Dear Alice,

I have suffered from agoraphobia since the age of thirteen. I am now twenty. I have tried hypnotherapy counseling and psychologists and herbal tablets, but nothing seems to help me. Please, can you help a young, outgoing twenty-year-old who wants to start living!

Dear Reader,

Although agoraphobia can be incredibly isolating, almost two percent of the United States population experiences it in some form. This mental health condition is characterized by intense anxiety and fear of places or situations that might cause you to panic and feel trapped, helpless, embarrassed, or uncomfortable. This may result in the avoidance of public places. Having agoraphobia — and trying to figure out the best course of treatment — can feel incredibly frustrating and time consuming. Read on for more about agoraphobia and the two most common forms of treatment: psychotherapy and medication.

While agoraphobia can occur on its own, it’s often associated with panic disorder — a type of anxiety disorder in which a person experiences sudden, often seemingly out-of-the blue attacks of extreme fear (known as panic attacks) that reach a peak within a few minutes and trigger intense physical symptoms. Some of the most typical symptoms of a panic attack include chest pain, heart palpitations, trembling, feeling faint or dizzy, and shortness of breath. Because these attacks can be terrifying and physically overwhelming, once a person has experienced a panic attack they may begin to fear having one in public and thus develop an additional panic reaction to these situations.

One of the most common and effective treatments for agoraphobia is psychotherapy, which involves working with a mental health professional who’s trained to guide people in setting goals and learning to practice skills to reduce anxiety. The most effective form of psychotherapy for agoraphobia is cognitive behavioral therapy (CBT), which helps people confront and challenge the sources of their anxiety. Through CBT, people with agoraphobia learn to reduce anticipatory anxiety and the avoidance of feared situations, treat panic attacks, tolerate symptoms of anxiety, and develop ways to directly challenge their worries (such as the probability that unwanted events will occur in social situations). This treatment often involves real or imagined exposure (in a protected environment) to the situations or triggers that cause the fear. CBT for agoraphobia generally takes at least eight to twelve weeks to produce results and has a low relapse rate. Other therapies such as hypnosis, meditation, and relaxation therapy — although considered less effective than CBT — have also been found to help some people experiencing agoraphobia.

The other most common and effective form of treatment for agoraphobia is prescription medication, which is often used in combination with psychotherapy. Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that are typically considered the most effective medication for agoraphobia. For those who don’t benefit from SSRIs, other classes of antidepressants, such as monoamine oxidase inhibitors (MAOIs), may be recommended by a health care provider. Benzodiazepines, a type of anti-anxiety medication, are another common medication used to treat the symptoms of agoraphobia. These sedatives can temporarily relieve acute anxiety on a short-term basis. Keep in mind that it may take weeks for medication to relieve symptoms of agoraphobia, and that you may have to try several different medications before you find one that works.

Your persistence in seeking help is commendable, especially when you haven’t found success in the treatments you’ve tried. And the fact that you have experience with a variety of treatments — even if they haven't worked — may actually help you and your health care provider determine the next best course of treatment. Additionally, just as the treatment needs to be the appropriate fit for you, seeking a good fit with health care providers and mental health professionals is also key to individualized care. If they aren't meeting your needs, you don't click with them, or you don't feel as though they're providing effective help, you may consider seeking out help from other professionals who may be a better fit. They may be able to better match you to the care you need. As you know, it can take time to find the right treatment (or combination of treatments) that works for you. Here’s to hoping you soon start living the life that you want!

Alice!

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