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Treatment

A stepwise approach is usually recommended for treating agoraphobia and any underlying panic disorder.

The steps are as follows:

  1. Find out more about your condition, the lifestyle changes you can make, and self-help techniques to help relieve symptoms.
  2. Enrol yourself on a guided self-help programme.
  3. Undertake more intensive treatments, such as cognitive behavioural therapy (CBT), or see if your symptoms can be controlled using medication.

Self-help techniques, lifestyle changes and apps

Learning more about agoraphobia and its association with panic disorder and panic attacks may help you control your symptoms better.

For example, there are techniques you can use during a panic attack to bring your emotions under control. 

Having more confidence in controlling your emotions may make you more confident coping with previously uncomfortable situations and environments.

Making some lifestyle changes can also help. For example, ensure you:

You could also try one of the mental health apps in the NHS Apps Library.

Psychological therapies

If your symptoms don't respond to self-help techniques and lifestyle changes, your GP may suggest trying a psychological therapy.

If you prefer you can refer yourself directly for psychological therapies, such as cognitive behavioural therapy (CBT), without seeing your GP.

Read more about psychological therapies on the NHS.

Guided self-help

With guided self-help you work through a CBT-based workbook or computer course with the support of a therapist.

The therapist works with you to understand your problems and make positive changes in your life.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is based on the idea that unhelpful and unrealistic thinking leads to negative behaviour.

CBT aims to break this cycle and find new ways of thinking that can help you behave more positively. For example, many people with agoraphobia have the unrealistic thought that if they have a panic attack it will kill them.

The CBT therapist will try to encourage a more positive 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 in terms of a person being 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, such as going to your local corner shop.

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

A course of CBT usually consists of 12 to 15 weekly sessions, with each session lasting about an hour.

Applied relaxation

Applied relaxation is based on the premise that people with agoraphobia and related panic disorder have lost their ability to relax. The aim of applied relaxation is therefore to teach you how to relax.

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

As with CBT, a course of applied relaxation therapy consists of 12 to 15 weekly sessions, with each session lasting about an hour.

Medication

In some cases, medication can be used as a sole treatment for agoraphobia. In more severe cases, it can also be used in combination with CBT or applied relaxation therapy.

Selective serotonin reuptake inhibitors (SSRIs)

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

SSRIs were originally developed to treat depression, but they've also proved effective for helping treat other mood disorders, such as anxiety, feelings of panic, and obsessional thoughts.

An SSRI called sertraline is usually recommended for people with agoraphobia. Side effects associated with sertraline include:

These side effects should improve over time, although some can occasionally persist.

If sertraline fails to improve your symptoms, you may be prescribed an alternative SSRI or 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.

When you and your GP decide it's appropriate for you to stop taking SSRIs, you'll be weaned off them by slowly reducing your dosage. You should never stop taking your medication unless your GP specifically advises you to.

Pregabalin

If you're unable to take SSRIs or SNRIs for medical reasons or you experience troublesome side effects, another medication called pregabalin may be recommended. Dizziness and drowsiness are common side effects of pregabalin.

Read more about pregabalin

Benzodiazepines

If you experience a particularly severe flare-up of panic-related symptoms, you may be prescribed a short course of benzodiazepines. These are tranquillisers designed to reduce anxiety and promote calmness and relaxation.

Taking benzodiazepines for longer than 2 weeks in a row isn't usually recommended as they can become addictive.

Support groups

Charities like Mind and Anxiety Care UK are useful resources for information and advice about how to manage anxiety and phobias. They can also put you in touch with other people who've had similar experiences.