Agoraphobia treatment

Agoraphobia treatment can be very successful and anyone who has suffered from or knows someone who has suffered from agoraphobia knows it is an extremely debilitating condition.  Agoraphobia is a term used to describe people who struggle with panic disorder who also have a fear of being in any environment where escape is difficult.  In other words it is a condition that accompanies 95 percent of people with panic disorder and is responsible for often leaving them housebound to to fear of being out in public.  Their fear is typically focused on the fear they will have a panic attack in a public setting and will be unable to safely make it home or escape.  Panic disorder itself is ultimately a disorder of fear.  It is fear of fear essentially, meaning fear of having a panic attack causes a cycle of ongoing panic attacks.  After a longstanding pattern, the brain of someone with panic disorder becomes set in “automatic” mode where they no longer need to be exposed to a typically anxiety-provoking situation but rather spontaneous panic attacks occur regularly.

Agoraphobia treatment options are all very effective but can require more of a time commitment than treatment of other psychiatric disorders.  Both therapy and medication is very useful for panic disorder with agoraphobia, especially when used in conjunction with each other.

Agoraphobia treatment specifically utilizes cognitive behavioral therapy as a first line option which has a success rate of over 75 percent when used correctly.  Cognitive behavioral therapy essentially takes “cognitive distortions” which are irrational thoughts that have developed over time, and restructure these thoughts into more realistic thoughts.  Ultimately by restructuring erroneous thoughts, the cycle of panic and thus agoraphobia is broken and with ongoing therapy, the cycle can remain dormant. The most common example that occurs in agoraphobia treatment involves someone fearing they will die during a panic attack. They are scared to leave the house and be in public because a panic attack will occur. When they have a panic attack they worry that the symptoms associated with it such as heavy breathing, chest pain, rapid heart rate, dizziness, weakness-will literally give them a heart attack or will cause them to completely lose-control of their mind.  During cognitive therapy, these irrational thoughts of believing panic attacks will cause death are addressed by first questioning the evidence for such an event actually happening.  This includes education with the patient regarding the benign nature of the panic attack, the fact it does not kill your or cause a heart attack and although uncomfortable is not “dangerous.”

During regular sessions, the psychiatrist and patient continue to question and review the evidence for the irrational thoughts that occur during the week, which the patient writes down. Overtime they begin questioning their irrational thoughts on their own and are able to restructure their thinking from irrational to rational. With more rational thoughts they are able to venture into situations they otherwise avoided and with enough exposure they learn that there is nothing dangerous that occurs during these panic attacks which will ultimately teach their brain there is no point in having a panic attack.  With ongoing work the cycle can be broken.

The other cornerstone of agoraphobia treatment is medication with serotonin re-uptake inhibitors (SSRI’s).  Medication such as prozac, zoloft, celexa, paxil and lexapro all are approved to treat the entire spectrum of anxiety disorders, including panic disorder with agoraphobia.  Typically they work best when used in conjunction with cognitive therapy but they do have good efficacy when used alone.

Other options in agoraphobia treatment include another medication class called benzodiazepines. These medicines include xanax, klonopin and ativan which are all effective if used properly.  Properly in this case means for a short-time (few months at the most) and at a relatively subtle dose.  The cornerstone of cognitive therapy is having people still experience anxiety and discomfort but realize to be comfortable with the feelings in order to break the cycle. Using benzodiazepines can cause total emotional numbness and can garner proper cognitive therapy ineffective. Benzo’s are more of a band-aid rather than a cure and over-time they tend to not work well and require higher and higher doses to provide the emotional numbness that is desirable to people struggling with panic.

There are many great agoraphobia treatment options and with a combination of good cognitive therapy and proper medication, agoraphobia treatment can be extremely effective.

Michael Yasinski M.D