What is an example of agoraphobia?

The treatment of phobias is often highly successful. The goal of treatment is to help the agoraphobic person function effectively, and the most effective remedy is systematic desensitization, also called exposure therapy. It is a behavioral technique in which the sufferer, under expert guidance, is gradually exposed to the feared situation and comes to understand that the feared outcomes do not materialize.

The success of treatment usually depends on the severity of the phobia. The person is first taught, then practices, techniques of relaxation. When relaxed, the individual imagines the components of the phobia, working from the least fearful to the most fearful.

Graded real-life exposure has also been used with success to help people overcome their fears. The technique involves exposure to real aversive situations, progressing from less to more extreme situations. For example, a person might be in contact with a few people before progressively spending time with larger groups of people to overcome a fear of crowds.

The individual works with a therapist to develop coping strategies to allay anxiety, such as relaxation and breathing techniques. While in-vivo, or real-life, exposure is ideal, imagined exposure is an acceptable alternative in desensitization. Treating agoraphobia with exposure therapy reduces anxiety and improves morale and quality of life in many cases.

Other types of therapy such as biofeedback, hypnosis, meditation, relaxation, or couples therapy have been found to be helpful for some patients. Cognitive-behavioral therapy (CBT) can help patients modify or eliminate thought patterns contributing to the symptoms and help them change behavior.

CBT generally requires at least 8 to 12 weeks. Some people may need more time in treatment to learn and implement their newly acquired skills. This kind of therapy, which is reported to have a low relapse rate, is effective in eliminating panic attacks or reducing their frequency. It also reduces anticipatory anxiety and the avoidance of feared situations.

Treatment may be complicated when patients have difficulty getting to appointments because of their fears. To address this issue, some therapists will go to an agoraphobic patient's home to conduct the initial sessions. Often therapists take their patients on excursions to shopping malls and other places the patients have been avoiding; this provides support and helps the patients cope with their fears.

The patient approaches a feared situation gradually, attempting to stay in spite of rising levels of anxiety. In this way, the patient sees that as frightening as the feelings are, they are not dangerous, and they do pass. In each attempt, the patient faces as much fear as he or she can stand. Patients find that with this step-by-step approach, aided by the encouragement and skilled advice of a therapist, they can gradually master their fears and enter situations that had previously seemed unapproachable.

Many therapists assign their patients "homework" to do between sessions. Sometimes patients spend only a few sessions in one-on-one contact with a therapist and continue to work on their own with the aid of a manual.

Often the patient will join a therapy group with others striving to overcome agoraphobia, meeting with them weekly to discuss progress, exchange encouragement, and receive guidance from the therapist.

Treatment with Medications

Patients who experience panic attacks as part of their agoraphobia may benefit from prescription medication to prevent panic attacks or reduce their frequency and severity, and to decrease the associated anticipatory anxiety. When patients find that their panic attacks are less frequent and severe, they are increasingly able to venture into situations that had previously been anxiety-provoking.

The groups of medications most commonly used are tricyclic antidepressants; selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa); high-potency benzodiazepines; and monoamine oxidase inhibitors (MAOIs). Determination of which drug to use is based on considerations of safety, efficacy, and the personal needs of the patient.

SSRIs are also used to treat panic disorder when it occurs in combination with OCD, social phobia, or depression. The medications are started at low doses, which are gradually increased until they produce a beneficial effect.

The high-potency benzodiazepines—alprazolam, clonazepam, and lorazepam are members of this class—take effect rapidly, have few bothersome side effects, and are well-tolerated by the majority of patients. However, some patients, especially those who have had problems with alcohol or drug dependency, may become dependent on benzodiazepines.

Treatment with high-potency benzodiazepines is usually continued for six months to a year. One drawback of these medications is that patients may experience withdrawal symptoms—malaise, weakness, and other unpleasant side effects—when the treatment is discontinued. Reducing the dose gradually generally minimizes such problems. There may also be a recurrence of panic attacks after the medication is withdrawn.

Many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Talking with a trusted friend or confidante can also provide support, but it is not a substitute for care from a mental health professional.

Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. Aerobic exercise can also have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided. Check with your physician or pharmacist before taking any additional medications.

How does agoraphobia affect daily life?

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What does the start of agoraphobia look like?

What exactly causes agoraphobia?