Talk therapy and certain medications are considered first-line treatments for agoraphobia, but you can also improve symptoms with certain self-care strategies.
When you have agoraphobia, you may fear not being able to escape a certain place or situation, such as the subway, movie theater, a large crowd, or a long line at the grocery store.
You may also fear not having help if you experience distressing physical sensations, like a panic attack or physical health problems.
This fear may lead you to avoid certain situations or to engage in safety behaviors, such as asking someone to ride the subway with you or accompany you to the grocery store.
In severe cases, people with agoraphobia may be unable to leave their homes.
However, while living with agoraphobia can be challenging, effective help is available.
Psychotherapy (“talk therapy”) is considered the treatment of choice and may offer long-term benefits. Medication can also be helpful, especially if you experience symptoms of panic.
Plus, there are certain self-care strategies and lifestyle changes you can try to help reduce and manage symptoms.
A note about agoraphobia as a condition
Until 2013, agoraphobia was considered a part of panic disorder and not as a distinct disorder. This is why research exclusively on agoraphobia is limited. Most studies on recommended treatments focus on panic disorder with agoraphobia.
Psychotherapy, or talk therapy, is often considered the gold standard for treating agoraphobia. It may be particularly useful as it may offer long-term benefits.
Cognitive behavioral therapy (CBT) and exposure-based therapy
CBT, particularly a type of CBT called exposure-based therapy, is highly effective for people who have panic disorder with agoraphobia.
Exposure-based therapy involves being gradually and systematically exposed to different agoraphobic situations, from the least to the most anxiety provoking.
You move through this hierarchy of activities at your own pace. Once you’ve successfully completed one level, you move on to the next one until you’ve successfully completed that one, and so on.
Another critical aspect is reducing your use of safety behaviors, which may include checking for exits, bringing others with you, and carrying a full or empty medicine bottle.
Exposure therapy also includes interoceptive exposure, which involves bringing about feared physical symptoms. It can retrain the brain to see that those symptoms aren’t as harmful as one may believe.
For example, you may be asked to breathe quickly to induce hyperventilation or spin around in a chair until you feel dizzy.
The idea is that because you know exactly why you’re experiencing these physical symptoms in the moment, they’re less likely to cause you anxiety or panic.
Eventually, when you’re ready, feared sensations are paired with feared situations.
In other words, physical sensations are induced when you’re taking the subway, at the movie theater, in line at the grocery store, or anywhere else that typically sparks anxiety.
In addition, with CBT, you’ll:
- gain an understanding of the nature of your anxiety
- learn to restructure unhelpful thoughts and catastrophic beliefs
- practice relaxation techniques
Panic-focused psychodynamic psychotherapy extended range (PFPP-XR)
If exposure-based therapy doesn’t work for your agoraphobia, another option may be panic-focused psychodynamic psychotherapy extended range (PFPP-XR).
Research has found PFPP-XR can be effective for anxiety disorders, including panic disorder with agoraphobia.
In 24 biweekly sessions, people gain a deeper understanding of their anxiety. They explore its origins along with the underlying feelings and conflicts of their symptoms in a supportive, therapeutic environment.
There’s no medication that’s specifically approved for agoraphobia. Still, a doctor may prescribe you medication to prevent and reduce panic symptoms if you have them.
SSRIs and SNRIs
A selective serotonin reuptake inhibitor (SSRI) is the initial treatment for panic disorder.
SSRIs that have been approved by the Food and Drug Administration (FDA) for treating panic disorder include:
A doctor may prescribe one of these medications or a different SSRI “off label.”
They may also prescribe the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR). It’s also FDA approved for treating panic disorder.
Common side effects of SSRIs and SNRIs include:
- dry mouth
- nervousness or agitation
- sexual dysfunction, such as decreased sexual desire or delayed orgasm
In some people, venlafaxine may increase blood pressure.
Benzodiazepines, another class of medication, can reduce symptoms of anxiety right away.
However, they also have an increased risk of misuse and dependence, and they can interfere with CBT. If they’re prescribed, it’s typically short term.
Common side effects of benzodiazepines include:
- impaired coordination
Because benzodiazepines are so fast acting, they can boost anxiety and trigger other adverse effects, such as insomnia and tremors, when you stop taking them.
This is often why many mental health professionals may recommend CBT or other talk therapies as an alternative to medication, or while treating agoraphobia with medication.
TCAs and MAOIs
Two other classes of medication have been found to be helpful for panic disorder: tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).
However, both are often difficult to tolerate because of their side effects.
For instance, the common side effects of TCAs include:
- blurred vision
- sexual dysfunction
MAOIs require dietary restrictions. People must avoid foods high in tyramine, such as:
- lunch meat
- aged cheeses
Things to keep in mind
It’s important to have a thorough discussion with your mental healthcare team about potential side effects, drug interactions (if you’re currently taking medication), and any other concerns you may have about taking medication.
