How the coronavirus pandemic could trigger a crisis of agoraphobia

‘Where I am just now, due to government handling, I am really scared of a second wave,’ says Shirley, 57, a housekeeper and youth support worker.

‘I got a shock when I got a letter advising to shield – I have an underlying condition but not a serious one, I thought. That caused heavy anxiety to grow, to be told I was at risk.

‘Since we went into lockdown, as the situation grew and I realised it wasn’t under control by the government, my anxiety got worse and worse.

‘My whole life just stopped.’

Shirley used to be outgoing and sociable, spending her spare time out meeting up with friends and going to music events.

Since coronavirus hit, she has felt increasingly terrified of leaving her home in Scotland and interacting with other people. Shirley fears that the government isn’t handling the pandemic in a way that will ensure her safety and finds herself feeling that staying indoors is the only way she can protect herself.

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‘I am at the stage now where if I see someone I get extremely anxious, especially if neighbours come to talk,’ says Shirley. ‘I was always in contact with lots of friends, my anxiety is stopping me from being able to do that. I have two sons, I have only seen one son once at a distance and my mum once.

‘I haven’t been in a shop, beach or public place in 10 weeks – I am literally terrified to do that now. The postman even gives me a fright.’

Shirley is not alone in experiencing increased anxiety at the prospect of leaving the house and interacting with other people.

In fact, experts fear that the coronavirus pandemic – and the government messaging around it – could lead to a crisis of agoraphobia, and more specifically a paralysing fear of leaving the safe space of the home.

What is agoraphobia?

Agoraphobia isn’t just the fear of open spaces, it’s being terrified of any situation that doesn’t feel ‘safe’, whether that’s because escape would be difficult, there are perceived threats, or there would be no help if things go wrong.

Someone with agoraphobia may feel unable to leave the house, get public transport, go to an office, or visit the supermarket, for example.

Doing these things – or even thinking about entering these situations – can result in a panic attack and severe distress.

Dr Paul McLaren, consultant psychiatrist and medical director at Priory Hospital Hayes Grove, explains: ‘Agoraphobia often starts with a panic attack in a crowded place, which leads to avoidance. Initially the person may only go out with someone they trust who can rescue them if the panic comes back, but that can progress to them not wanting to go out at all.

‘Not going out can relieve anxiety at least initially, but then creates other problems such as social isolation, unemployment and depression.

‘Agoraphobia is a complex condition. About 5million people suffer from it in the UK, but by its very nature it is often hidden from view.

‘In essence, it is an anxiety trap. People are trapped in what they regard as their safe place, usually their home and the prospect of leaving it causes them severe and paralysing anxiety.

‘They can feel relatively comfortable at home but even the thought of leaving the home creates a surge of intense fear that can become paralysing at the prospect of leaving the home.’

There are many reasons for this.

The coronavirus pandemic has introduced an invisible threat that we’re told lurks outside the safe space of the home, ready and waiting to cause us harm. The consequences of leaving the house feel immense: not only could you fall sick, but you could create a chain of infection and cause harm to others.

Then came the messaging around lockdown, urging us to stay home and thus do our civic responsibility to protect the NHS, again tying the confined space of home to ideas of safety and the outdoors and other people as sources of danger.

For many, the easing of lockdown measures and the insistence that we can safely go out for certain needs doesn’t allow those fears to evaporate. Agoraphobia has deep roots, and after weeks of being told that the outside world is a scary place, giving people the go ahead doesn’t reassure them that everything’s truly okay.

Add in a lack of trust in not just the government’s dealing with coronavirus, but in other people’s adherence to public safety recommendations, and it’s no wonder that many will continue to stay confined to their homes long after lockdown is lifted.

Professor Paul Gilbert, a clinical psychologist at the Uni of Derby who provides academic advice to Compassion in Politics, tells that all these aspects of the coronavirus pandemic could worsen or trigger agoraphobia.

‘It is likely that there will have been an elevation in anxiety throughout the population but for those individuals who have been moved to more extreme or intense states of fear, then that fear may take on a quite specific complexion and texture,’ Paul says. ‘For example, some people may be fearful of getting the virus and requiring hospital admission or even dying. This may be particularly true for those who have a predisposing anxiety about health (called simply ‘health anxiety’).

‘Some people may be frightened of being a contaminant themselves (more of an obsessional compulsive dimension).

‘Some may worry that others will see them that way (more of a social anxiety dimension). Some people maybe very sensitive to others and the possibility to be harmed/contaminated by them – the focus is on the danger of the other (slightly more paranoid flavour to it).

‘Some people may just be more socially anxious because they haven’t been socialising with others and they have come to see the social environment as one of threat.

‘Some people may also become more agoraphobic as part of getting depressed. So there are new complexions around agoraphobia that we haven’t seen before and that we will need research on.

‘The government (rightly or wrongly) deliberately emphasised the fear of the virus and importance of staying indoors and of saving lives. To people who are anxiety prone that will really trigger their threat-based system.’

Paul takes issue specifically with the language the government has used around safety amid Covid-19, noting that advice to ‘stay alert’ will only trigger anxiety to those who are prone to poor mental health.

