No place like HOME?
If the prospect of braving restaurants, cinemas and public transport causes a twinge of anxiety, you’re not alone
Many people will feel fearful of leaving their homes as a result of the restricted lives we’ve been leading, according to Professor Paul Salkovskis. ‘We’ve seen a big increase in agoraphobia as a result of lockdown,’ he says. ‘Some people already have a tendency to be agoraphobic, but it’s kept at bay by the fact that we go out shopping, to the cinema or to restaurants, all of which weren’t possible for months. Even for those without agoraphobic tendencies, living under such extreme conditions has some kind of effect.’
Many assume agoraphobia is a fear of open spaces, but it’s a fear of being in crowded or busy situations, where you don’t feel safe and can’t easily escape to a place of safety, says Professor Salkovskis. ‘It is a complex problem and there are multiple causes, but a common one is panic attacks,’ he explains. ‘Most of the people I see are afraid of going to places where they might have a panic attack.’
Far more women than men experience agoraphobia and, although scientists don’t know exactly why, Professor Salkovskis says contributing factors are that, traditionally, women have stayed home to look after children or assume caring responsibilities. Added to that, conditions associated with an increased susceptibility to agoraphobia are more common among women. Living with osteoporosis can increase anxiety about tripping up. People with irritable bowel syndrome often don’t like to be more than 100 metres from a loo, which can mean no more than 100 metres from home. There is also an association between increased levels of anxiety leading to panic attacks and premenstrual syndrome. Finally, as reaction to the tragic death of Sarah Everard earlier this year highlighted, many women feel and are more vulnerable outside of their homes than men.
Reasons for agoraphobia not caused by panic attacks are individual, but can stem from irrational fears, as well as personal experiences and circumstances, says Professor Salkovskis. He adds, however, that the condition is widely under-reported. ‘It may be people find it easier to talk to GPS about panic attacks, so more people get referred,’ he says. ‘Symptoms are clear and easy to describe; you experience palpitations, you can’t breathe, your legs feel like jelly, you’re dizzy, you may have pins and needles in your fingers, your face goes numb and you think you’re having a heart attack or dying. It’s much harder to go to see your GP and say you simply can’t go to the supermarket or cinema, so this group are less likely to seek help.’
Pushing yourself to go out, perhaps with the support of a partner or friend, is the best first step, says Professor Salkovskis, stressing he recognises this is often difficult. ‘If you feel anxious in the supermarket, it’s natural to want to leave or find a chair and sit down,’ he says. ‘We call these “safety seeking behaviours”. However, they reinforce the belief it was only by using these tactics that a panic attack was prevented. Anxiety is driven by fears about what may happen if a panic attack occurs. For example, you may have a heart attack and hundreds of people will gather around, perhaps think you’re drunk and no one will help. Therapists help people accept the reality of what would actually happen. I’ve gone to shops with patients and pretended to faint to prove one or two kind people help and everyone else carries on without comment.’
Support groups (see left) have advice on talking to GPS about mental health. One suggested opener might be: ‘The extended period of lockdown has really heightened how I can sometimes feel very anxious about leaving the house.’
Above all, don’t think you’re the only person feeling anxious. In these strangest of times, everyone has felt a whole range of emotions and for those who need help, it is there.