AGORAPHOBIA

AGORAPHOBIA
What is agoraphobia? Agoraphobia is the fear of being in
an enclosed place. Examples of this could be:

 crowds of people
 confined spaces
 public transport
 being away from home
 being home alone

People sometimes feel worried if they are far away from an exit.
They might not be able to get out easily, for example if they are
on a train and the doors are closed. They worry that they will
lose control, faint or collapse if unable to escape.

People may be embarrassed to leave, for example, leaving

friends in a busy restaurant, or pushing past people in the
cinema or at a concert.

They feel trapped, and begin to imagine what might happen

to them if they cannot escape the situation.

For example:

Mary has been asking her husband to get the shopping for the
past three weeks. This has been since she collapsed at the
supermarket on a busy Saturday. Recently she had been
feeling poorly, and suddenly fainted. The experience had
been so terrifying and embarrassed Mary so much that she felt
great panic every time she thought about going to get the
family groceries. Mary stays at home to avoid this happening,
as it makes her feel better.

Sometimes people are able to put themselves in the feared

situation but will do so with intense dread. They may find it
easier to do these things when somebody is with them.

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How this booklet can help

If you think you may be suffering from agoraphobia, this

booklet can:

1. Help you understand what keeps your fear and

agoraphobia going

2. Show you how you can change this pattern and begin to
tackle your fear

What fear is like for you?

Think about a time when you were very anxious

What I was anxious about: ................................................................

How did it make you feel? (Tick all that apply)

I was shaking □ My hands were sweating □

I felt faint □ I felt hot □
My heart was racing □ I felt sick □
My throat felt tight □

What did you do?

You may have stayed in the situation for as long as you could
bear before leaving as quickly as possible. You probably
experienced the horrible feelings the whole time as well,
perhaps feeling they were getting worse as time went on.
When you left this situation (reaching home for example) you
probably felt great relief at reaching your ‘safe’ place.

What I did ...........................................................................................

...............................................................................................................
...............................................................................................................

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What keeps your fear and agoraphobia going?

By leaving situations where you feel afraid you are showing

yourself how much better it feels to get away. This leads to you
wanting to avoid them altogether.

Whatever you are afraid of, you may have found yourself
asking a partner, friend or relative to help you. For example:

Fear of going to Friend now goes to

the supermarket the supermarket for
you

Fear of going on Husband gives you a

the bus lift in the car instead

The problem with this is that it becomes a comfort zone for you.
It makes you feel better at the time but means you continue to
avoid doing the thing(s) you are afraid of. The avoidance will
keep on going.
Fear

Avoidance

It is in this way that your fear keeps going.

How can you break the cycle?

If the avoidance is taken away, then gradually the fear will

subside.

The aim is to break the vicious circle

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How this can be done

There are techniques you can use to cope with your fear
instead of escape. Firstly try to be more aware of your thoughts
and feelings when you feel panicky. When you are aware of
them beginning you can calm yourself down by using the
following:

1. Deep breathing

When we are anxious or panicking, we tend to take lots of

fast, short breaths of air. This only adds to our panic and
makes us worse. Just by taking long, slow breaths, you are
a long way towards coping in any stressful situation. This
helps to relax your muscles, for example your shoulders,
telling your body that you are okay in the situation.

2. Realistic thinking

Try not to worry about all the possible things that could
happen. You will just get yourself worked up, which is the
habit we are trying to break. A realistic thought would be,
"if I get off the bus now, I’ll have to walk for ages to get to
where I want to be."

3. Distraction

To distract yourself, you might find it useful to try counting or

doing some sums in your head. Another example would be
to try clenching/unclenching your fists tightly, giving you
something else to focus on.

By using these methods of coping you will gradually find you

are able to stay in the feared situation for longer. This breaks
the habit of avoidance and shows you that the feared situation
is not so frightening or dangerous. It is the avoidance that
builds it up and makes it seem this way.

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How to begin

Whether your agoraphobia is a specific fear of one thing (lifts,

for example) or of many areas of life (for example
supermarkets, buses and other confined spaces) your tackling
of it should be exactly the same – in small manageable steps.
It is important that you tackle one area at a time and at one
stage at a time.

It will be most helpful to be honest with yourself about all areas

of life that your agoraphobia is affecting. Think of the following
examples and place a number next to them, showing how
scary each situation would be for you (1 being the least scary
and 10 the most)

Going to the supermarket � Sitting in a meeting or lecture �

Sitting in a cinema/theatre � Walking alone �
Taking a bus � Going on a train journey �
Eating in a café/restaurant �

All that you have scored higher than 1 or 2 could probably do

with being looked at. However, as mentioned before – only
deal with one at a time.

Example: Fear of travelling on a bus

The first step is to work out what you feel most scared of and
what might not be so bad. For example, the thought of
walking through the bus station might not be as terrifying as
being on a bus on a long journey. Next, think about what you
would like your goal to be. What would you like to be able to
do, so that your agoraphobia was no longer affecting your life?
In this example,

Goal: to be able to take a bus to Edinburgh without

experiencing great anxiety.

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Next, think of steps that could lead to your goal and put them
in order. This means you can start by trying to achieve the less
difficult task first, and in time you will be ready to move on to
the next stage.

