Help for agoraphobia

Originally Published: April 13, 2001 - Last Updated / Reviewed On: May 12, 2014
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Dear Alice,

I have suffered from agoraphobia since the age of thirteen. I am now twenty. I have tried hypnotherapy counseling and psychologists and herbal tablets, but nothing seems to help me. Please, can you help a young, outgoing twenty-year-old who wants to start living!

Dear Reader,

It is understandable that you are frustrated with the impact that agoraphobia has had on your life. As you have probably realized, it can take time to figure out the best possible course of treatment. Agoraphobia is a disorder characterized by intense anxiety about having a panic episode in places or situations from which escape could be challenging or uncomfortable. Some people experience agoraphobia as a fear that stems from not being able to receive assistance during an anxiety attack. For instance, many people with agoraphobia fear leaving their homes alone, being in a large gathering of people, being on a bridge, or riding in various vehicles.

Agoraphobia frequently is associated with other anxiety disorders, including panic disorder and specific phobias. Panic attacks are intense feelings of fear and often doom, which usually build and peak within about ten minutes of onset.

Some of the most typical symptoms of a panic attack include:

  • chest pain and/or heart palpitations
  • trembling
  • feeling faint or dizzy
  • shortness of breath or difficulty catching your breath
  • fear of dying
  • fear of losing control
  • sweating
  • feeling nauseated
  • strange sensations: numbness, tingling, pricking, or burning

These attacks can be terrifying and physically overwhelming. (People experiencing panic attacks often rush to the emergency room convinced that they are having a heart attack.) Sometimes the attacks are prompted by a particular experience, and sometimes they seem to come out of the blue. Once a person has had some panic attacks, they may begin to fear having one in public and thus develop an additional panic reaction to these situations, and therefore, agoraphobia.

It's important to be as specific as possible when describing your experiences to your health care provider(s). This will help them to determine, with your help, what kinds of treatment approaches might be right for you. They're likely to ask you questions such as:

  • How long have you been experiencing these symptoms?
  • Are there particular situations that cause you anxiety?
  • How significantly do you feel your anxiety impairs your ability to function on a day-to-day basis?
  • What are the treatments you've tried so far? What did you like about them, and what didn't seem to have an effect?

Also, keep in mind that although you may not have had much success with certain therapists or therapies, that doesn't mean that you couldn't find the right treatment with another therapist.

Some possibilities that you may want to consider with your health care provider include cognitive behavioral therapy and/or medication. Research has shown these treatments to be very effective in treating panic attacks and agoraphobia. Cognitive behavioral therapy is essentially just what it sounds like: an approach that aims to change behavior by helping a person adjust his or her way of thinking. It often includes real or imagined exposure (in a protected environment) to the situations or triggers that cause the fear. Over time, a person can learn to understand and therefore manage the fear that comes with being confronted with the traumatic object or situation and identify what maladaptive coping mechanisms have arisen. In doing so, that person can develop new, more reasonable ways of managing stress.

Your persistence in seeking help is commendable. With your determination to get your life back, and a good therapist who's knowledgeable about your particular concerns, there is a lot of hope. For more information about panic disorders and agoraphobia, check out the Anxiety and Depression Association of America. If you're a student at Columbia, you can contact Counseling and Psychological Services (CPS) (Morningside) or the Mental Health Service (CUMC) for a full assessment and referral for follow-up.

Alice