It’s also important to take your medication as prescribed. For example, abruptly stopping an SSRI, SNRI, or TCA can trigger discontinuation syndrome, also known as withdrawal.
During withdrawal, you may experience:
- flu-like symptoms
If you’d like to stop taking your medication, talk with your doctor about how to do it gradually.
Some home remedies and lifestyle changes may help you manage agoraphobia symptoms by reducing everyday anxiety.
Exercising regularly may help lift your mood and relieve stress, which may reduce feelings of anxiety.
Doing activities you enjoy — whether walking, biking, or yoga — can provide meaning and focus attention away from your condition.
Practice breathing and relaxation skills
If you experience panic attacks as part of your agoraphobia, these techniques can help you feel grounded.
You can ask your primary care physician or therapist for specific breathing or relaxation exercises.
Alternatively, you can find many guided meditation exercises on YouTube or download a meditation app.
Here is one breathing exercise you may want to try if you experience a panic attack:
- Deeply inhale for a count of 4.
- Hold your breath for 1 second.
- Exhale on a count of 4.
- Repeat this exercise until you feel calmer.
Avoid alcohol and other substances
Some people with agoraphobia may use substances to manage their anxiety, but this can worsen the condition.
For instance, alcohol may affect your sleep and spike anxiety as the effects wear off. Caffeine can heighten physical sensations associated with anxiety.
If you find it difficult to quit alcohol or other substances on your own, talk with your healthcare team. Your primary care doctor or therapist can work with you to create a quit plan.
You can also join online support groups for connection and advice.
Work through a self-help book
Self-help books may help you gain a deeper, fuller understanding of agoraphobia and learn the specific tools and skills to get better.
For example, Anxiety UK offers a free agoraphobia workbook that you can download at this link. Keep in mind that this workbook may be outdated.
The Moodjuice self-help guide for panic and agoraphobia may be another useful free resource.
You can also ask your therapist, if you have one, for recommendations. You can also check in with folks in support groups or forums for people with agoraphobia to see which resources they’ve found helpful.
There’s no shame in living with agoraphobia, and no need to hide that you have it. Being open about your condition with people you trust may give you additional strength to practice things you learned in therapy or elsewhere.
Reducing your reliance on safety behaviors, such as bringing others with you, may be an important goal as part of your treatment.
Of course, there’s nothing wrong with surrounding yourself with supportive people — people with whom you can talk, celebrate successes, and discuss challenges.
These supportive people may be family members or close friends, or others you feel comfortable talking with, like a pastoral counselor if you’re a member of a religious community.
You may also find it helpful to attend a support group or use an online forum to meet others with the condition, share your experiences, trade tips, and remember that you’re absolutely not alone.
Try a mental health app
Mental health apps specifically for people with agoraphobia aren’t very common, though some do exist.
So, if you can’t find an agoraphobia app that works for you, try expanding your search to include apps designed to:
- help people with anxiety
- help people with panic disorder
- help people going through CBT, such as by offering a thought diary
- help people learn how to meditate
While these apps may not be specifically designed for people with agoraphobia, they may still help you reduce feelings of anxiety and stress, which may help you feel better overall.
If you prefer personal recommendations, ask your treatment team or people living with agoraphobia in forums or support groups which apps they’ve found particularly helpful.
Be kind to yourself
It’s common for people with mental health conditions to get frustrated with the symptoms they’re experiencing and the effects the condition may have on their life.
You may even feel like you’re the only one who feels this way and who experiences these symptoms and reduced quality of life. But you’re not.
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When you experience feelings of frustration and maybe even anger, remind yourself that you’re not alone. Remember your strengths and the progress you’ve already made — no matter how small it may seem.
Being kind to yourself and staying positive may help you reach your goals better than negative self-talk.
If you’re ready to discuss your agoraphobia symptoms, effects on your life, and possible treatment options with a doctor, it’s important to be your own advocate.
Jot down any questions you want to ask before your first appointment. Some things you may want to ask about include:
- What kind of therapy would you recommend, and why?
- Are medications an option for me? If so, which ones?
- How long will it take until the medication begins to work?
- What are possible side effects of this medication?
- Should I avoid anything when taking this medication or when following this therapy?
- What if I have a severe reaction to a medication?
- Can you recommend a mental health app?
- Do you know of any local support groups?
- Can you recommend a self-help book?
- What can I do in a crisis?
Basically, you want to bring up anything that concerns or interests you. This is your health journey, and you deserve to speak up and be heard.
Psychotherapy, particularly cognitive behavioral therapy (CBT) and exposure-based therapy, are considered the treatment of choice for people with agoraphobia. These types of talk therapy may offer long-term benefits.
Some medications may also be helpful, especially if you experience symptoms of panic.
Lastly, self-help strategies like regular exercise or meditation may help reduce symptoms as well. You may also want to try a mental health app or work through a self-help book.
Don’t be afraid to discuss your condition with your doctor or therapist. Together, you can find the treatment plan that works best for you.