Coping Skills to Use When in a Crowded Place

Coping with crowded places still presents a challenge to me. Many people I know avoid big crowds, so much of this if personal preference. I know that mine is more than just personal preference - I dread the confining feeling of a crowd. The combination of feeling trapped along with the noise and sensory overload triggers an anxiety response in me that I have to deal with consciously.

Agoraphobia In some cases, panic disorder is linked to agoraphobia, the fear and avoidance of public places. The problem may have started when a person had a panic attack in a certain place, or type of place. He or she may then become afraid the panic will return if going to that place or that type of place again.

Therapists have developed successful methods of treatment involving exposure therapy. This type of therapy involves gradually exposing the person to a situation in order to overcome the fear it stimulates. Some require only a few sessions of treatment while others may require several weeks, or even months.

Exposure Therapy Exposure therapy involves being exposed to the situation that frightens us. That may sound extreme, but if it is done gradually, it is non-threatening.

There is a natural defense system within all people (the “fight or flight” response) which can be properly aroused with professional exposure therapy. That natural defense system relies on our senses becoming all keyed-up in a response to warning signals of danger. This is also called hyper vigilance.

If aroused, but nothing terrible happens, people will typically have less hyper vigilance the next time, and even less the next. People with panic disorder, however, usually have an extra-sensitive natural defense system.

Exposure therapy helps you deal with the fear-producing situation under controlled conditions. Once you are become used to a threatening situation, you generally stop seeing it as a brand-new threat.

While there are as many different approaches to the process of exposing you to your fears as there are therapists, here is an example of how exposure therapy can work:

  • “Mary” panics at the grocery store. She and her therapist create a schedule of gradual exposure.
  • Twice a day, “Mary” goes into the grocery when it isn’t crowded. She is to spend only three minutes there, and leave without buying anything.
  • “Mary” continues to go into the store twice a day, still choosing a time when it isn’t crowded. Now, on each visit, she buys two items and picks a checkout line with only one person ahead of her.
  • As she becomes more comfortable, she buys more items and picks longer lines.
  • “Mary” is told that she must do the prescribed task, even if her level of anxiety is high. She knows she can expect some feelings of panic, but is told to let those feelings "peak and pass."
  • It is left up to “Mary” to decide when she is ready to move from one step to the next.

    How Long Does Exposure Therapy Take? That depends on the person, the therapist, and the situation. It can be a relatively quick process or it can take weeks or months. There also can be setbacks – after some successes, you may start to feel anxious again. This can happen if there is other stress in your life at the time.

    It is important not to let setbacks defeat you. Setbacks are common and they do not indicate any kind of failure. Good techniques for dealing with your panic are being learned along the way, so permanent success will be attained in time.

    Social Phobia

    Similar to Agoraphobia is Social Phobia. Social phobia - fear of certain social situations – can be as mild as just feeling shy. But for others, this type of phobia can make it difficult or even impossible to be in contact with other people. People with social phobia are usually afraid of being humiliated or embarrassed.

    • They may feel others will notice they are ill at ease (trembling or blushing.)
    • They may think people are talking about them or laughing at them.
    • They may be afraid of losing control of bodily functions in public.
    • They may find it difficult to do routine things such as eating in public. Unlike people who are just shy, people with social phobia may experience blushing, sweating, heart palpitations, dry mouth/throat, muscle tension, shaking, stomach ache, or being overly hot or cold. They can also become dizzy, have to use the toilet urgently, or become weak or faint.

    Some Things To Try

    To cope with crowded places, here some ideas you can discuss with your doctor or therapist:

    • Medication. As with other severe phobias or panic attacks, the doctor may prescribe medication. This may be given for just a short time, as people learn ways to get comfortable in situations that have been difficult.
    • Exposure Therapy. Starting with situations that are not too threatening, a therapist might arrange for you to practice surviving social encounters. Sometimes, a friend, relative, or other trusted person might be asked to observe what actually happens. For example, a social phobic may be convinced that everyone in the room will stare at a trembling hand. The observer can report that this doesn't happen.
    • Diary. Keep a diary of your thoughts as you go through the day. Sometimes recording your thoughts and what you imagine other people may be saying at the time will help you develop a new perspective.
    • Scripting. You can prepare, in advance, a script or some responses to use when placed in an awkward situation – it will help make those situations less threatening.
    • Social Skills. You can take classes or receive specific training to help you overcome fears such as public speaking or making good eye contact. Ask your doctor about assertiveness training or learning positive body language.
    • Self Analysis. When in an awkward or threatening situation, find time to stop and analyze the situation and learn from that analysis. You may find that others were not really laughing at you or that the threat was not actual. You may, upon reflection, decide that the person you thought was staring at you may have been admiring your outfit or your smile.
    • Seek Professional Help. Too many people feel that seeking help from a psychiatrist or therapist is a sign of weakness or feel the “are crazy.” Having an anxiety disorder or a phobia is not a mental illness – to the contrary, these conditions are generally treated successfully. Just make sure that you find someone with whom you are comfortable.
    • Group Therapy. An alternative is Group Therapy, which has the advantage of generally being less expensive. There is also the benefit of having several other people who can offer one another help. In a group, you will typically find many who experience the exact same things as you and you can learn from them.

      There are other coping techniques and skills that you can learn for dealing with crowded places – your doctor can direct you to sources of assistance.

      Page last updated April 5, 2009

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