For some people what most of us would consider the most mundane of daily chores can become a Herculean task as fear of a panic attack takes hold, writes Niamh Kavanagh.
We all have a fear of something - a fear of flying perhaps, or water, or being trapped in a lift.
But agoraphobia, now defined as a fear of panic attacks rather than a fear of open spaces, can overwhelm people, leaving them virtual prisoners in their own homes.
Even an everyday task like shopping can become a mammoth task. According to Aware, some 320,000 people in Ireland suffer from anxiety disorders.
Now an online course is helping Dublin sufferers to beat their phobias and give them back their lives.
"One participant had agoraphobia for seven years and went out once a year at Christmas and then only at night. This person didn't have their curtains open for those seven years," says Val Smith, one of two facilitators at the distance learning course operated by Roslyn Park College in Sandymount, Dublin, part of the Rehab group.
Homelink is radical in that help is brought directly into the participant's home through the online support system and it works a bit like an outreach programme, as the facilitators visit people in their homes.
Participants "meet" each other through an online discussion board where they can share opinions and eventually get to the stage where they meet face-to-face either independently or through one of the weekly events organised through the programme. There is also a counselling service available if needed.
Some people are referred to the college by their GPs or public health nurses. Others are self-referred having heard about the course through word of mouth.
Agoraphobia affects people across the age, gender, educational and social strata although currently, there are more women on the course than men.
Because people have a different educational background, the computer techniques needed for the course are aimed at levelling that difference.
All participants complete an equal skills certificate and are given the loan of computer equipment for the duration of the course, usually a year to a year-and-a-half.
Initially, Val or the other facilitator, Philip Keogh, meet a potential participant and assess them as to their suitability for the course. The only criteria for the course is that the person be in receipt of a disability benefit although there is a certain degree of flexibility about this. They talk about the person's aims and what they want to achieve for the year.
Monthly targets are set out and fragmented into more manageable tasks.
Ordinary tasks like taking a bus into town can be an epic journey for some agoraphobia sufferers and may involve several trips to the bus stop, even in the company of Val or Philip, before the person gains the confidence to take the trip themselves.
For the first couple of months, Val and Philip will visit the participant every fortnight, or more frequently if needed, in their homes.
"You can go out to some of the most beautiful locations in the city at a time like now when all the flowers are blooming and you'll say to someone, 'it's a beautiful day', and they'll say, 'this is hell'. They might as well be in prison," says Philip.
The course was the idea of Philip Byrne in 1999, a teacher at Roslyn Park College and an agoraphobia victim himself. Philip, married with children, was shocked when he first suffered a panic attack - out of nowhere. In retrospect, however, he realised he had been under considerable strain.
The course comprises 17 modules. There is a continuous intake of participants so it runs all year long but usually would have about 21 people doing the course at any one time.
Each module is designed to give the sufferer more skills and education about their condition, such as coping skills and breathing techniques in the event of a panic attack.
Agoraphobia is a fear of panic attacks - likened to the symptoms of a heart attack - as distinct to social phobia which is a fear of social settings.
"Social phobia can be an extreme kind of shyness right through to where people avoid all sorts of social situations, not talking to anybody and not using the same shop twice," says Val.
"Some professionals draw a line between them and see them as quite different but in our experience, we don't see that line," says Philip.
Agoraphobia then is the culmination of a build-up of anxiety, driven by a deep desire to avoid a panic attack, even a place where someone may have had one.
The initial panic attack was probably triggered by stress, possibly one traumatic event such as death, or divorce or moving house or a build-up of stress.
But Val and Philip are not fixated on the cause of the phobia, rather the solution.
"In some ways, whatever leads you to where you are now is immaterial. The fact is that you're paralysed now and you can't get out and that is what you have to work on," says Val.
Some 95 people have completed the course since it was started. However, success is not always valued in the conventional manner of work or education. Those were our aims for participants initially, says Philip but after evaluative studies, they discovered things were not so black and white.
For instance, several participants may be full-time mothers with no desire to get a job. Others do go back into the workforce or on to further education, but for all it is the start of a new chapter.
"It's the difference it makes to a person's quality of life before and after, doing their own shopping, going to social events. They are so much happier and more self-confident," says Val.
And it is an irony that the very method of support - the online support - can sometimes serve to further isolate a sufferer. Because of the convenience of online chatrooms or banking or shopping, a person can manage to get by without leaving the house.
"The only thing we regard as failure in the programme is if someone sets themselves up working from home. It's not that that's a failure in itself; it's just that we've helped someone reconsolidate their position," says Philip.
And for the future, he would like to see more help for others with agoraphobia, for people who are managing to hold down jobs but whose lives outside work are restricted.
For more information on Homelink contact Roslyn Park College at 01-2057205.