For example:

Walking past bus stops

Walking through the bus station

Taking a short bus trip, getting off at the first stop

Taking longer bus trips, to different destinations

Taking any length of bus journey to any destination

You might also want to try each step with a friend first before
doing it on your own.

After each stage you should reward and praise yourself for
what you have achieved.

Example: Fear of leaving the house to go to the supermarket

Goal: To be able to do weekly shop in local supermarket

Felt most scared at the thought of: being in a large busy

supermarket with really long queues

Might not be so bad to: walk to the neighbour’s house two

doors down.

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Suggested steps that could lead to goal:

Leaving the house to go to neighbour’s house for a cup of

tea

Going for a walk to the end of the road and back

Going for a longer walk (for example, around the block)

Going to a nearby corner shop, just to buy one thing (for

example, a carton of milk or a loaf of bread)

Going to corner shop to buy a few items

Going to a larger shop at a quieter time, to buy one thing

Going to larger supermarket to buy more of the shopping

you need at a quieter time

Going to the supermarket to buy what you need at a busier

time

It would be helpful to slow down as you walk around the shops.

It can be tempting to rush, so that you can leave faster, but this
only heightens the feelings of panic and tension. Again, you
would probably find it helpful and supportive to try each of
these stages with a friend first, before trying it on your own.

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How to create your own steps

Fear of: ................................................................................................

My goal: ..............................................................................................
Feel most scared at the thought of: ...............................................
...............................................................................................................
Might not be so bad to: ...................................................................

Next, decide what your gradual steps to achieving this will be.
(Although there are 4 numbers here, you should split your goal
up into as many steps as you can think of).

1.

2.

3.

4.

You have now developed a plan for tackling your

agoraphobia. Remember to treat yourself to a reward when
you achieve each stage.

How family and friends can help

The support of others in the treatment of agoraphobia is very

helpful. Family and friends may know what can be difficult for
you and so can help support you in doing day-to-day things. It
might be helpful for friends/family to read this booklet also.
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You may also find it helpful to keep a record of your practice,
for example, listing the lengths of journeys you take and the
specific destinations. This is both for you to see what progress
you are making and to help in identifying any stumbling blocks.

Things to remember

If you feel panicky

 sit down somewhere/find somewhere to rest
 use your 3 methods of coping – breathing, realistic thinking
and distraction

The important part here is to try to stay as near the place where
these feelings started as possible.

Practice is likely to be frightening, boring at times, and hard

work. It is very important, however, to stick at it and praise and
reward yourself for all your achievements. If this can be done
then the vicious circle can be broken.

Further help

Breathing Space – mental health helpline

(Weekdays: 6pm – 2am)
(Weekends: Fri 6pm – Mon 6am) Tel: 0800 83 85 87

Samaritans - confidential support for anyone in a crisis

National Helpline (24 hours a day) Tel: 116 123
E-mail Helpline jo@samaritans.org (answer within 24 hours)
Visit Local Branch 21West Port, Selkirk, TD7 4DG

Websites
https://www.anxietyuk.org.uk/anxiety-type/agoraphobia/
This site focuses on anxiety-related conditions. A free self-help
manual for agoraphobia can be downloaded from the
‘Recommended Resources’ section at the bottom of the
agoraphobia page.
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www.nomorepanic.co.uk
A site that looks specifically at phobia, anxiety, panic and
related problems. Detailed page on agoraphobia.

www.topuk.org
A site with short, to-the-point links covering phobias, the effects
of them and what can help.

www.llttf.com
A general self-help website offering advice on a wide range of
issues. It helps you to understand your behaviour, thoughts and
offers help on healthy living, better sleep and relaxation.

Books

Bourne, Edmund (2015) The Anxiety and Phobia Workbook

New Harbinger ISBN: 978-1626252158 (A practical guide to
facing fears associated with anxiety-related conditions. Based
on Cognitive Behavioural Therapy)
Marks, Isaac (2005) Living with Fear McGraw-Hill Professional
ISBN 978-0077109820 (A self-help book giving some practical
advice on phobias. Also covers areas such as panic and stress
following a traumatic event)
Silove, Derrik & Manicavasagar, Vijaya (2009) Overcoming
Panic and Agoraphobia Robinson ISBN: 978-1849010023
(A step-by-step guide on how to manage symptoms of
Agoraphobia. Based on Cognitive Behavioural Therapy)

Apps for mobile phone and tablets

A range of self-help apps are available for your mobile phone
and tablet. Some of these apps are free of charge, whilst
others have a cost attached depending on the developer.
Please use the link below to view some suggested self-help
apps for different mental health problems:
https://www.nhs.uk/apps-library/category/mental-health/

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Booklets/leaflets available on the following:

Anger
Anxiety
Bereavement
Depression
Hyperventilation
Loss
OCD
Panic (short version and long version)
Phobia
How to solve problems: a simple DIY technique
Relaxation
Self-Esteem
Self-Harm
Self-Help Websites
Sleep
Stress
Trauma
Worry

Copies of any of the above booklets are available to

download and print at:

E-mail – wellbeing@borders.scot.nhs.uk

P Mills, M Henderson, J Hastings 2006

NHS Borders
Revised Jan 2020
Review Jan 2021
SH20.6

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