopping center. I was a new therapist at the time, so I had some awareness about what was happening, but that didn’t stop the experience from feeling terrible.
Fast forward a couple months and I was struggling to leave my apartment without feeling significant anxiety. Several subsequent panic attacks had made me fear being in public, especially in busy restaurants since one of my panic attacks happened while eating.
I finally got to the point where I knew I needed to reach out for help. For me, relief came through a combination of medication, EMDR, and exposure therapy.
My primary care provider prescribed an SSRI and I found an EMDR-trained therapist to help me process the memories of my panic attacks. I also challenged myself to leave home and put myself in uncomfortable settings - even though it made me feel anxious, I always felt better after awhile and felt more confident the next time I went out.
It’s been years since I struggled with agoraphobia and can attest that this is a disorder that is treatable!
I hope my story gives you hope. If you need some help overcoming your agoraphobia, feel free to reach out to schedule a free consultation. I’d love to help you start treating your agoraphobia and getting back outside.
