A woman is shopping at a mall when, without warning, a feeling of doom sweeps over her and panic strikes, leaving her gasping for breath. Later, the same thing happens in a grocery store and on a crowded sidewalk. To cope, she may avoid such places altogether.

Such symptoms of agoraphobia can take a toll on sufferers' families as well as the sufferers themselves, as some agoraphobics may become housebound or cling to certain people for safety, says Dianne Chambless, PhD, who has been studying agoraphobia and its effects on relationships since 1973.

While agoraphobia can strain family ties, such relationships might also play a key role in the treatment of agoraphobia, according to research by Chambless--the director of clinical training at the University of Pennsylvania--and social worker Gail Steketee, PhD, of Boston University's School of Social Work. In fact, just the way a family member talks about the loved one who has agoraphobia can indicate whether that person will succeed in treatment or drop out early, Chambless finds.

Spouses or parents who seem to be hostile toward the person or overly involved emotionally tend to jeopardize treatment outcomes, Chambless says. In one study, when relatives expressed hostility toward the person with agoraphobia, the agoraphobic patients were about six times more likely to drop out of treatment than those whose families were not hostile, according to research by she and Steketee in the Journal of Consulting and Clinical Psychology (Vol. 67, No. 5, pages 658-665). They conducted interviews with relatives of agoraphobics and scored their feelings about the patient; family members also completed questionnaires that the researchers used to assess whether they felt responsible or guilty for the patient's anxiety problems.

While supportive families can aid in treatment, relatives who hover, become overly involved in treatment or feel guilty about the agoraphobic's problems can also hinder therapy, according to the study.

"They may be unwittingly undermining treatment or undermining the client's belief that they may be able to do this difficult thing" of completing treatment, Chambless says. "When a person is rejected by their most intimate relatives, that causes a lot of psychological distress and...heightens the phobic anxiety and likelihood of panic attacks."

With family support, however, people with agoraphobia are more likely to bounce back into normal routines. Chambless recommends therapists devise family interventions to help mitigate the effects of hostile and over-involved family members' attitudes toward the agoraphobic patient. Interventions might include education about agoraphobia and training on positive problem-solving strategies and communication skills. Such training may help reduce patient's tendencies to drop out of therapy and increase the overall effectiveness of treatment, she says.