Agoraphobia

STEPS primary care mental health team, Glasgow








Agoraphobia
(the fear of busy places)








Anne Joice
Jim White

















©Anne Joice and Jim White (2008). All rights reserved. Do not amend in any way.

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Some people can get really scared about going out of the house. It can be hard
going to the shops, making visits to friends, or even simple things like taking out
the rubbish to the bins.

Here are some of the things people say about agoraphobia:

• Fiona is 64 years old and lives with her husband who is close to retiring. She is very scared
about going to the shops. “I can go to the shops with my husband but doing it on my own just
makes me feel panicky."

• Susan is a 42 year old mum who is scared about going out of the house. She can’t use buses
and it is costing a fortune using taxis to take her kids to school. She can go on the bus locally if
her sister takes her in the morning before it gets too busy. “I hate being up so close to so many
people, I feel I can’t breathe!”

• Jenny is 19 years old and has been starting to feel anxious whenever she goes to the pictures
with her friends. She can still go and see films as long as she gets the aisle seat and can get
out quickly if she starts to feel panicky. “I can’t stand the way it gets so dark. I start to panic if I
think I won’t be able to get out in a hurry if I need to”

• Bill is 33 years old and can hardly put a foot across the front door. He was out with some
friends when one of them was stabbed. Now he finds it hard to go out anywhere. “I wake up
each day and I feel I can’t face things because I know I’m too scared to go out. I seem to be
the only person that feels like this


IMPORTANT:
Agoraphobia can cause great stress, but it is not dangerous.
It will do you no harm.

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This booklet aims to teach you better ways of coping with such problems. It is in
two parts:

PART 1: Finding out about agoraphobia

What is agoraphobia?
What causes agoraphobia?

Part 2 Fighting agoraphobia

Step 1 – Becoming more aware
Step 2 – Break down the challenges
Step 3 – Face the situation
Step 4 - Be prepared
Step 5 – Come up with a ‘Big Challenge Thought’

PART 3: Dealing with panic
What is a panic attack?
Work out the problem
Control your stress
Control your breathing
How to prevent panic
What to do in a panic








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PART 1
Finding out about agoraphobia





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What is agoraphobia?

Agoraphobia is a fear of busy places. It can also be a fear of going into places where escape is
difficult. It can cause great distress and badly affect the way you are able to live your life.



A fear of being in busy places. The most common places people
AGORAPHOBIA
fear are: cars, buses, trains, planes, traffic jams, shops/
supermarkets, queues, crowds, lifts, being alone at home, being
far from home, escalators, cinemas/theatres, churches,
pubs/restaurants, tunnels, shopping centres, large offices. You
may be able to go out in the darkness or when you have
someone with you,



A fear of going into small, small spaces such as lifts, cupboards,
CLAUSTROPHOBIA
the back seat of two door cars etc. You may find it hard flying
due to the anxiety caused when they close over the door leaving
you feeling trapped. For example; you may fear that you will lose
control if trapped in a lift with other people.


We must take this one step further: You are not afraid of a shop, a bus, the post-office queue:

You are afraid of what might happen to you there

You are maybe afraid that something awful will happen; such as fainting, having a panic attack,
losing control, being sick, losing control of your bladder/bowels, acting in a 'strange' way, making a
fool of yourself, getting self-conscious, going mad or maybe even dying.

Your fear will usually be worse if you feel that escape from the place is difficult or that you would
draw attention to yourself. Usually when you feel anxious your blood pressure rises. You might
feel like fainting, but your blood pressure rising will stop this happening.


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Avoiding going to places is a common way of coping. You may be able to go when the places are
quieter or if someone you can rely on is with you. Often people say that even having the children
with them helps. They may help distract attention away from the fear. You may feel that you can
control your stress better when you have to be responsible for your children's safety.

Sometimes there will be a fear of staying alone in the house in case something happens to you as
there would be no-one there to help you. So it isn't just a problem you have when outside the
house.


Related problems - It is common for people to have agoraphobia at the same
time as stress, depression, panic attacks. You can find out about help for these
other problems at the end of this booklet.


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What causes agoraphobia?

Agoraphobias are a specific form of stress; the things which can cause it are often the
things which cause any form of stress. It is not clear why people develop a particular form
of stress. They may be caused by:

DIRECT CAUSES - Sometimes bad things happen to you like being mugged in the
street.

INDIRECT CAUSES – Sometimes people don't know why agoraphobia started when it
did. This is the usual picture in stress. Life events in previous years may be important.
It may be triggered by one small event which acts as the straw that breaks the camel's
back. In itself it may not seem important but coming at the end of a host of stresses
and strains, it may be the final straw.

"PREPAREDNESS" - One explanation is 'preparedness' which says that we can,
when under stress, develop fears of things which might involve danger to the human
race. So it is useful to have a built-in fear that you might be attacked if you live in a
dangerous place.

SAFETY SIGNALS - Related to 'preparedness' is the idea that we look for 'signs' which
send out signals saying that we are near safety. Common 'signs’ are your own house,
the house of friends or relatives, maybe even things like toilets in the shops - anywhere
that you might run to in a panic and feel safe there. So when you leave home, you are
moving away from 'signs'. When you return, you are moving closer to your safe haven.
You will then feel more secure. You may feel better in certain streets if you know that
you can knock a friend's door if you feel too tense. Try to work out where your safety
signals come from.


There is no magic cure - don't be impatient. It takes time to control stress.
Believe in yourself - you can do it.




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PART 2: Fighting agoraphobia





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Step 1 – Becoming more aware
Keep a diary – It is a good idea to keep a diary of situations you find difficult or scary. It will
help you understand the things that are happening to you. Then you can fight the
agoraphobia. You can watch your own progress and notice what you are doing well.
Sometimes when we are stressed we only remember the bad days and not the good ones.
Make a diary like the one below. Fiona has filled in the first line and has rated her anxiety
in a difficult situation (0 = not at all frightening, 10 = very frightening). As you progress you
will see your anxiety rating for difficult situations go down. Have a look at Fiona’s example
below.

Diary Card
Date
Doing What?
How did you
Anxiety rating
Where?
feel?
Rate on a scale of 1- 10
1 = not anxious at all
10 = extremely anxious
10 Sept
In Asda
Terrible panic
9

































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Step 2 – Break down the challenges
The next step is to make a list of scary things. Each thing will have a rating (1 = no anxiety,
5 = fairly anxious, 10 = very anxious). Put the most scary things at the top, then the next
scary one, and so on, all the way to the bottom – just like Fiona’s example below.

Break down the challenges

Situation
Rating
In busy supermarket alone
9
In the supermarket alone when its not busy
7
In the supermarket with my sister when its not busy
7
Buying a magazine at the front of the supermarket without going in
6
Shopping at the local shops alone
5
Going to local shops with family / friends
4
Getting something from the van
3
Asking my husband to get something at the van
2


Use the challenge sheet below to make your list

Break down the challenge

Situation
Rating




















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