Agoraphobia is generally known as a fear of open spaces, but is a complex condition that may involve fear of visiting certain public areas like shopping centers, fear of specific situations like public transit, or a fear of leaving home altogether. Exposure to the feared stimulus usually results in anxiety or a panic attack. Symptoms of a panic attack include rapid heartbeat, hyperventilation, sweating, and nausea.
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Agoraphobia can cause significant distress and interfere with functioning in life. A number of treatments are available to alleviate or cure the symptoms of agoraphobia.
Cognitive behavioral therapy (CBT) is the most commonly used form of therapy for agoraphobia. The goal of CBT is to learn skills to help with tolerating anxiety, changing distorted thought patterns, and returning to normal activities.
For patients who have trouble leaving home, alternatives to office appointments are possible. Some options are meeting in the home, having sessions over the phone, or using a computer. In more severe cases, hospital inpatient treatment may be necessary.
Exposure therapy is usually part of treatment with CBT. In exposure therapy, the patient is gradually exposed to the object or situation that triggers their fear. Through exposure, the fear reaction is reduced.
Applied relaxation is a therapy that helps the patient regain the ability to relax. The patient is taught certain exercises toward this goal. Those include identifying signs of tension, relaxing the body to relieve the tension, and applying the techniques during stressful everyday situations. A typical course of applied relaxation therapy will cover 12 to 15 weekly sessions.
Agoraphobia can be treated with antidepressants and anti-anxiety medications. Selective serotonin reuptake inhibitors (SSRIs) are often prescribed for panic disorder with agoraphobia. SSRIs have some side effects, including:
- loss of libido
- blurred vision
Other types of antidepressants can also be effective for agoraphobia. Benzodiazepines may be prescribed for temporary relief of acute anxiety, but cannot be used over the long term because they are habit-forming.
In addition to therapy and medication, a person with agoraphobia can use some strategies for self-help during a panic attack. Some such strategies are:
- Stay put: During a panic attack, resist the urge to run to some safe place.
- Focus on something non-threatening: Look at objects around you and remember that the sensations will pass.
- Slow, deep breathing: Count to three on each breath in and out to calm anxiety.
- Challenge distorted thoughts: Figure out what your fear is and think about why it’s not realistic.
- Accept that you are having a panic attack: Don’t try to fight the panic attack. Reassure yourself that it will pass.
Lifestyle changes can also reduce symptoms of agoraphobia. Regular exercise and a healthy diet can improve mood overall. Avoidance of alcohol and recreational drugs will also help to stabilize your moods. Alcohol and drugs can worsen symptoms in the long term. Avoidance of caffeine can also reduce symptoms, since caffeine is a stimulant and can exacerbate anxiety.
- Mayo Clinic, Agoraphobia, www.mayoclinic.org/.../drc-20355993
- NHS Choices, Treating agoraphobia, https://www.nhs.uk/Conditions/Agoraphobia/Pages/Treatment.aspx
- In Vivo Exposure Treatment for Agoraphobia, http://psycnet.apa.org/fulltext/2014-44574-009.pdf
- The efficacy of cognitive behavioral therapy: a review of meta-analyses, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/
- Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610618/