Treatment - Agoraphobia

The recommended way to treat agoraphobia is to try out treatment in a certain order. This is called a stepped approach.

Try the treatment recommended in each step and only move to the next step if the treatment has not worked.

Treating agoraphobia often involves treating panic disorder.

If you have agoraphobia

1. Learn more about agoraphobia causes and symptoms, and any lifestyle changes and self-help techniques that can help.
2. Do a guided self-help programme.
3. Try treatment with psychological therapy such as cognitive behavioural therapy (CBT), relaxation therapy or medicine your GP can prescribe.

Lifestyle changes and self-help techniques

If you have agoraphobia you may have fear of having a panic attack.

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

Stay where you are

Try to resist the urge to run to a place of safety during a panic attack outside your home.

If you're driving, pull over and park where it's safe to do so. This will 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.

Mindfulness

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.

Relaxation tips

Challenge your fear

Try to work out what it is you fear and challenge it. Start with the type of situation that causes the least anxiety. As you follow through with it, allow the anxiety to happen and to pass. Ask yourself if it is as bad as you thought it would be. The answer will often 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. When you have this image in your mind, try to focus your attention on it.

Do not fight an attack

Trying to fight the symptoms of a panic attack can often make things worse. Reassure yourself that it will pass. Although it may seem embarrassing, the attack is not life-threatening.

Lifestyle changes

Making some lifestyle changes can also help.

For example:

• staying active
• eating well
• avoiding drugs and alcohol
• reducing or avoiding caffeine and other stimulants

Guided self-help

If self-help techniques and lifestyle changes do not work, try guided self-help.

Guided self-help is where you work through a self-help workbook or computer course with the support of a therapist.

The workbook or course has information and practical advice on how to cope.

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

CBT can also use a type of therapy called exposure therapy. This involves being gradually exposed to the object or situation you fear. You then use relaxation techniques and breathing exercises to ease your anxiety.

Most self-help programmes consist of a series of goals to work towards over the course of 5 to 6 weeks.

Some programmes are offered online, such as the HSE and Silvercloud digital self-help service.

Mental health support services

More intensive treatments

If lifestyle changes, self-help techniques and self-guided help do not work, ask your GP about other treatments for agoraphobia.

They may recommend:

• CBT with a therapist
• applied relaxation
• medicine

You may have 1 or more of these treatments.

Cognitive behavioural therapy (CBT)

CBT is based on the idea that unrealistic thinking and unhelpful coping behaviours (usually avoidance) make anxiety worse.

CBT aims to break this cycle and find new ways of thinking that can help you behave more positively.

For example, if you have agoraphobia, you might have the unrealistic thought that a panic attack will kill you.

Your counsellor or therapist will try to encourage a more balanced and realistic way of thinking. For example, although having a panic attack may be unpleasant, it is not fatal and will pass.

This shift in thinking can lead to more positive behaviour. A person may be more willing to confront situations that scared them in the past.

You may 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.

CBT is usually combined with exposure therapy. Your therapist will set 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

Applied relaxation is provided by trained mental health professionals such as psychologists. Your GP may also be able to recommend videos and self-help apps.

Medicine

Your agoraphobia may not have improved from education or self-help. If so, you may benefit from medicine as well as a psychological treatment such as CBT.

Selective serotonin reuptake inhibitors (SSRIs)

If medicine is recommended, your GP may prescribe selective serotonin reuptake inhibitors (SSRIs).

The SSRI that is usually recommended to treat agoraphobia is called sertraline.

If sertraline fails to improve your symptoms, your GP may prescribe:

• a different SSRI
• a similar type of medicine known as serotonin-norepinephrine reuptake inhibitors (SNRIs)

How long you take an SSRI or SNRI for will vary depending on how you respond to treatment. Some people may have to take SSRIs for 6 to 12 months, or more.

Pregabalin

Your GP may recommend pregabalin if:

• you cannot take SSRIs or SNRIs for medical reasons
• you have 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 tranquilisers designed to reduce anxiety and promote calmness and relaxation.

Taking benzodiazepines for more than 2 weeks in a row is not usually recommended. They can become addictive. Ask your GP or psychiatrist for guidance.