A stepwise approach is usually recommended for treating agoraphobia and any underlying panic disorder.
The steps are as follows:
The various treatments for agoraphobia are outlined below. You can also read a summary of the pros and cons of the different treatments for agoraphobia, allowing you to compare your treatment options.
For example, there are techniques you can use during a panic attack to bring your emotions under control.
Having more confidence in controlling your emotions may make you more confident coping with previously uncomfortable situations and environments.
These self-help techniques are described below.
Making some lifestyle changes can also help. For example, ensure you:
If your symptoms don't respond to these self-help techniques and lifestyle changes, your GP may recommend enrolling on a guided self-help programme.
This involves working through self-help manuals that cover the types of issues you might be facing, along with practical advice about how to deal with them.
A number of internet-based programmes are also available. For example, Moodjuice is an online resource designed to help you think about emotional problems and work towards resolving them.
Guided self-help for agoraphobia is based on CBT, which aims to change unhelpful and unrealistic patterns of thinking to bring about positive changes in behaviour.
In turn, CBT uses a type of therapy called exposure therapy, which involves being gradually exposed to the object or situation you fear and using relaxation techniques and breathing exercises to help reduce your anxiety.
As part of the programme, you may have brief sessions with a CBT therapist – around 20 to 30 minutes long – over the telephone or face to face. You may also be invited to take part in group work with other people with a history of agoraphobia and panic disorders.
Most self-help programmes consist of a series of goals to work towards over the course of five to six weeks.
If the self-help programme hasn't worked, you may be referred for more intensive therapies. There are three main options:
Cognitive behavioural therapy (CBT) is based on the idea that unhelpful and unrealistic thinking leads to negative behaviour.
CBT aims to break this cycle and find new ways of thinking that can help you behave more positively. For example, many people with agoraphobia have the unrealistic thought that if they have a panic attack it will kill them.
The CBT therapist will try to encourage a more positive way of thinking – for example, although having a panic attack may be unpleasant, it isn't fatal and will pass.
This shift in thinking can lead to more positive behaviour in terms of a person being more willing to confront situations that previously scared them.
CBT is usually combined with exposure therapy. Your therapist will set relatively modest goals at the start of treatment, such as going to your local corner shop.
As you become more confident, more challenging goals can be set, such as going to a large supermarket or having a meal in a busy restaurant.
A course of CBT usually consists of 12 to 15 weekly sessions, with each session lasting about an hour.
Applied relaxation is based on the premise that people with agoraphobia and related panic disorder have lost their ability to relax. The aim of applied relaxation is therefore to teach you how to relax.
This is achieved using a series of exercises designed to teach you how to:
As with CBT, a course of applied relaxation therapy consists of 12 to 15 weekly sessions, with each one lasting about an hour.
In some cases, medication can be used as a sole treatment for agoraphobia. In more severe cases, it can also be used in combination with CBT or applied relaxation therapy.
If medication is recommended for you, you'll usually be prescribed a course of selective serotonin reuptake inhibitors (SSRIs).
SSRIs were originally developed to treat depression, but they've subsequently proved effective for helping treat other mood disorders, such as anxiety, feelings of panic, and obsessional thoughts.
An SSRI called sertraline is usually recommended for people with agoraphobia. Side effects associated with sertraline include:
These side effects should improve over time, although some can occasionally persist.
If sertraline fails to improve your symptoms, you may be prescribed an alternative SSRI or a similar type of medication known as serotonin-norepinephrine reuptake inhibitors (SNRIs).
The length of time you'll have to take an SSRI or SNRI for will vary depending on your response to treatment. Some people may have to take SSRIs for 6 to 12 months or more.
When you and your GP decide it's appropriate for you to stop taking SSRIs, you'll be weaned off them by slowly reducing your dosage. You should never stop taking your medication unless your GP specifically advises you to.
If you're unable to take SSRIs or SNRIs for medical reasons or you experience troublesome side effects, another medication called pregabalin may be recommended. Dizziness and drowsiness are common side effects of pregabalin.
If you experience a particularly severe flare-up of panic-related symptoms, you may be prescribed a short course of benzodiazepines. These are tranquillisers designed to reduce anxiety and promote calmness and relaxation.
Taking benzodiazepines for longer than two weeks in a row isn't usually recommended as they can become addictive.