What is the treatment for agoraphobia?
There are many treatments available for overcoming agoraphobia, including specific kinds of psychotherapy as well as several effective medications. A specific form of psychotherapy that focuses on decreasing negative, anxiety-provoking, or other self-defeating thoughts and behaviors (called cognitive behavioral therapy) has been found to be highly effective in treating agoraphobia. In fact, when agoraphobia occurs along with panic disorder, cognitive behavioral therapy, with or without treatment with medication, is considered to be the most effective way to both relieve symptoms and prevent their return. In fact, sometimes patients respond equally as well when treated with group cognitive behavioral therapy or a brief course of that kind of therapy, as they do when treated with traditional cognitive behavioral therapy. Psychotherapy for agoraphobia is also effective for many people when they receive it over the Internet, which is optimistic news for people who live in areas that are hundreds of miles from the nearest mental-health professional.
Another form of therapy that has been found effective in managing agoraphobia includes self-exposure. In that intervention, people either imagine or put themselves into situations that cause increasing levels of agoraphobic anxiety, using relaxation techniques in each situation (systematic desensitization) in order to master their anxiety. When avoiding the cause of the anxiety is gradually, thoughtfully prevented as part of this mode of therapy, it is often referred to as exposure and response prevention. As people gain access to the Internet, there is increasing evidence that exposure therapy can also be done effectively through that medium.
Regarding medication therapy, agoraphobia is usually treated in connection with panic disorder. Commonly, members of the selective serotonin reuptake inhibitor (SSRI) and the minor tranquilizer (benzodiazepine) groups of medications are used in treatment. Examples of SSRI medications include vortioxetine (Brintellix), vilazodone (Viibryd), escitalopram (Lexapro), citalopram (Celexa), fluvoxamine (Luvox), sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). The possible side effects of SSRI medications can vary greatly from person to person and depend on which of the drugs is being used. Common side effects of this group of medications include dry mouth, sexual dysfunction, nausea or other stomach upset, tremors, trouble sleeping, blurred vision, constipation or soft stools, and dizziness. In rare cases, some people have been thought to become acutely more anxious or depressed once on the medication, even trying to or completing suicide or homicide. Children and teens are thought to be particularly vulnerable to this rare possibility. Phobias are also sometimes treated using beta-blocker medications, which block the effects of adrenaline (like rapid heartbeat, stomach upset, shortness of breath) on the body. An example of a beta-blocker medication is propranolol.
Panic disorder and phobias are sometimes treated with drugs in a medication class known as benzodiazepines, also sometimes referred to as anxiolytics or sedatives. This class of medications causes relaxation but is used less often these days to treat anxiety due to the possibility of addiction, increasing need for higher doses, and overdose. The risk of overdose is especially heightened if taken when alcohol is also being consumed. Examples of medications from that group include diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin).
As anything that is ingested carries the risk of possible side effects, it is important to work closely with a doctor to decide whether medication is appropriate, and if so, which medication would be best. Further, the treating doctor will likely closely monitor for the possibility of side effects that can vary from the minor to the severe and in rare cases may even be life-threatening.
A variety of mental-health specialists treat agoraphobia. In this age of managed care (involvement of insurance companies in determining payment for treatment), psychiatrists are often relegated to managing medication treatment for this condition despite the training these professionals receive in conducting therapy. Other mental-health prescribers, like nurse practitioners and physician assistants, may also provide medication management for this condition. Psychoanalysts of a variety of disciplines, as well as psychologists, social workers, and psychiatric nurses, are some of the specialists that may conduct psychotherapy to treat agoraphobia.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Treatment Revision. Washington, D.C.: American Psychiatric Association, 2000.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, D.C.: American Psychiatric Association, 2013.
Bienvenu, O.J., Onyike, C.U., Stein, M.B., Chen, L., Samuels, J., Nestadt, G.,
and Eaton, W.W.
Agoraphobia in adults: incidence and longitudinal relationship with panic. The
British Journal of Psychiatry 188: 432-438, 2006.
Biondi, M. and Picardi, A. Increased probability of remaining in remission from
panic disorder with agoraphobia after drug treatment in patients who received
concurrent cognitive-behavioural therapy: a follow-up study. Psychotherapeutic
Psychosomatics 72(1): 34-42, 2003.
Bruce, S.E., Vasile, R.G., Goisman, R.M., Salzman, C., Spencer, M., Machan, J.T., Keller,
Are benzodiazepines still the medication of choice for patients with panic
disorder with our without agoraphobia? American Journal of Psychiatry 160:
1432-1438, August 2003.
Bruce, S.E., Yonkers, K.A., Otto, M.W., Eisen, J.L., Weisberg, R.B., Pagano, M., Shea, T.,
and Keller, M.B. Influence of psychiatric comorbidity on recovery and recurrence in
generalized anxiety disorder, social phobia and panic disorder: a 12-year
prospective study. American Journal of Psychiatry 162: 1179-1187, 2005.
Chou, T., A. Asnaani, and S.G. Hofmann. "Perception of racial discrimination and psychopathology across three U.S. ethnic minority groups." Cultural Diversity and Ethnic Minority Psychology 18.1 (2012): 74-81.
Collier, D.A. FISH, flexible joints and panic: are anxiety disorders really
expressions of instability in the human genome? The British Journal of
Psychiatry 181: 457-459, 2002.
Fava, G.A., Ruini, C., Rafanelli, C., and Grandi, S. Cognitive behavior approach to loss
of clinical effect during long-term antidepressant treatment: A pilot study.
American Journal of Psychiatry 159: 2094-2095, December 2002.
