Agoraphobia - Treatment

Treatment for agoraphobia and panic disorder should happen in steps.

The steps are as follows:

1. Learn more about your condition, lifestyle changes you can make, and self-help techniques.
2. Sign up for a guided self-help programme.
3. Try more intensive treatments, like cognitive behavioural therapy (CBT). Talk to your GP about medication.

Cognitive behavioural therapy (CBT) helps you manage problems by thinking more positively. It frees you from unhelpful patterns of behaviour.

Various treatments for agoraphobia are described below.

Lifestyle changes and self-help techniques

Learning more about agoraphobia may help you control your symptoms.

There are techniques you can use during a panic attack to bring your emotions under control.

Here are some self-help techniques:

Stay where you are

Try to resist the urge to run to a place of safety during a panic attack. If you're driving, pull over and park where it's safe to do so. The aim of this is to allow the emotion to pass. It might be uncomfortable but it will allow you to see that it will pass.

Focus

Focus on something non-threatening and visible outside of you. This could be the time passing on your watch, or a sound, smell or any other sensation external to you.

Remember that frightening thoughts and sensations are a sign of panic. They will pass if you allow them to.

Breathe slowly and deeply

Feelings of panic and anxiety can get worse if you breathe too quickly. Try to focus on slow, deep breathing. Count slowly to 3 on each breath in and out.

Challenge your fear

Try to work out what it is you fear and challenge it. Start with the least anxiety-provoking situation, following through with it. Allow the anxiety to happen and to pass. Then ask yourself "was it as bad as I thought it would be?" Often, the answer will be no.

Creative visualisation

During a panic attack, try to resist the urge to think negative thoughts, such as "disaster".

Think of a place or situation that makes you feel peaceful, relaxed or at ease. Once you have this image in your mind, try to focus your attention on it.

Don't fight an attack

Trying to fight the symptoms of a panic attack can often make things worse. Reassure yourself. Accept that although it may seem embarrassing, the attack isn't life-threatening.

Making some lifestyle changes can also help.

For example:

• regular exercise
• a healthy diet
• avoiding drugs and alcohol
• avoiding drinks with caffeine

Guided self-help

If self-help techniques and lifestyle changes don't work, try a guided self-help programme.

This involves working through self-help manuals. The manuals have information and practical advice about how to cope.

Guided self-help for agoraphobia is based on CBT. This aims to change unhelpful and unrealistic patterns of thinking.

CBT also uses a type of therapy called exposure therapy. This involves being gradually exposed to the object or situation you fear. Then you use relaxation techniques and breathing exercises to help reduce your anxiety.

You may also have brief sessions with a CBT therapist by phone or face-to-face. You may also be invited to take part in group work. This will be 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.

More intensive therapies

There are 3 main options:

• CBT with a therapist
• applied relaxation
• medication

Cognitive behavioural therapy (CBT)

CBT is based on the idea that unhelpful and unrealistic thinking, with unhelpful coping behaviours (usually avoidance), will maintain your anxiety difficulties.

CBT aims to break this cycle and find new ways of thinking that can help you behave more positively. You might have the unrealistic thought that a panic attack will kill you.

The CBT therapist will try to encourage a more balanced and realistic 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. A person may be 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. For example, going to your local shop.

As you become more confident, you can set more challenging goals. For example, going to a large supermarket or having a meal in a busy restaurant.

Applied relaxation

The aim of applied relaxation is to teach you how to relax.

This is achieved using a series of exercises designed to teach you how to:

• spot the signs and feelings of tension
• relax your muscles to relieve tension
• use these techniques in stressful or everyday situations to prevent you feeling tense and panicky

Medication

Your condition may not have improved from education or self-help. If so, you may benefit from an high-intensity psychological intervention or medication, or both.

Selective serotonin reuptake inhibitors (SSRIs)

If medication is recommended, you'll usually be prescribed selective serotonin reuptake inhibitors (SSRIs).

An SSRI called sertraline is usually recommended for people with agoraphobia.

If sertraline fails to improve your symptoms, you may be prescribed:

• an alternative SSRI
• 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.

Pregabalin

Pregabalin may be recommended, if:

• you can't take SSRIs or SNRIs for medical reasons
• you experience troublesome side effects

Dizziness and drowsiness are common side effects of pregabalin.

Benzodiazepines

You may be prescribed a short course of benzodiazepines for a severe flare-up. These are tranquillisers designed to reduce anxiety and promote calmness and relaxation.

Taking benzodiazepines for more than 2 weeks in a row isn't usually recommended. They can become addictive.