The Kusnacht Practice Podcast #19 Interview with Melissa Nobile, psychologist MSc, on agoraphobia and its effects on mental health

Interviews Podcasts Podcast 19 V1 Farbe

“It’s one of those difficulties that, just in the space of weeks, can go from being afraid to going to Starbucks, to being afraid to leave their bed.”– Melissa Nobile, psychologist MSc.

In the latest podcast from The Kusnacht Practice, we’re talking with Melissa Nobile – psychologist MSc – about the rising incidence of agoraphobia and its effect on mental health.

Melissa explains the complex nature of the disorder, the signs to initially look out for and the rapid progression that follows.

She addresses the damaging impact of the pandemic and lockdown on those affected and the ‘other risk factors’ that can lead to the development, as well as the urgency in seeking help to avoid any advancement of the illness.

Presenter: Hello, today we have the pleasure to welcome Melissa Nobile. Melissa is a psychologist here, at The Kusnacht Practice.

Melissa Nobile: Hello.

PR: Hello Melissa. So, we want to talk today about the increasing cases of agoraphobia related to the COVID-19 pandemic. We’ve actually drilled down into this topic because the figures around the globe indicate an increase in cases of agoraphobia, across age groups, brought on by the pandemic.

According to a University of Oxford survey, as many as one in five primary age children are afraid to leave their homes. The poll indicates that more than half of younger children, 53% actually, are worried about family and friends catching the disease. How common, Melissa, is agoraphobia in young people and what signs should one look out for in those that may be suffering this?

MN: So, agoraphobia is actually equally common in children, adolescents and adults. So we don’t see a huge difference across the spectrum of ages, at least not in the past few years. Agoraphobia falls under the category of anxiety disorders, and it involves an extreme and irrational fear of not being able to escape a certain situation if they were to develop panic-like symptoms. And that’s what people usually don’t know about agoraphobia.

So someone with agoraphobia is able, for example, to be very afraid that if they go to the mall and they start experiencing a panic-like symptom, which in an ironic twist, if they’re afraid of them developing they’re likely to develop them, they’ll be scared of not being able to go somewhere safe. And they’ll have this belief that these panic-like or panic attack-like symptoms are dangerous, which is absolutely wrong. Nothing can happen in a panic attack, it’s actually a sign that your body’s functioning very well and getting you ready to fight or flight, but at the wrong time.

So that defines someone with agoraphobia. And signs to look out for would be someone who usually, if not always, had a first panic attack in a certain place. It can be at the restaurant, in the mall, even with family. Wherever it was, and then, as a result, they don’t want to go back to that place.

That’s how it starts. But, very quickly, the signs you’ll see is someone who then, what we call, ‘generalise that behaviour’. So they’ll not only be scared of going in restaurants, but a week later, they don’t want to go in somewhere that has a roof and is a closed space. And over the course of two, three weeks, they’ll be just trapped in their own house. So that’s what agoraphobia looks like.

PR: Similarly, a recent YouGov survey revealed 46% of the Brits were fearful about sitting in a barber’s chair or shopping for clothes, once lockdown was over, while just under 60% say that going back to restaurants and coffee shops would make them ‘uncomfortable’. Gyms, pubs and bars fared even worse on the survey, with as little as 60% of respondents saying that both pints and pull up bars were going to be off the agenda for a while. These figures show just how far-reaching the effect of the pandemic is with most age groups being hit. So could you explain the reasons behind this, these views that we’re observing here?

MN: I, actually, read this article, before this podcast, to prepare a little. And what’s interesting is that it described the questions that were being asked in this survey; will you be uncomfortable going back to a restaurant? A bar? Club? And if you remember the definition I gave of agoraphobia before, it was an irrational fear. Agoraphobia is this irrational fear that ‘if my heart starts to beat quite quickly, or I get a little bit dizzy, that I’m going to die’. It’s a panic attack. ‘And so I can’t go there because I might die, etc’.

In this article and the example you gave, for me, this is not something that’s actually agoraphobia, it’s individuals who are simply afraid of going back in certain contexts because they’re scared of catching the virus. But there’s nothing related to panic-like symptoms in this survey.

So, two very different processes. One is rational avoidance – a personal decision, I would say, of avoiding certain contexts without any fear of having panic attacks. If they go, they’re simply afraid of catching the virus. And an agoraphobic person, they wouldn’t go there because they’re terrified of having a panic attack and, maybe, don’t even care about catching coronavirus.

PR: We have been bombarded with official messages like ‘stay at home’ and ‘avoid contact with others’. So these pronouncements and the enforcement of social distancing only increases the feelings of isolation and agoraphobia. How long term do you think this problem is? And how do you think this issue will naturally solve itself as vaccines roll out and this kind of messaging disappears?

MN: The first thing, I would say, is isolation and agoraphobia can be two different things. Isolation, really, is this experience of being cut off from other people, experiences, etc, which we pretty much all experienced during the pandemic. And agoraphobia, it’s not so much about being isolated, it’s about avoiding a certain place, and then, as a consequence, ending up isolated.

That being said, it’s true that these messages, ‘that the world is basically dangerous right now, stay in etc’. For some individuals who also have, what we call in psychology, ‘other risk factors,’ so, maybe they have a certain type of personality, certain things going on at home, other social, biological, cultural factors, additionally to living through the pandemic, will develop agoraphobia. And the more they stay in, the harder it is to get back out.

And some individuals who had symptoms, early signs of agoraphobia, so maybe had a few panic attacks, but weren’t yet, completely, avoiding situations, and then the COVID-19 and the lockdown happened. They went back home and for months they couldn’t re-expose themselves to what made them afraid. By the time the lockdown was over, for them, it was terrifying to go back out because so much time had gone by without them being able to re-expose themselves to those situations. So it’s a very complex interaction, to answer your question.

PR: According to the National Institute of Mental Health, 1.3% of adults in the United States experience agoraphobia at some point in their lifetime, and this is likely to increase due to the pandemic. In the UK, for instance, calls to mental health charities such as SANE and Anxiety UK have increased by 200% during the lockdown.

Residents in tower blocks are particularly at risk of agoraphobia during the lockdown, according to the mental health charity SANE. In this perspective, how should individuals and families who are worried about loved ones know when it is time to seek help, in your opinion?

MN: With agoraphobia, I would urge families to encourage the loved one to seek help very early on. Because it’s one of those difficulties that, just in the space of weeks, as I said a little earlier, can go from being afraid to going to Starbucks, to being afraid to leave their bed. This is actually a common experience.

There’s a very strong link between agoraphobia and panic attacks. If someone had a panic attack, lots of people have panic attacks and it doesn’t lead them to avoid situations, but for those people who had a panic attack associated with a situation and started to avoid it, at that time I’d already seek help. Very early on, so that the brain doesn’t generalise, ‘okay I need to avoid the situation, so now I’m also going to avoid this situation and this situation’. And before it becomes completely out of control. So early on, and it’s a matter of a few sessions for things to already get a lot better.

PR: I really think we’ve covered this topic very much in depth. We were discussing agoraphobia in cases of the COVID-19 pandemic. Today we were here with Melissa Nobile, our psychologist. Melissa, thank you very much for answering these questions today. I really think we’ve covered this topic very much in depth. We were discussing agoraphobia in cases of the COVID-19 pandemic. Today we were here with Melissa Nobile, our psychologist. Melissa, thank you very much for answering these questions today.

MN: Thank you for having me.

PR: And looking forward to having you in our next session. Goodbye.

MN: Bye bye.