Furukawa, T.A. and Watanabe, N. Psychotherapy plus antidepressant for panic disorder
with or without agoraphobia. The British Journal of Psychiatry 188: 305-312,
Gersley, E. Phobias: Causes and treatments. All Psych Journal, 11/17/01.
Godemann, F., Ahrens, B., Behrens, S., Berthold, R., Gandor, C., Lampe, F., and Linden, M.
Classic conditioning and dysfunctional cognitions in patients with panic
disorder and agoraphobia treated with an implantable cardioverter/defibrillator.
Psychosomatic Medicine 63: 231-238, 2001.
Goodwin, R., Faravelli, C., Rosi, S., Cosci, F., Truglia, E., de Graaf, R.,
and Wittchen, H.U. The
epidemiology of panic disorder and agoraphobia in Europe. European Neuropsychopharmacology 15(4): 435-443, 2003.
Grant, B.F. The epidemiology of DSM-IV panic disorder and agoraphobia in the
United States: results from the national epidemiologic survey on alcohol and
related conditions. Journal of Clinical Psychiatry 67(3): 363-374, 2006.
Hofmann, S.G., and D.E. Hinton. "Cross-cultural aspects of anxiety disorders." Current Psychiatry Reports 16.6 June 2014: 450.
Ito, L.M., de Araujo, L.A., Tess, V.L.C., de Barros-Neto, T.P., Asbahr, F.R.,
and Marks, I.
Self-exposure therapy for panic disorder with agoraphobia: randomized controlled
study of external v. interoceptive self-exposure. The British Journal of
Psychiatry 178: 331-336, 2001.
Kenwright, M., Liness, S., and Marks, I. Reducing demands on clinicians by offering
computer-aided self-help for phobia/panic. The British Journal of Psychiatry
179: 456-459, 2001.
Kessler, R.C. The epidemiology of panic attacks, panic disorder and agoraphobia
in the National Comorbidity Survey Replication. Archives of General Psychiatry
63(4): 415-424, 2006.
Kikuchi, M., Komuro, R., Oka, H., Kidani, T., Hanaoka, A., and Koshino, Y. Panic disorder
with and without agoraphobia: comorbidity within a half-year of the onset of
panic disorder. Psychiatry and Clinical Neurosciences 59(6): 639-643, 2005.
Kumano, H., Kaiya, H., Yoshiuchi, K., Yamanaka, G., Sasaki, T., and Kuboki, T. Comorbidity
of irritable bowel syndrome, panic disorder and agoraphobia in a Japanese
representative sample. The American Journal of Gastroenterology 99(2): 370-376,
Leinonen, E., Lepola, U., Koponen, H., Turtonen, J., Wade, A., and Lehto, H. Citalopram
controls phobic symptoms in patients with panic disorder: randomized controlled
trial. Journal of Psychiatry Neuroscience, 25(1): 25-32, 2000.
Magee, W.J., Eaton, W.W., Wittchen, H.U., McGonagle, K.A., and Kessler, R.C. Agoraphobia,
simple phobia and social phobia in the National Comorbidity Survey. Archives of
General Psychiatry 53(2): 159-168, 1996.
McLean, C.P., and E.R. Anderson. "Brave men and timid women? A review of the genter differences in fear and anxiety." Clinical Psychology Review 29 (2009): 496-505.
Mental Health America. Mental Health and Complementary and Alternative Medicine. April 2016.
Milrod, B. Emptiness in agoraphobia patients. Journal of the American
Psychoanalytic Association 55(3): 1007-1026, 2007.
Nascimento, I. Psychiatric disorders in asthmatic outpatients. Psychiatry
Research 110(1): 73-80, 2002.
Roberge, P., Marchand, A., Reinharz, D., and Savard, P. Cognitive-behavioral treatment
for panic disorder with agoraphobia: A randomized, controlled trial and
cost-effectiveness analysis. Behavior Modification 32(3): 333-351, 2008.
Rosenberg, F. "Treating panic disorder with exposure response prvention (ER/P) therapy." Anxiety.org. July 2014.
Schuckit, M.A., and Hesselbrock, V. Alcohol dependence and anxiety disorders: what is
the relationship? Focus 2: 440-453, 2004.
Shandley, K., Austin, D.W., Klein, B., Pier, C., Schattner, P., Pierce, D., and Wade, V.
Therapist-assisted, internet-based treatment for panic disorder: can general
practitioners achieve comparable patient outcomes to psychologists? Journal of
Medical Internet Research 10(2), 2008.
Sibrava, N.J., C. Beard, A.S. Bjornsson, et al. "Two-year course of generalized anxiety disorder, social anxiety disorder and panic disorder in a longitudinal sample of African American adults." Journal of Consulting and Clinical Psychology 81.6 (2013): 1052-1062.
Takeuchi, D.T., N. Zane, et al. "Immigration-related factors and mental disorders among Asian Americns." American Journal of Public Health 97.1 Jan. 2007: 84-90.
Thomas, S.E., Thevos, A.K., and Randall, C.L. Alcoholics with and without social phobia:
a comparison of substance use and psychiatric variables. Journal of Studies
on Alcohol (60) 1999.
Wittchen, H.U., Nocon, A., Beesdo, K., Pine, D.S., Hofler, M., Lieb, R., and Gloster, A.T.
Agoraphobia and panic: Prospective-longitudinal relations suggest a rethinking
of diagnostic concepts. Psychotherapy and Psychosomatics 77(3), 2008.
Yardley, L., Britton, J., Lear, S., Bird, J., and Luxon, L.M. Relationship between balance
system function and agoraphobic avoidance. Behavior Research Theory 33(4):
Zimmerman, M. and Mattia, J. Principal and additional DSM-IV disorders for which
outpatients seek treatment. Psychiatric Services 51:1299-1304, October 2000.