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The fear of public places in the age of COVID: Is it agoraphobia or something else?

illustration of one isolated orange circle surrounded by many other blue circles and a few pink circles.
(Jim Cooke / Los Angeles Times)

Few places are more evocative of early-pandemic anxiety than the grocery store.

In that first year before vaccines, when we had much less information about how the coronavirus spread, a jolt of panic would squeeze my chest if someone got too close to me in Trader Joe’s. I power-walked down the aisles, eyes narrowed, tossing oatmeal and bread into my cart with the determination of a permed contestant on “Supermarket Sweep."

For those of us who are vaccinated and have strong immune systems, indoor public places like the grocery store can feel much less treacherous these days. But two and a half years into the pandemic, many people still experience mild to significant unease when they leave their homes. This week, I’m answering a question about this from Kari, 56, of Monrovia: “How do I distinguish whether it’s agoraphobia or the pandemic that keeps me home and avoiding grocery shopping?”

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To really answer this question, we would need to know more about what Kari’s going through. Even still, it’s an opportunity to better understand the relationship between the pandemic and the ongoing anxiety surrounding life outside our living rooms.

What’s agoraphobia, actually?

In film and fiction, agoraphobia is mostly portrayed as a debilitating fear of leaving the house. In actuality, the diagnosis is given to people who are afraid of specific places or situations that might cause them to panic or feel trapped or embarrassed, said Sandy Capaldi, associate director for the University of Pennsylvania’s Center for the Treatment and Study of Anxiety.

Commonly, these are places that are hard to leave — like crowded concerts, planes and Metro trains.

What distinguishes agoraphobia from other anxiety disorders is the cause of the fear. Those living with this disorder are often worried they might have a panic attack in public and embarrass themselves or be unable to escape. Older people who live with agoraphobia often fear that they’ll fall and hurt themselves and no one will be able to help, Capaldi said. A more specific example is someone who avoids driving on bridges because they worry that they’ll panic and crash.

That’s a lot different than avoiding the grocery store because you’re afraid of contracting COVID-19, your social skills aren’t what they used to be or because depression has zapped your motivation to leave your home.

It’s unclear whether the pandemic has triggered more agoraphobia, experts said. People often have their first panic attacks during high-stress situations, and research suggests an increase in anxiety disorders during the pandemic — but not necessarily agoraphobia. “If there was a proclivity toward agoraphobic tendencies, these past two years may have worsened it, but it didn’t necessarily create it from nothing at all,” Capaldi said.

Some of us might be experiencing social anxiety, rather than agoraphobia, after being secluded for so long, or an adjustment disorder, which can occur when we struggle with a major change to the point of significant anxiety or depression.

Christina Charlotin, a clinical psychologist in Los Angeles who specializes in anxiety disorders, told me she sees an uptick in clients seeking support for reluctance to be in public when national crises are in the news, such as mass shootings. Movie theaters, grocery stores, concert venues and schools are now all places to fear.

In 2020 and 2021, fear of getting COVID-19 in public places was a “major theme” in Charlotin’s therapy sessions. “I’m hearing the word ‘COVID’ less now,” Charlotin said.

So what can we do?

If you’re feeling anxious about being in public, for whatever the reason, you can take baby steps to gradually make those situations less stressful.

“Let’s say you’re not ready to go to a concert,” Charlotin said. “Can you go to a get-together with 20 people instead?” Opt to visit a small store at first instead of a shopping mall. Bring along someone you trust, and then move onto doing it alone. Identify what would feel challenging but not completely overwhelming; this will build your tolerance.

“It’s about proving to yourself that what the anxiety is telling us is wrong, that nothing bad is going to happen, that we can handle it,” Capaldi said.

Talking about your fear can build your tolerance too, Charlotin added, as does thinking about it in an intentional way. “Practice in your mind: If a panic attack were to happen, how would you address that? What would happen afterward? How would you remove yourself from the situation and ground yourself?” Charlotin demonstrated.

Self-compassion is critical here. “Recognize that it’s not something you’re asking to experience, and that we all have different challenges we have to overcome,” Charlotin said. “Just that by itself helps us build trust in ourselves.”

How we relate to public spaces right now is highly personal. If your immune system is compromised, for example, threats to your well-being are very real. Each of us has to decide what level of risk regarding COVID we’re able and willing to take to achieve the quality of life we desire while still feeling safe.

There’s a good chance your COVID-related anxiety will subside on its own as the virus (hopefully) becomes less prevalent. “People tend to be really resilient,” said Steven Taylor, a clinical psychologist at the University of British Columbia in Vancouver who wrote the book “The Psychology of Pandemics.” “Many, but not all, will recover without help.”

If your anxiety feels like too much to handle on your own, or it’s all you can think about, you may want to seek professional support. Experts recommend reaching out to a therapist who specializes in anxiety disorders. “Don’t lose heart,” Taylor said. “There are very good treatments out there.”

In essence, whatever is at the root of your fear, there are ways to overcome it. But you don’t have to do that alone.

See you next week,
Laura

If what you learned today from these experts spoke to you or you’d like to tell us about your own experiences, please email us and let us know if it is OK to share your thoughts with the larger Group Therapy community. The email GroupTherapy@latimes.com gets right to our team.
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Group Therapy is for informational purposes only and is not a substitute for professional mental health advice, diagnosis or treatment. We encourage you to seek the advice of a mental health professional or other qualified health provider with any questions or concerns you may have about your mental health.


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