Reviewed by Lauren Guilbeault
When someone has agoraphobia, they are scared that they might be trapped in a place or situation, such as a long line at the bank or grocery store, subway, movie theater, and unable to escape. They may also be scared of not getting help in a high state of distress, which could be anything from signs of anxiety to incontinency. The anxiety issue can cause avoidance or an abundance of safety precautions, such as asking someone to accompany you to the subway or grocery store. In severe cases, people with agoraphobia may be unable to step outside their houses.
Before 2013, when the DSM-5 was published, agoraphobia was not regarded as a distinct condition. Instead, the opinion was that it was a form of panic disorder. Panic disorder is a condition that causes a regular feeling of abruptly occurring panic attacks. For example, the person may feel like they are losing control and suffer difficulty breathing, profuse sweating, lightheadedness, and shakiness or numbness.
Agoraphobia is a distinct and sometimes devastating condition. Sometimes, it co-exists with panic disorders or other conditions such as major depression and anxiety disorders. Fortunately, you can learn how to overcome agoraphobia. Overcoming agoraphobia is not a day’s job, but it is possible. With the combination of psychotherapy and medication, you can take gradual but practical steps towards recovery and enjoy long-term benefits.
Since it took a while for agoraphobia to be considered a distinct condition, only a few studies evaluate agoraphobia exclusively. Most of the existing research covers panic disorder with agoraphobia, so the recommended therapies often focus on that condition. Agoraphobia is a serious mental health disorder, and it can have a remarkable impact on someone’s life without treatment. Some of the potential complications include depression, substance abuse, school or work issues, development of other mental health issues, challenges in a relationship, and being unable to leave the house.
Although there are steps to take on your own, seeking professional health can produce remarkable improvements in life symptoms and quality. To diagnose agoraphobia, the primary care doctor will ask the patient about their symptoms, the situations or locations where they feel the fear or panic, the frequency of the symptoms, and how long they have been experiencing the feelings. The doctor may perform a physical exam or request some lab tests to eliminate other symptoms. Using this information, the primary doctor may refer the patient to a psychiatrist or therapist.
Some of the treatment options for agoraphobia include:
Psychotherapy for Agoraphobia
Psychotherapy entails working with a therapist to create goals and learn effective techniques to reduce symptoms of anxiety. Cognitive-behavioral therapy (CBT) is one of the most practical psychotherapy forms for agoraphobia and other anxiety disorders. Typically a short-term treatment, cognitive behavioral therapy teaches you ways to manage anxiety, challenge your fears, and slowly resume the things you avoided due to anxiety. With this method, the symptoms get better with time. Another particularly powerful type of CBT is exposure-based therapy.
Exposure-based therapy entails gradually exposing a patient to different conditions or locations that may trigger agoraphobia, from the least threatening to the most provoking. Patients will gradually pass through the level of activities at their pace. After they surmount a level successfully, they move on to the next stage until they complete that as well, and so on.
Another important part is reducing your dependence on safety precautions, which might include searching for exits, finding people to accompany you, or going around with a full or empty bottle of meds.
Exposure therapy also involves interoceptive exposure, which triggers the feared physical symptoms such as dizziness, sweating, and hyperventilation. In the end, when you are up to it, the scary feelings are combined with scary situations. Simply put, physical sensations are triggered when you go through the subway, the movie theater, queue at the grocery store, or anywhere else that usually triggers anxiety.
With CBT, you will learn about the nature of the anxiety, learn to alter unhelpful thoughts and catastrophic opinions that only worsen and extend your anxiety, and cultivate relaxation techniques. If exposure-based therapy is ineffective, another alternative is panic-focused psychodynamic psychotherapy extended range (PFPP-XR). Studies have discovered PFPP-XR to be effective for anxiety disorders like agoraphobia.
