Fear of Open or Crowded Spaces Phobia – Agoraphobia
Agoraohobia is an interesting phobia since it can exist in a crowded environment, or a very open and exposed one. One of the key influences is personal space. If a person feels crowded in, there is s suffocating feeling for some, others their personal space is being invaded. Conversely in a very open space, there is no apparent limit to personal space. In either example the “safe” or “comfortable” range of distances that define personal space is absent.
How does Agoraphobia present?
Often the first sign that someone has the phobia is a tendency to avoid very crowded or very open spaces. It is often mild at the start, but reinforced over time. As the person becomes very uneasy in the wrong setting there is often a strong anticipatory stress present at the thought of entering such an environment. This then causes a reinforcement and the very crowded or open space becomes more significant in it’s fear level over time.
By the time a person presents for therapy, the phobia can be very disabling. Often the person will not tackle certain environments unless supported by a friend or carer, and will avoid certain spaces completely. The environment will typically trigger the anxiety reactions common in fight and flight response, from extreme fear to full panic attack.
As with most anxiety conditions, treatment is based around cognitive behavioural psychological therapies. These, such as CBT, are often combined with psychoeducation, which enables greater understanding of the condition. Generally fear reduces somewhat with understanding, the scariest monster is the unknown one lurking in a cupboard! A known quantity can then be planned for and challenged.
CBT and other cognitive behavioural based therapies enable altered perception of threat and triggers, and behavioural change to minimise exasperating behaviours. Mindfulness techniques for stress reduction such as MBSR can also reduce the anxiety reaction and panic, handing back control and rational thought to the sufferer. Hypnotherapy can be useful for reinforcing the CBT and can be used for visualisation or in a cognitive behavioural model.
Treatment Plan for fear of open spaces and crowds
There are no effective “quick fixes” for phobias. They require knowledge of the individual case, its causes and triggers. Then cognitive and behavioural changes are required. The sufferer needs to learn skills for remaining calm, and everything needs to be made to work outside the clinic room in real life. Therefore a combination of Stress Inoculation Therapy and desensitisation is always required, taking the client into the real world and testing and measuring results.
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