Agoraphobia with Panic is defined as fear and avoidance of places or activities where escape might be difficult if a panic attack occurred. Over time, places and activities where panic has occurred are avoided. It is this cycle that lead to progressive increase in agoraphobic avoidance. Moreover, once Panic gains a foothold, unexpected attacks can increase, which can lead to preemptive avoidance of certain situations. Without treatment, the geography of "safe" places shrinks, freedom of movement becomes more limited, undermining relationships, career, quality of life and in extreme cases can leading to disability.

Travel Agoraphobia with Panic is intense fear and avoidance related to travel or forms of transport where escape is thought to be difficult and "help" not available. Common feared travel or transport situations are:

Public Transportation such as buses, trains, undergrounds/metros, airplanes
Driving or being driven in a car particularly on motorways, at faster speeds and longer distances or over long bridges.
Traveling far from home, where it would not be possible to quickly return home
Crowded Stations or other places typically associated during travel

These are behaviors and actions that panickers believe will keep them safe from (or during) panic, in general,and during travel specifically. Some examples of these are:

The choice of safety behavior (SB) often aligns with the type of anxiety or specific fear. Some examples of common safety behaviors during travel would include:

The problem with safety behaviors is that they are false friend: on the surface it seems natural and intuitive to lessen or head off the perceived "threat" of panic. But, in reality, panic is not dangerous and the feared consequences, of course, never happen. But when panikers use safety behaviors they reinforce the belief that SBs protected them from the imagined catastrophic consequences of an attack.

There are two main components in the treatment of travel agoraphobia with panic:

• Panic Control Therapy a Cognitive and Behavioral approach tailored to treat panic attacks
• Progress Exposure to travel/transport situations avoided related to fear of panic

Panic Control Therapy
Panic Control Therapy (PCT) is a Cognitive and Behavioral approach adapted to treat Panic. Developed by American psychologist David Barlow more than 40 years ago, PCT remains the treatment of choice for Panic Disorder. The main components of Panic Control Therapy are:

1. Psychoeducation to help clients understand panic attacks and the causes of physical symptoms during a flight or flight response
2. Cognitive Restructuring (CR)- challenging and reframing catastrophic thoughts related to panic and travel fears, using standard CBT methods. In my practice, I incorporate a more recent Cognitive Therapy approach developed for the treatment of OCD, known as Inference-Based Cognitive and Behavioral Therapy ICBT.
3. Exposure to feared bodily sensations, where the person progressively desensitizes to sensations and symptoms experienced during these false alarms.
4. Progressive exposure to feared situations, activities and contexts associated with panic.
5. Dropping of safety behaviors panickers rely on to stave off a panic attack or 'Keep them safe" if one were to occur.

Transport-Travel Exposure Therapy Consists of progressive exposure to all feared transport situations. This component is the bridge back to recovering the lost geography of movement and travel. Clients are asked to create a ladder of difficulty or hierarchy of travel/transport feared and avoided, from the least challenging to the most difficult. Examples of the types progressive transport/travel situations I do with clients include:

• Riding in cars as a passenger, Ubers and taxis
• Driving agoraphobia related to fear of panic on roads, motorways and in traffic.
• Local and long distance bus travel, locally, regionally or internationally across Europe.
• Travel on local, regional, national high-speed rail to inter-European rail such as Eurostar and/or Eurorail