- It’s natural to feel anxious about visiting places and seeing people after a year of the pandemic. In severe cases, these fears may resemble agoraphobia.
- Three thought processes involved in agoraphobia are anticipated panic, panic consequences, and panic coping. Research suggests that these processes can predict the severity of agoraphobia and panic disorder.
- Developing skills to cope with anxiety and panic ahead of time can prevent people from avoiding new experiences.
After a year of lockdown, social distancing, and the constant drumbeat of bad news about COVID-19, it’s quite likely that you have developed a certain amount of fear about ever leaving your home. There is, of course, value in protecting yourself and the people you care about by following public health advice. You may attribute the fact that you’re still around to having adhered strictly to these measures.
However, with the vaccine now available, government officials are beginning to ease those restrictions. Mask mandates are going away in several states in the U.S. You may not agree with these decisions, but they do signal (one might hope) that normal life is getting closer and closer to becoming a reality.
Now imagine, when it is truly safe, that you have the ability to get out of the house and go shopping, eat at restaurants, and perhaps even travel to a vacation destination. However, before you feel ready to take the plunge, perhaps your employer decides it’s time for you to return to the workplace. Rationally, you know that people who had to work outside the home throughout the lockdown didn’t have the same choices that you had if you’ve been able to get your job done from your kitchen table. However, you feel the panic rise as you contemplate losing the luxury of that choice and being forced back into your old routines.
The psychological disorder of agoraphobia involves precisely some of these inner feelings. People with agoraphobia often panic at the thought of being out of the home, particularly in places where they have no ability to escape. Even if you never had any of these symptoms, you can now see them developing as a result of the pandemic’s effect on your life.
According to a new study by Youngrae Cho of Hallym University, Chuncheon in South Korea (2021), thoughts or cognitions are crucial to understanding the reasons that people develop panic disorder and agoraphobia. These cognitive processes fall into three “panic appraisal” or evaluation dimensions related to feelings of panic. In other words, your thoughts about a situation determine your emotions. By examining these panic appraisal (PA) dimensions, you might eventually find your way out of your COVID-induced agoraphobia.
Cho et al. tested the role of PA dimensions in predicting the severity of agoraphobia and panic disorder (non-COVID related) among 84 outpatients (51 women, 33 men) seeking treatment at a specialized clinic in Seoul, South Korea. A trained clinical interviewer diagnosed the participants with an established standard interview designed to assess these disorders. The evaluation took place prior to treatment. Participants had the option of volunteering for the project, with no penalty should they decline.
With this background, see how you would perform on the research instrument known as the Panic Appraisal Inventory (PAI; Telch et al., 1989). You can tailor the instructions for your current COVID-19 agoraphobic symptoms, if applicable:
Imagine yourself in a situation such as being in a large crowded public place, waiting in long lines, and taking public transportation. Now rate yourself on a 0-100 scale indicating the probability that you will panic in each of these situations.
Put yourself in the situation that causes you the most fear and rate the extent to which you would experience each of these, using a 0 to 10 scale of probability:
Physical symptoms: fainting, having a heart attack, suffocating, having a stroke
Social symptoms: people may stare at you, people may think you’re weird, and people may laugh at you
Loss of control: you may scream, do something uncontrollable, or lose control of your senses
Rate yourself on a 0 to 100 scale indicating the extent to which you will engage each of the following:
- Experience panic without avoiding the situation
- Prevent a panic attack from coming
- Stop a panic attack midstream
- Experience panic without frightening thoughts
- Use adaptive self-talk during a panic attack
- Distract one’s thoughts during a panic attack
- Control one’s breathing during a panic attack
- Confront a situation that will bring on an attack
- Relax one’s muscles during a panic attack
- Be confident, overall, in coping with panic attacks
As you can see, these items are very specific and situationally-focused. In other words, you don’t rate how much you panic in general, but how much you experience specific thoughts while encountering specific situations. The PAI, then, provides an excellent way to tap into the way you might feel about re-entry into a post-COVID world. Seeing yourself in these situations can help you gain insight into the thoughts that are the most likely to prompt panic.
In the study, as predicted, scores on the PAI were related to all facets of panic and agoraphobic symptoms, even after the research team controlled for other possible factors. Additionally, the rating of anticipated panic was most likely to predict agoraphobic avoidance, or the tendency to stay away from situations that could provoke panic attacks. Based on the data from this scale, a rating of 67% would place you at risk.
However, based on the Cho et al., findings, you could overcome even this high score if you could increase your ratings of coping efficacy. Look back at those items now. Could you talk yourself down from the anxiety you predict you would feel when you return to life as normal? Could you relax and control your breathing? Could you accept the fact that you might feel highly anxious and still get back out there?
As the researchers note, it’s the “perceived coping inefficacy” rather than the “sheer fearfulness of the event” (p. 309) that will lead you to avoid a situation in which you might have a panic attack. Bolster that coping efficacy, and your panic should subside.
To sum up, there is value in maintaining vigilance as you emerge from your past year of protectively staying out of public places. Health experts encourage, and some localities mandate, that everyone continue to wear masks and remain socially distant. Eventually, though, these cautions will subside and you will be expected to leave lockdown conditions for good. By looking at your own coping efficacy, and trying to increase your belief in your ability to manage your anxious feelings, you’ll once again be able to find fulfillment in the ordinary routines of daily life.
Cho, Y., Choi, Y., & Kim, S. (2021). Role of panic appraisal in predicting the severity of panic and agoraphobic symptoms. Journal of Clinical Psychology, 77(1), 298-311. doi:10.1002/jclp.23028
Telch, M. J., Brouillard, M., Telch, C. F., Agras, W. S., & Taylor, C. B. (1989). Role of cognitive appraisal in panic-related avoidance. Behaviour Research and Therapy, 27, 373–383. https://labs.la.utexas.edu/telch/files/2015/02/Role-of-Cognitive-Appraisal-In-Panic.pdf