What is agoraphobia?

You're not afraid of leaving your house or being in large, busy open spaces. You're afraid of what happens when you leave your house.

It's not about being outside, at the supermarket, on the highway, at school, the office, or the hospital. It's not any of these places themselves but how you feel in those places.

You're afraid of having a panic attack, afraid of feeling tension and then passing out, unable to cope. You're afraid of vomiting, losing control of your bowels, and not being able to handle the shame. You're afraid a panic attack is a real medical issue or afraid of leaving home without someone who makes you feel safe.

Agoraphobia, then, is the intense fear of being overwhelmed, feeling tension or physical sensations without being able to escape or seek help.

Why the tension grows

By trying to control something you can't, like your feelings and physical sensations, you begin avoiding situations.

When you avoid situations, you're telling your brain that the situation you're avoiding is dangerous. This increases the tension. The more you avoid it, the greater the tension becomes.

And so, your world becomes smaller. You can no longer cross the bridge, go to the store alone, or drive by yourself. Not only does your world shrink, but your fear also keeps growing.

For some people, it goes so far that they can't even leave their room in their own home or get off the couch.

It's not that you're physically incapable of doing these things. A mental rule has been created that says: "If these things make me feel anxious, then they must be dangerous, and I must avoid them."

Agoraphobia is fueled by beliefs and thoughts

Many beliefs and thoughts increase the tension, such as: "If I feel bad, everything will go wrong," "I can only go out if I no longer feel tense," "I'm sure the worst will happen" (catastrophizing), "Everyone's looking at me, everyone is judging me, and no one wants to help," or "It would be awful to have a panic attack. I must make sure I don't have one."

You can't think the fear away

You often get stuck in a continuous loop trying to control your thoughts. First, you think: "If I can think my way out of this," "If I can convince myself that I'm safe," or "If I can change the way I think, then it'll all be solved!" This doesn't work! You can't think your fear away, stop trying! It's a form of avoidance. You get stuck in a thought loop where you first try to control your thoughts and then hope that you'll feel better and can leave the house because you no longer feel anxious.

The only way to get rid of agoraphobia

There is only one way to get rid of agoraphobia, and that is by reprogramming your brain. You need to show your brain that the things that feel uncomfortable aren't really dangerous. The way to do this is by gaining experiences, by going out. You have to do something uncomfortable and allow the feeling to be there. Don't run, don't avoid, don't try to control. By doing this, you retrain your brain to understand that you are safe.

You let everything happen without stopping it. It takes courage. And when you don't run away, you face the things that make you anxious. You feed your brain with new positive experiences (you have a panic attack, but nothing happens). You got through it, and you handled it. I didn’t give in, and I was okay. Do this again and again until it sinks in.

Your brain will be fed with new experiences, teaching it that it's safe to go outside. You learn to develop a new relationship with uncomfortable feelings. You need to break the fear connection, the fear of sensations in your body.

Keep repeating exposure therapy

If you set yourself the task of repeating a specific goal ten times, you’ll notice that the first and second time will bring a lot of tension. The third and fourth time, you’ll still find it scary. But after several times, as the tension decreases, you’ll start to think: "This is boring, it's no longer special, I'm just doing what I have to do." But if you had stopped after the first time, your fear would have remained the same.

Focus on the positive during exposure

It's important not to focus on your feelings during exposure. The goal of exposure is to get you back out there. You have no control over your feelings. "Did I feel anxious?" or "I still had panic attacks" is not what you should focus on. Focus on what you've done. Did I visit my family? YES! I needed groceries today, did I get them? YES! It was a success, even if I felt anxious. This is what you have control over.

Be cautious of safety behaviors

Safety behaviors can prevent you from overcoming agoraphobia. These are things like always having candy with you for nausea, always having someone with you, always carrying your phone, or taking certain substances. These are all ways to try to control the fear, which actually keeps the fear going. If you use safety behaviors during exposure, you're essentially telling your brain: "The only reason this worked is because I had someone with me." This teaches your brain that you actually can't do it and aren't safe. This keeps the fear alive. It can be helpful to use certain aids in the beginning, but be careful not to become dependent on them.