Agoraphobia is the irrational fear of crowded places. Someone suffering from this condition will find it extremely difficult to be around large groups of people for even a brief amount of time. If they were to be in such a situation, then they may experience anxiety that is so intrusive and extreme that they may experience full blown panic attacks.

Agoraphobia is one of the most common phobias that exists, right up there with glossophobia (fear of public speaking) and kakorrhaphiophobia (fear of failure). People who suffer from this disorder will be exclusively fearful of large crowds, as opposed to actually being fearful of other people or of confined spaces.

People who suffer from full blown agoraphobia will feel intense anxiety when in a very crowded area as they will feel as though such a situation brings forth with it the potential for grave danger. Though this may be true theoretically, the intensity and extent of anxiety that someone with agoraphobia will experience will be out of touch with reality and over-dramatized. Though this will almost always be the case, someone suffering from agoraphobia will not believe this to be so.

People suffering from this fear will likely be over cautious about their environment and may make decisions based solely on their agoraphobia. Their fear of crowded places may also negatively impact their relationships with others as they will likely have a very difficult time with going out to certain social events.



Symptoms of Agoraphobia

Anxiety will be the main symptom experienced for someone with agoraphobia. As previously mentioned, their anxiety may be so intense that they may even experience full blown panic attacks as a result of it. In some extreme cases, they may even need to be hospitalized depending on how severe their panic attack was.

Someone with a fear of crowded places will likely go out of their way to ensure that they do not put themselves in a position where they will feel “trapped” in the middle of a large crowd. To help prevent this from happening, they may only go to certain areas where they know there will not have many people or they may just try to isolate themselves from others altogether.

Though avoiding large crowds will give them some relief from their anxiety, by doing so they will also by reassuring to themselves that large crowds are something worthy of being feared. A behavior such as this will likely be counterproductive to their long-term mental health and may even worsen their agoraphobia as a whole.

Below, you will see some more common symptoms of agoraphobia:

  • Intense anxiety when in a large crowd
  • Anxiety when thinking of large crowds
  • Avoiding areas where crowds may be
  • Difficulty coping with their anxiety
  • May experience full blown panic attacks

Causes of Agoraphobia

There is no known cause of agoraphobia. However, genetics and one’s environment may play very significant roles. For instance, if someone had a family history of mental illness, then they may have a higher chance of developing an irrational fear of crowded spaces. This would likely be due to them being at risk for having a genetic predisposition to developing mental illness in general.

If someone were to have such a genetic predisposition, then it may only take them experiencing some sort of traumatic event for them to develop full blown agoraphobia. An event that may trigger this disorder to develop could be that they were injured once before in a crowd or that they were in a crowd of people and had difficulty getting out, panicking all the while.

It is also possible for someone to develop this condition due to them already suffering from a separate, yet similar disorder, such as generalized anxiety disorder (GAD) or social anxiety disorder. However, this will depend on many different factors.

Though we do not know the exact cause of agoraphobia, there is a consensus among most mental health professionals that both genetics and one’s environment play very significant roles. So, taking a closer look at these different things may give you a better insight as to whether or not you are at risk for developing an irrational fear of crowded places.



Agoraphobia Treatments (abridged)

People suffering from agoraphobia may greatly benefit from exposure therapy. This form of treatment is one of the most common and effective types of therapy for people suffering from phobias and anxiety disorders. Exposure therapy works by having the patient become exposed to their fear for a given period of time.

When they are exposed to their fear, they will inevitably experience an intense influx of unwanted anxiety. Though this may sound counterproductive, the goal of exposure therapy is to help desensitize the patient from their fear by repetitively exposing themselves to that fear. Theoretically, the more someone is exposed to something they fear, the less it will bother them over time.

With regards to agoraphobia. The patient may expose the patient to their fear of crowds by showing them pictures or videos of very crowded areas. The patient may then move on to being exposed to real world situations by going to areas that are lightly crowded. The goal would be for them to be able to gradually build up their tolerance so that they would be able to eventually handle being in large crowds.

Anti-anxiety medication may also be beneficial for someone suffering from agoraphobia. For example, medications such as Valium or Xanax may be able to help someone when they are experiencing a panic attack by helping to soothe their anxiety. Though such medications may be advantageous for someone suffering from agoraphobia, they should first talk to their doctor before taking them to ensure it is safe and effective to do so.

If you think you may have agoraphobia or if you are suffering from some of the symptoms associated with this condition, then you should talk to your doctor as soon as you can so that you can be properly diagnosed and treated for your condition. Upon seeing your doctor, she may refer you to see a specialist such as a psychologist or a psychiatrist for further treatment.




