The Return of Agoraphobia

With lockdowns forcing people to be housebound for over a year, are we about to see a return of the traditional understanding of agoraphobia – that of somebody who struggles to leave their own home?

Everything would be fine and then a sudden sinking feeling would come over … like his chest was going to cave in. He could feel his heart bumping up against his rib cage … quickening with every beat and then radiating down his arms and up to his temples. It vibrated … making everything he saw bounce around like the world was just photographs being flipped in front of him.

(Highly Illogical Behavior – John Corey Waley)

In this ‘young adult’ fiction story, the hero Solomon gets these very unpleasant sensations when he tries to leave the safety of his house. Solomon has agoraphobia.

Solomon’s story begins at school when he starts getting panic attacks. The panic gets worse. So he is homeschooled instead. Because the panic attacks stop, the decision to keep the boy at home is declared a success by his parents. But three years on, the hero has a lifestyle that is entirely housebound. He can’t go outside. He gets a flush of unpleasant sensations and racing worries at the thought of going out. The boy is trapped.

At first glance, Solomon’s story and the story of lockdown might seem unrelated.

But as lockdown restrictions temporarily lift, some of you may be not feeling quite right either. You might be struggling to go out again too. Not everyone gets symptoms of a racing heart or pins and needles like Solomon. Headaches, muscle tension, sweating, difficulty breathing, nausea, bathroom urgency, dizziness, tricks of vision, feeling of crawling skin, are also common. This is to name but a few symptoms of a stressed and tired nervous system. Others have racing worries, feelings of unease and dread that take over their thoughts as they approach the front door.

Without a clear rationale as to why you are experiencing these unpleasant sensations, it seems like the logical choice to stay indoors, especially if this offers respite.

The story of ‘Highly Illogical Behaviour’ and the story of lockdown have their differences. But the patterns where both lead to agoraphobia are very similar. The retreat, the imprisonment – and then the frustration of finding yourself trapped. It is a very common pattern to feel bamboozled as to why you have ended up in this situation.

With Solomon, the retreat occurs after getting panic attacks at school. With lockdown it is the threat of contagion and illness that forces us inward. But the subsequent agoraphobia is no longer caused by the original threat. Agoraphobia is an anxiety of the sensations inside of us rather than that of the health crisis. The sensations and their unpredictable nature keep us locked down in retreat. At home the situation appears to be under control. Whereas going outside brings on a flush of frightening symptoms.

Home is safe, and outside is uncertain. But the reality is that home is not safety, if it has also become a prison. This is why I feel that the pain of agoraphobia is best captured by its traditional definition of being trapped indoors. (There is some debate over whether agoraphobia should now be classed as, ‘fear of a situation where escape may be difficult,’ but there are plenty of situations I can think of where this fear might be justified).

“fear of a situation where escape may be difficult” – Indiana Jones gets an attack of agoraphobia

The retreat, the imprisonment and the frustration. Staying home in ‘safety’ reinforces the patterns that keep the autonomic nervous system (ANS) in a state of oversensitivity.

Sometimes there is an identifiable trigger. A certain situation, or encounter with a neighbor, or an enclosed space, or yes, a crowded situation where ‘escape may be difficult.’ But for many the symptoms strike at random. And often, in unpredictable and dramatic fashion. This makes staying indoors seem like the safer option. All are signs that your ANS has fallen into the habit of being over-sensitised.

The patterns that lead to agoraphobia and ANS hypersensitivity are reinforced by habit. But the great news is that habits can be unlearned, and new habits formed. The key to learning a new habit is to seek rebalance with your nervous system. There are ways and methods to reconcile the disordered ‘fight or flight’ response with rest of your body. To do this takes time, courage and bravery. If you need education and support then we are here to help. We take a three-pronged approach of focus on breath, connection to body and developing the correct mindset. These are essential tools that will get you to where you want to be. There is no need to be frustrated or bamboozled any longer. You have what it takes.

In the meantime, here are three tips where you can start to build new habits.

1) Plan!

To leave the house after such a long time, we have to make a plan. Decide on the length of journey in advance. How about a fifteen minute walk to the local shop and back. Or, a car journey on a quiet road with no specific errands to be carried out. Don’t push things too hard. Don’t plan a huge trip, a three-flight itinerary via Heathrow Airport, to end up berating yourself when it ends in failure. At the same time, have the courage to leave the confines of the home and garden. Find the right balance.

2) Prepare!

Once you have chosen the date and time for the journey, spend some time anticipating what might come up. Write down some of the body stresses you anticipate might occur, some of which are mentioned above. Write down familiar worries - future scenarios that might convince you that leaving the house isn’t a good idea and it’s time to turn back home. Be prepared for them to arise. Expect them to come. Don’t push them away. Try and accept them for what they are – products of an over-stimulated nervous system.

3) Remember to Breathe!

Seems obvious, but it's very common to forget to breathe. Especially if thinking too far ahead, or focusing on strange sensations and worries. Are you holding your breath? Start to take conscious deeper breaths. Move your attention on to the sensation of breathing. It’s a good way to keep the ‘rest and digest’ part of your nervous system activated. Another habit that once re-established, becomes a lot easier.

Barry

https://www.nhs.uk/mental-health/conditions/agoraphobia/overview/