ASK DOCTOR K: Treating fears is possible
DEAR DOCTOR K: My daughter’s new roommate is afraid to leave a 10-block area around their apartment in New York City. She has something called “agoraphobia.” What is that?
DEAR READER: Agoraphobia is the fear of certain situations in which an individual feels threatened and trapped and unable to escape.
Most often, the fear is of being in open or public places. In the most severe cases, people with agoraphobia become afraid to leave home at all. Fortunately, your daughter’s roommate’s problem is not so severe. That’s a good thing; it suggests that — especially with help — she may be able to increase her range.
There are other situations that some people with agoraphobia fear. They might avoid driving, or specific types of public places (such as restaurants or shopping malls). They might fear entering a doctor’s or dentist’s office. It’s my understanding that former New York Gov. Mario Cuomo hated to fly; it may have affected his otherwise successful political career.
Ironically, a few people with agoraphobia fear being home alone and actually seek out places with other people — even crowded places. They behave in exactly the opposite way that most people with agoraphobia do.
People with agoraphobia often suffer symptoms of severe anxiety when they are in a situation they fear. They may experience a racing heart, difficulty breathing, sweaty palms and shakiness. This just increases their desire to avoid those situations.
We don’t know why agoraphobia develops. As with other forms of anxiety, agoraphobia is partly learned. For example, a person may have a panic attack in a crowded or unfamiliar place. Afterward, the individual starts to fear that similar situations will trigger more panic attacks and starts to avoid them.
Treatment depends on the particular symptoms and their severity, but it usually involves some combination of talk therapy and medication.
Cognitive behavioral therapy (CBT) is a type of talk therapy that modifies ingrained patterns of negative thoughts and behaviors. CBT has two parts: Cognitive therapy helps people modify thoughts that are preventing them from overcoming their fears. Behavioral therapy helps change a person’s actions in situations that trigger anxiety.
Often CBT is combined with exposure therapy and relaxation techniques. A mental health professional might first help the patient relax, then ask the patient to imagine a situation that provokes fear (like riding the subway).
In some cases the health professional might actually accompany the patient as he or she ventures into those situations. The goal is to desensitize the patient to the situation so that it is no longer so scary.
Relaxation and other psychotherapy can help many people learn to manage their fears, but some patients will also need medication. Options include antidepressants and anti-anxiety medications.
I suspect that agoraphobia is triggered by chemical changes in a person’s brain — changes that the person could not control. That’s unproven. Whatever its cause, there now are treatments that help.
Dr. Anthony L. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.