Can you imagine being afraid to go out on the street alone? Experiencing constant worry and fear about the possibility of having an anxiety attack? Being unable to take a bus to work or go to a shopping mall to buy a gift for your child?
Well, that’s how a person suffering from agoraphobia can be on a daily basis.
What is agoraphobia?
Agoraphobia, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), is the appearance of anxiety in places or situations where it is very difficult to escape , or where you cannot receive help in the event of an anxiety crisis.
The situations before which this fear or intense anxiety appears can be
- Public transport.
- Open spaces.
- Closed places.
- Standing in line or being in a crowd.
- Being out of the house alone.
Ana Claudia Alda , a psychologist from Málaga PsicoAbreu, points out that the fear that appears in agoraphobia is not a specific fear of situations, but rather a fear of fear. That is, it is the fear of experiencing the symptoms of anxiety and its possible consequences.
Therefore, the fear and anxiety that appears is disproportionate and excessive compared to the real danger posed by such situations.
Agoraphobia can appear in the following ways:
- Anxiety disorder with agoraphobia . The person has suffered crises of anxiety on several occasions and, in addition, experiences concern about the occurrence of another crisis and its possible consequences.
- Agoraphobia without a history of panic disorder . A panic attack has never appeared, but agoraphobia appears because of the fear of developing symptoms that resemble a panic attack.
What are the characteristic symptoms?
The most common symptoms of agoraphobia are the following.
On a physiological level. changes appear such as:
- Choking sensation.
- Chest pain.
At a cognitive level , there are anticipations related to the possible appearance of an anxiety crisis, as well as concerns about its possible physical consequences (heart attack, not being able to breathe, etc.), mental (loss of control, going crazy, etc.) and social (others thinking the person is crazy).
On a behavioural level , the person tends to avoid feared situations or face them, but with a high level of emotional distress. It is frequent to find safety behaviours that help to endure the discomfort, such as going with someone, taking medication or always carrying water.
Vulnerability and maintenance factors
There are different variables related to the development and maintenance of agoraphobia that facilitate the understanding of this phenomenon.
- Genetics and temperament . Neuroticism or the predisposition to experience unpleasant emotions in the face of stressful stimuli appears to be the trait most associated with the development of anxiety problems.
- Anxiety sensitivity . It refers to the belief that anxiety and its symptoms can have negative consequences on a physical, psychological and social level. This characteristic determines the appearance of the fear of fear referred to above.
- Interoceptive awareness . People with agoraphobia problems have a high awareness of their own physical sensations, as well as a good ability to detect them.
- Beginning of the crisis of anguish . When agoraphobia presents with panic attacks, the agoraphobia usually appears as a consequence of the fear experienced during the attacks. The concern about not knowing if it will come back or if it will be able to cope leads the person to develop agoraphobia.
Interoceptive conditioning . Due to previous experience, the person experiences any physiological changes as the beginning of a crisis of distress. In this way, physical sensations that may resemble anxiety (sexual excitement, physical exercise, etc.) awaken an emotional response of autonomic activation that facilitates the appearance of another attack.
Catastrophic interpretation of body sensations . The person interprets any somatic sensation as a symptom of the occurrence of a crisis. Thus, the belief that anxiety will have negative consequences (anxiety sensitivity) favours this catastrophic interpretation.
Is it treated? What is the most appropriate intervention?
The cognitive-behavioral psychological treatment has shown great effectiveness , becoming the main line of intervention.
There are two intervention programs within the cognitive-behavioral stream that have obtained great results. Both use very similar cognitive and behavioral techniques, but differ in the conceptualization they make of the problem.
1. Clark’s Cognitive Therapy Program for Anxiety Disorder
This program is mainly based on the idea that the main factor that maintains the problem is the catastrophic interpretation of body sensations. All the techniques used in this program aim at restructuring the catastrophic beliefs that exist about physical sensations.
2. Barlow’s Panic Control Treatment Program
In this case, priority is given to habituation to interoceptive sensations in order to eliminate existing interoceptive conditioning through exposure. As in the previous case, it also works on the restructuring of catastrophist beliefs based on the expositions made.
- American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington D. C.: American Psychiatric Association.
- Barlow, D. H. and Cerny, J. A. (1988). Psychological Treatment of Panic. New York: Guilford Press.
- Barlow, D. H. and Craske, M. G. (1989). Mastery of your anxiety and panic. Albany, New York: Graywind Publications.
- Barlow, D. H. and Craske, M. G. (2007). Mastery of your anxiety and panic (Workbook) 4th edition. USA: Oxford University Press.
- Clark, D. M. (1989). Anxiety states: panic and generalised anxiety. In K. Hawton, P. M. Salkovskis, J. Kirk and D. M. Clark (Eds), Cognitive therapy for psychiatric problems: a practical guide. Oxford: Oxford University Press.
- Salkovskis, P. M. and Clark, D. M. (1991). Cognitive therapy for panic disorder. Journal os Cognitive Psychotherapy, 5, 215-226.
- Vallejo, M. A. (2016). Behavioral therapy manual. Madrid: Dykinson.