If you cannot leave your house, consider finding a therapist that can help you get alternatives to office visits, at least in the initial stage of treatment. Some therapists provide sessions over the phone, via email, or through computer programs or other media. If the condition is so bad that you have no access to care, it might help to undergo an intensive hospital program that focuses on treating anxiety disorders. One can go to the appointment with a trusted friend or relative who can offer aid, support, and comfort if required.
Medications For Agoraphobia
The doctor may recommend certain types of antidepressants to treat agoraphobia and sometimes antianxiety drugs for limited use. Antidepressants are more effective for treating agoraphobia than antianxiety meds.
Antidepressants: Some antidepressants known as selective serotonin uptake inhibitors (SSRIs) such as sertraline (Zoloft) and fluoxetine (Prozac) are prescribed for treating agoraphobia. Other forms of antidepressants may also be effective in treating the condition.
Antianxiety Medications: Antianxiety drugs known as benzodiazepines are sedatives, which in rare cases, may be prescribed to relieve anxiety symptoms temporarily. Benzodiazepines are usually only used for controlling acute anxiety temporarily. Since they can be addictive, these drugs are not advisable if they have a history of anxiety or issues with alcohol or drug abuse.
It may take a while for drugs to minimize the symptoms. Also, patients may be prescribed different medications before they find the most effective one. At the initial and final stage of using antidepressants, you may experience side effects that cause unpleasant physical sensations or panic attack symptoms. Therefore, the doctor will probably increase your dose slowly during treatment and slowly reduce the dose when they think you are ready to stop using drugs.
It is crucial to have a proper discussion with your doctor about the possible side effects, drug interactions, and any other worries you may have about using medications. It is also advisable to use the medications according to instructions. For instance, if you stop taking an SSRI abruptly, you may experience discontinuation syndrome (called withdrawal), leading to symptoms like dizziness, lethargy, insomnia, sweating, and headache. Remember to discuss with your doctor before discontinuing the medication.
Address Underlying Issues
Even after learning to deal with the symptoms of agoraphobia, it is still crucial to identify and tackle the underlying factors contributing to the condition. The underlying causes can originate from different factors. Some of the potential causes of agoraphobia include environmental stress, panic disorder, other anxiety issues, trauma, abuse or disorienting life events, childhood experiences, and genetics.
The truth is that agoraphobia shows if different ways for each person. As you undergo treatment for agoraphobia, you will potentially resolve the underlying issues contributing to the condition. If the triggers eventually occur, you will have more power over your reaction.
Learn Coping Skills for Agoraphobia
There are coping skills to practice. It may require experimenting to discover the coping strategies that are the most effective for you. You can develop a formal anxiety strategy that outlines managing agoraphobia and shows how you will handle any specific situation as they happen. Some of the ways people cope include:
- Breathing exercises involve learning to slow down your breathing when you find yourself in situations that trigger panic or anxiety.
- Progressive muscle relaxation, a practical way to physically free up the tension in your body.
- Helpful thinking, aimed at altering how you address yourself
- Personal care. Rest and sleep adequately, stay physically active daily, take a healthy diet, including fruits and vegetables.
You must avoid turning to unhealthy coping methods if you have agoraphobia. This may include alcohol and other substances or living in total isolation from others. Some people resort to substances to relieve anxiety symptoms, but that only worsens the problem. For example, alcohol disrupts sleep and increases anxiety once the effect wears off.
Get Support for Agoraphobia
People around you can be a source of support. It might also help if you joined a support group or used an online platform to share your ordeals, exchange tips, and understand that you are not on your own.
In Conclusion- There is Help for Agoraphobia
The best treatment for agoraphobia is taking gradual steps towards recovery. Slowly, manage feared conditions one by one until you are ready to move on to another. Before trying to overcome agoraphobia, you can learn to replace panic feelings with positive thoughts. You can accomplish this by regularly practicing until you become used to it. Regardless of how severe the agoraphobia is, you can recover. Take an online assessment for agoraphobia.