Treatments (expanded)

Cognitive Behavioral Therapy (CBT) for Agoraphobia

CBT is a psycho-social intervention that aims to improve one’s mental health. It is a modality that is often used to treat people suffering from anxiety disorders such as generalized anxiety disorder and OCD. Someone with agoraphobia may also be able to benefit from CBT as well seeing as how it would allow them to have a much better understanding as to why they think and behave the way they do in relation to their irrational fears.

CBT can be immensely helpful for someone with agoraphobia given the sheer automaticity of their symptoms. For example, when someone with agoraphobia is exposed to their fear, they will almost always have an instantaneous subconscious reaction to their fear. Such a lack of introspection is likely a large part of why someone with this condition will suffer to the extent that they will. CBT can help you to take a step back and analyze your fears more deeply than you typically would.

Besides learning to be more fastidious with regards to understanding one’s specific fears, someone with agoraphobia engaging in CBT can also expect to learn various other skills aimed at helping to relieve the anxiety caused by their condition.

Mindfulness-Based Stress Reduction (MBSR) for Agoraphobia

MBSR is an 8-week evidence-based program that offers secular, intensive mindfulness training to help people who are suffering from anxiety, stress, depression, and other sorts of mental anguish. MBSR may be able to significantly help someone who is suffering from agoraphobia as mindfulness meditation has been shown to be very beneficial for anxious people. In such a structured program, someone with agoraphobia can expect to learn a plethora of different skills that can help them to relieve the intense anxiety that’s associated with their specific phobia.

Talk to your doctor or therapist to see if MBSR can help you to reduce the intensity of your symptoms of agoraphobia, as well as where to find MBSR programs in your area.

Meditation for Agoraphobia

There are many different forms of meditation that exists which can be very advantageous for someone suffering from agoraphobia. Specifically, mindfulness meditation has been shown to be quite beneficial for helping people to enter into a more equanimeous state. There are many different ways with which you can implement mindfulness meditation and there are also many different meditation apps which are designed to make things as easy as possible for you.

Mindfulness has the potential to significantly help those suffering from agoraphobia due to how it will help one to distract themselves from their fear by refocusing their attention onto something else that does not have any sort of emotional baggage attached to it, such as by focusing on the breath for example. This is one of the most basic ways that one can meditate and be present.

For someone with agoraphobia in the midst of a panic attack, redirecting one’s attention to the various sensations felt when breathing can actually help to reduce the amount of mental anguish experienced during such an influx of anxiety.

To implement mindfulness meditation to help relieve one’s symptoms of agoraphobia, you can do so by paying close attention to the way the muscles in your abdomen and chest contract and relax with every inhale and exhale. You can spend time dwelling on how it feels as your chest expands during each inhale and how it sinks in with every exhale.

Besides focusing on your breathing, you can also focus on the sounds around you, the way your skin feels as you touch certain objects, the way foods taste, as well as the way certain aromas smell. Essentially, honing into your 5 senses can significantly help you to reduce some of the anxiety that is associated with agoraphobia. Also, remember that it will take a lot of practice to become an adept meditator. So, practice is key.

Exposure Therapy for Agoraphobia

As previously mentioned, exposure therapy is one of the most common ways to treat anxiety disorders such as agoraphobia. It can be an efficient way to help desensitize the patient to their specific fears. Be that as it may, it is imperative that the therapist implementing it on their patient is very adept at doing so. For example, if the therapist were to slightly expose someone with agoraphobia to their fear, then it may not be very effective as they may need a higher amount of exposure to truly trigger any sort of worthwhile change in the patient.

The same can be said for the antithesis of this scenario. If the therapist were to excessively expose someone with agoraphobia to their fear, then doing so could be highly counterproductive to the point to where their agoraphobia may become immensely worse due to the therapy alone. So, it is paramount that the therapist implementing exposure therapy for someone with agoraphobia has a very strong sense of just how severe their symptoms are so that they can know the level of exposure that the patient will likely be able to handle.

Exercise for Agoraphobia

Exercise has been shown to be extremely beneficial for people suffering from anxiety disorders, including agoraphobia. Specifically, cardiovascular exercise can significantly help to relieve one’s stress. This is not to say that weight-resistance training would not benefit someone with anxiety, but rather that aerobic exercise is has been shown to be more effective at releasing those feel good chemicals in the brain, such as endorphins.

According to the American Psychology Association, exercise can help to condition the mind to better cope with stressful situations. This makes sense when we take into consideration the high amount of stress that the body is put under during strenuous exercise. So, if you yourself are sedentary, then engaging in some form of aerobic exercise may be able to significantly help reduce your symptoms of agoraphobia by making it much easier for you to cope with the anxiety and stress that’s associated with this condition.

