Agoraphobia

Finding the right treatment

Treatment

Treatment for agoraphobia usually involves a combination of psychotherapy and medication. The good news is that most people's symptoms improve with a combination of therapy, medications, and lifestyle modifications.

Finding a therapist

The primary treatment for agoraphobia is cognitive behavioral therapy (CBT), a proven means to help many people overcome their agoraphobia. CBT helps individuals identify the irrational thoughts underlying their agoraphobia and to replace them with thoughts that better reflect their reality.

Therapists may also use exposure therapy, a form of CBT, in which the individual thinks about or engages with the feared situation and learns to manage their anxious feelings. This experience frequently generalizes to actual direct experience with the feared situation if possible. For example, if the person is afraid of bridges and learns to tolerate thinking about bridges, although there may be some anxiety when a person goes to (or over or under) a bridge, often the anxiety is significantly decreased as a result of therapy. In concert with medications and with the new understanding and skills that a therapist provides, an individual with agoraphobia can make meaningful changes.

There are different kinds of professionals who can provide effective therapy, including:

• Clinical psychologists (PhD)
• Licensed clinical social workers (LCSW or LMSW)
• Licensed professional counselors (LPC)
• Licensed clinical professional counselors (LCPC)
• Licensed Marriage and Family Therapists (LMFT)
• National certified counselors (NCC)

The decision to start therapy

Many people try to cope with their distress on their own, and then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Asking one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes one's insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.

Determining whether medications will play a role in treatment

Many people with agoraphobia benefit from taking medications, especially antidepressants, as well as an anti-anxiety medication in the benzodiazepine class of drugs. These medications are often the same drugs used to treat panic disorder. Note that people with mild agoraphobia may not require medication, and psychotherapy alone can help them overcome symptoms. Medications are reserved for people with moderate to severe agoraphobia.

FDA warning about suicide risk with antidepressants

Some research exists that, occasionally, newly initiated anti-depressants may increase the risk of suicide. If an individual begins to have these thoughts after starting an anti-depressant, please stop this medicine and contact a prescriber immediately. This risk is more evident in children, adolescents, and young adults.

Dietary supplements

There are an increasing number of supplements, such as an herb, vitamin, mineral, and other supplements claiming to improve sleep, depression, stress, restlessness, or anxiety. While it is possible for a supplement to improve one’s symptoms, their effects are often unproven.

Be aware that dietary supplements are not controlled by the FDA and, therefore, are not subject to the standards of quality, uniformity, and testing for efficacy and safety as regulated medications. It is important to share a list of all medications and supplements with one's treating provider because some of them may interact with the medications they prescribe.

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN, or a new primary doctor.