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.
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