There are many different aerobic modalities that you can partake in to help reduce your symptoms of agoraphobia, such as swimming, biking, skiing, walking, and jogging. You can also acquire the many benefits of exercise by playing sports such as tennis, soccer, basketball, and racquetball, among many other sports. Engaging in some form of exercise consistently may be able to help relieve some of the pain associated with agoraphobia over time.



Yoga for Agoraphobia

There are numerous different yoga poses that can substantially benefit someone who is suffering from agoraphobia. In part, this is due to the meditative state of mind that yoga tends to emit in those who practice it on a consistent basis. Yoga can be thought of as meditation in motion. It can help to relieve some of the anxiety associated with agoraphobia due to the mere fact that by engaging in yoga, your attention will be redirected to something more productive.

There are many different types of yoga that someone with agoraphobia can benefit from, such as hatha yoga or hot yoga, among many others. Nevertheless, regardless of the many different forms of yoga that exist, virtually all of them can help to relieve some of the stress and anxiety that is associated with agoraphobia.

If you have never practiced yoga before, then it may be in your best interest to take a class or watch some guided videos that can help you through each pose. Just like with meditation, the more you practice yoga, the more adept you will become at it. Besides helping you to reduce your symptoms of agoraphobia, you can also expect to acquire increased strength and flexibility, among other benefits.

Reducing Caffeine for Agoraphobia

It is no secret that consuming large amounts of caffeine throughout the day can aid in making you more anxious. This makes sense when we look closely at how caffeine affects our body’s physiology. When we consume a high dose of caffeine, our heart will start to beat faster and we become more tense. Essentially, our body will begin to go into a “fight or flight” state of mind. Such a frame of mind is often a precursor for someone with agoraphobia to experience panic attacks.

So, consuming little to no caffeine throughout the day may be able to significantly help reduce your day to day anxiety. Although doing so will likely not make all of your anxiety go away, it will indeed help you to reduce any unnecessary suffering that you would have otherwise experienced if you were to consume a large amount of caffeine.

Beverages like coffee and tea are often high in caffeine, as well as some energy drinks. In fact, even some foods have caffeine in them as well, such as dark chocolate. Being more conscious of your daily caffeine consumption may help you to reduce some of the symptoms associated with agoraphobia.

Dialectical Behavior Therapy (DBT) for Agoraphobia

DBT is a very effective form of treatment for people struggling with emotion regulation. It is often used to treat people suffering from borderline personality disorder. Nevertheless, it can also be very advantageous for someone suffering from anxiety disorders like agoraphobia too. This is due to the numerous amount of coping skills you can expect to learn in a DBT group. These groups typically last about 6 months long and can have anywhere from two people to several people depending on how many join the group.

One very effective DBT skill for helping someone with agoraphobia is half-smiling. This technique works by having you think about that which you fear or upsets you all while slightly raising the corners of your mouth by lightly smiling, thus the term “half-smiling.” Although, it isn’t enough to just think about your fear while half-smiling, you also have to try and refrain from entertaining those painful emotions that your specific fear may evoke.

Mindfulness meditation is also heavily used in DBT and can greatly benefit someone with agoraphobia as it is done in a group setting, which helps to put the patient out of their comfort zone. These group mindfulness practices may include drinking warm tea to hone in on the sense of taste and tactile senses or simply focusing on the breath.

Coping ahead is another very useful DBT skill that can help someone with agoraphobia. With coping ahead, you will want to find a place where you can sit down quietly without distraction. Close your eyes and then think about the many different possible scenarios where you would face your specific fear and overcome it or cope with it. Doing so will help you to be much better adept at coping with your agoraphobia when you are actually exposed to the specific fear associated with it in real life.

Psychiatric Medications for Agoraphobia

Anti-anxiety meds

These types of medications are very useful to help prevent panic attacks. Such drugs can be extremely useful for people suffering from severe agoraphobia due to the fact that people with phobias often experience panic attacks as well. Some common anti-anxiety medications include Xanax, Valium, and Klonopin, among many others.

These types of drugs are not typically taken on a daily basis, but they may be insofar as their agoraphobia is severe enough. However, this is something that you should first discuss with your doctor before you decide to do so to ensure that it is safe and effective.

Antidepressants

These types of medications aren’t only for people who suffer from depression as they can also help people suffering from anxiety disorders as well, such as agoraphobia. Some common antidepressants are Paxil, Zoloft, and Lexapro, among several others. These drugs may be able to help reduce some of the symptoms of agoraphobia.

These types of drugs are typically taken on a daily basis. They can indeed help prevent panic attacks from occurring, but they are more so used to help reduce people’s daily anxiety. Talk to your doctor to see if taking antidepressants can help to reduce your symptoms of agoraphobia, as well as whether or not it is safe to do so.