‘The messages should have focused much more on safe relating (my preferred term) rather than on social distancing and on highlighting the importance of being aware, mindful, sensitive or careful as opposed to staying alert,’ he says.

‘The idea of “staying alert” in this situation is highly problematic – alert to what, whom, where? This is likely to trigger anxiety, especially when there is no obvious way of addressing that anxiety – we cannot see the virus.

‘I don’t believe the messages have been properly researched in terms of their likely impact on the mental wellbeing of the public.’

Dr Elena Touroni, a consultant psychologist and co-founder of The Chelsea Psychology Clinic, agrees that the messaging around lockdown – while it may be necessary to ensure people stay safe – can confirm all the most fearful thoughts running through an anxious person’s brain.

‘Lockdown and coronavirus can both really trigger and worsen symptoms of agoraphobia,’ Dr Elena explains. ‘The messaging of “stay home, stay safe” is very consistent with the way people with agoraphobia already manage anxiety. Adding the element of contamination is only going to make someone more fearful of crowds [or going outside].’

With staying home held up as the ‘right’ thing to do, it can be difficult to know when refusing to leave the house has become an issue.

Are you staying home because that’s what’s recommended, or because the outside world feels like an increasingly terrifying space?

It’s vital to tune into your thoughts and feelings to check in with what’s really going on. Dr Elena says you should watch out for ‘feeling an intense sense of panic at the idea of leaving the house or being amongst people – to the extent that it’s enough to give you a panic attack’ – as a sign that you may be experiencing agoraphobia.

Kayleigh, 27, says she won’t be leaving the house for a long time.

‘I used to get occasional panic attacks when I was in crowded places and feel a bit anxious sometimes when leaving the house,’ she tells us. ‘I definitely have social anxiety, but with coronavirus it’s become much worse.

‘This week I’ve had friends asking to meet up in parks and do pub picnics. I don’t know how to tell them I can’t do that, because I know I’ll have a panic attack the minute I step outside.

‘I can’t really explain it, I just feel so, so scared. Staying home feels safe. I worry if I go outside there will be people who aren’t social distancing or I’ll touch something that someone else has touched with dirty hands. I could get ill or I could end up unknowingly spreading it and causing someone’s death. The guilt of that is overwhelming.

‘I’m lucky to be working from home at the moment and I’m just praying my workplace doesn’t say we need to go back to the office any time soon.

‘I haven’t left my house in weeks, not since the last time I went out for a walk and had a panic attack because there were so many other people around. I’m terrified.’

What can people experiencing this level of anxiety do? It’s incredibly difficult. Usually our anxious thoughts centre on threats that aren’t real or are exaggerated, that we can deal with by confronting the facts. But now, at least in part, those fears are real – and they’re being confirmed and promoted by government messaging.

Paul Gilbert wants the government to gently tweak its language to offer more care and compassion to those struggling mentally.

He advises: ‘Government should make use of empathic statements such that “we understand that as we come out of lockdown some of us will be more anxious than others and this may take a little time to begin to adjust again but we want to assure you that we are doing everything we can to create safeness between us so that we can get on with our lives”.

‘Empathetic understanding goes a long way.

‘Secondly, the emphasis of the message should change towards focusing on safeness, not on threat ie how we will create a safer environment for everyone.

‘Thirdly the tone of the message should be friendly, encouraging, supportive and caring. I would prefer they used a less masculine, authoritarian sounding voice.’

It’s vital, too, that those feeling deeply anxious about leaving the home feel able to access professional help and speak about what they’re experiencing. The worst thing we can do is allow those experiencing agoraphobia to retreat further away from our view, suffering in total isolation as the walls keep closing in.

‘Agoraphobia is a serious mental health condition and therefore requires the help of a professional,’ says Dr Elena. ‘The treatment usually involves exposure therapy, where the person takes baby steps to gradually expose themselves to the idea of going outside – looking out of their window, going into the garden, stepping outside the front door etc.

‘While practising skills like mindfulness, breathing techniques can be supportive, ultimately agoraphobia requires the help of a professional.’

Offering support over phone calls and virtual hangouts can help, as well as being understanding that someone may not feel ready to venture outside the house just yet.

But bear in mind that professional help is the best possible option for anyone experiencing agoraphobia.

‘You can be as supportive and validating as you possibly can but ultimately it’s not something you can help someone with, without first finding them the right support,’ Elena says. ‘The best thing you can do is get an understanding of agoraphobia and find them an appropriately qualified psychologist who will be able to help them on the road to recovery.’

Shirley finds it helpful to keep her mind and body busy, spending her time in the garden so she has ‘less time to think about things’. Kayleigh is working on plans for small outings with the option to retreat back home, to slowly ease herself into being able to venture freely.

It’s hugely important not to fall into destructive forms of self-soothing, such as drinking to excess, shutting off all communication, or disordered forms of eating.

But remember you’re not alone in this, and you shouldn’t have to tackle the overwhelming fear of all that’s going on by yourself. Fear and anxiety is valid – and to be expected when there’s a pandemic going on outside your door.

Need support? Contact the Samaritans

For emotional support you can call the Samaritans 24-hour helpline on 116 123, email [email protected], visit a Samaritans branch in person or go to the Samaritans website.

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