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In a recent conversation with a thoughtful and concerned individual on how to help a friend, the label “strange” arose to describe their friends behavior. To the outsider who lives anxiety free, agoraphobia may seem strange. Why — you might wonder — would a person get so fixated that they are afraid to leave their home? What drives people to isolate themselves to avoid being in embarrassing or distressing situations?

The first question that comes to mind is, “how do we change the perception of mental health issues?” If a friend has a broken arm, we empathize and console them. But if it’s more mental than physical, people unconsciously stigmatize those who suffer with various mental health related conditions.

Like a broken arm, agoraphobia is a treatable condition. It generally arises from feelings of anxiety which are reinforced as the person engages in behavioral changes. B. F. Skinner, a noted psychologist, referred to this as operant conditioning. I’ll share an example:

Susie is going about her day as usual when she suddenly experiences changes in her body. Her heart rate accelerates to the point she feels like it will come out of her chest, her palms get sweaty, her breathing changes, and she feels a sense of terror. To Susie, the experience is so profound and frightening that she NEVER wants to feel this type of sensation again. She literally becomes anxious about what just happened. This is a valid physiological fear response. It is not strange or weird. It’s actually what keeps us safe from harm.

Unfortunately what happens next is where the problem develops. Susie, now anxious about having another panic attack like the one the other day, changes her normal daily routine. The very act of changing her daily behavior reinforces the anxiety (operant conditioning) which makes the fear response stronger. The brain, being a powerhouse of neural patterning, looks for other situations to avoid. Susie begins to worry, “What if this happens in the car, or on the bus, or at work?” Susie’s amygdala, doing what it is perfectly designed to do,  reminds Susie with a physiological reinforcing fear response any time she simply thinks about the original panic situation. This thought becomes linked in the brain to other situations which may invoke the same type of panic she had originally felt. Susie then starts to avoid any situation which may cause similar types of distress or embarrassment. Susie then decides it’s best not to leave the house.

Susie’s original one time feeling of panic has now developed, been reinforced, and linked to situations which make it difficult to leave the house at all. Susie’s original anxiety is now growing into agoraphobia. 

Her story, although a case example, is not strange, it’s absolutely biologically sound. Her body is responding exactly how it is designed. Without a healthy sense of fear, we’d all put our hands on a hot stove. Instead, all it takes is one accidental brush with a hot burner and we’re cured for life of ever repeating the same behavior. The problem in Susie’s case is that the fear was not linked to a situation that would cause her harm. As she unconsciously reinforced her bodies physiological reaction by changing her daily routine, the fear became intensified.

There are a variety of treatments for agoraphobia. Cognitive behavioral therapy works with individuals to reverse and extinguish the fear response and get to the heart of the original anxiety which precipitated the descent into agoraphobia. Other forms of therapy which are effective include various forms of relaxation therapy which calm and control the physiological response.

If you, or someone you know is suffering from anxiety, talk to a professional who understands and can offer some assistance. The earlier the cycle of anxiety is treated, the more quickly a person will be able to resume a healthy lifestyle devoid of panic and anxiety.

Tip: The next time you feel fearful and anxious and you’re not in immedidate danger, do the opposite of what your body is urging you to do. Reinforce what you’d like to do, not what you are afraid of doing.