Agoraphobia:
The Fear of Fear

Agoraphobia is a condition in which a person avoids a number of otherwise ordinary activities and places, including some that the person used to enjoy before the trouble started. This avoidance usually develops in response to panic attacks. Because a panic attack can be such an upsetting and scary experience, people are naturally motivated to do whatever they can to avoid additional attacks. Unfortunately, it's precisely a person's efforts to protect himself from panic which create the greater problem of Agoraphobia.

A typical example would be a person who avoids several ordinary activities and situations, such as highway driving, large supermarkets, and crowded theaters and churches. Even a mild case can be a big burden, because people with Agoraphobia experience lots of shame, frustration, and anticipatory worry, in addition to the loss of the ability to participate in activities you used to enjoy.

The original meaning of the word comes to us from the Greeks, and it meant "fear of the marketplace". Today we understand the problem to be much broader than fear of one location or another - it's fear of anything or any place that you think might lead to a panic attack. But the fact that the ancient Greeks had a word for it tells us that this problem has been around for a while.

Safe Zones

Agoraphobia comes about when a person with Panic Disorder gets tricked into believing that he (or she) has a "safe zone" within which he is "protected" from the ravages of a panic attack, and beyond which he is subject to great danger. It leads him to believe that he if he limits his activities, and engages in other protective behaviors, he might be able to prevent any more attacks.

Sometimes the "safe zone" is purely geographic, and involves only distance from home, and if that's the case, the person gets worried when it seems as if he is "too far from home". But there are usually other factors. One major factor is that people with Agoraphobia will avoid any situation that seems to them to be a "trap", by which they mean a place from which they can't leave, as quickly, quietly, and invisibly as they may wish, in the event they have a panic attack. From this perspective, lots of otherwise harmless situations can resemble a trap: long grocery lines, traffic jams, crowded churches, divided highways, express trains, office meetings, haircuts, job interviews, parent teacher conferences, and so on.

People often think Agoraphobia means "housebound", but that's just a really severe case of it. It's more common to have a variety of avoidances, and also maintain one's work, school, or other responsibilities, although with lots of difficulty. However, agoraphobic people can become housebound if they continue to shrink their "safe zone" until it doesn't extend beyond their front porch or living room.

Avoidance Maintains the Problem

The effort to limit your activities and travel in the hopes of avoiding panic attacks rarely, if ever, results in a good outcome. You might avoid panic attacks a lot of the time, but the anxiety never goes away, because you're always worried about the "next time". The more you avoid, the more anxious you become, and next thing you know, your life has become quite limited, and filled with worry and shame. That's Agoraphobia.

The Road to Agoraphobia
Is Paved with Safety Behaviors

Panic is the driving force behind this problem. And Panic is a Trick. Panic tricks you into treating a panic attack as something dangerous, and trying to protect yourself from it.

If a panic attack were really dangerous, it would help to protect yourself from it. But while panic attacks offer a really good imitation of something dangerous, they aren't dangerous.

When people get tricked by a panic attack, they try real hard to protect themselves from things that aren't dangerous, and the result is that they become more afraid over time.

Consider how you might react if you became persuaded that you needed protection from a crime syndicate which wasn't really interested in you, and hired a bodyguard to accompany you everywhere. It would feel reassuring, at first, to have a bodyguard at your side. But if you momentarily lost sight of your bodyguard in a grocery store, you would probably feel more afraid than before. You might find yourself wondering what you would do if your bodyguard caught the swine flu, or decided to take a day off. Over time, you would feel more dependent, and less secure, because you came to rely on your bodyguard. You would never have the chance to find out that you were all right without the guard.

Safety Behaviors:
Wolves in Sheepdog Clothing

Safety behaviors are some of the ways that people try to protect themselves. When I say "safety behaviors", I mean the things people instinctively try in an effort to "protect" themselves from a panic attack.

Some of the most obvious safety behaviors include avoiding situations, and fleeing them when you feel anxious. But others masquerade as helpful coping tools, when they're really more like saboteurs. These include such responses as reliance on support people and support objects (cell phones, water bottles, etc.) and the use of distraction.

Safety behaviors foster the illusion that they protect you from a danger, but they actually keep your fear alive over time. They're what I think of as "wolves in sheepdog clothing." They seem to be a help, but they're actually part of the problem, in disguise.

Overcoming Agoraphobia

This problem will persist as long as you have such a fear of panic attacks that you get tricked into treating them as a Danger, and relying on safety behaviors in an effort to avoid panic attacks. So the road to recovery starts with learning how to manage panic attacks.

Agoraphobia is actually a very treatable problem. However, many people find it very difficult to overcome. This is generally because they think the way out is to first find a way to get rid of their fears, and then re-enter the situations they have come to avoid.

Someone who is afraid of a panic attack on an airplane or a divided highway will come to me for help, hoping that I will first show him how to be unafraid, so he can then board a plane or drive on a highway in total comfort. These are very treatable problems, and I can usually help that person get back on the airplane or the highway, but it's in the airplane, and on the highway, that he will learn to be unafraid. First you need practice handling the fear, and that means practicing in the actual phobic situation. It's there you can become confident in your ability to cope, and it's there that you will lose your fear.

Agoraphobia treatment based on Cognitive Behavioral methods can help you overcome Agoraphobia with two key steps. First, you learn how to respond to panic attacks in ways that calm them down, rather than aggravate the situation. Secondly, as you get better with those skills, you practice them in more and more challenging circumstances, until you have regained all the territory that you previously gave up to panic. This kind of treatment is usually called exposure treatment, and it's considered the most effective treatment available for panic and agoraphobia.

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