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5 - The Cognitive Behavioral Treatment of Agoraphobia

from Part One - Cognitive Behavioral Therapy for Anxiety Disorders

Published online by Cambridge University Press:  06 January 2022

By
Vijaya Manicavasagar  and
Derrick Silove
Edited by
Gillian Todd  and
Rhena Branch
Gillian Todd
Affiliation:
University of East Anglia
Rhena Branch
Affiliation:
University of East Anglia
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Summary

Agoraphobia is characterized by the avoidance of places such as shopping centers, bridges, tunnels, and crowds due to fear of experiencing intense and often debilitating anxiety symptoms and is commonly diagnosed in young to middle-aged adults and women. When entrenched, agoraphobia imposes severe restrictions on the person’s capacity to venture out of the home. Evidence supports the use of CBT in treating the disorder. Key elements of intervention include psychoeducation, cognitive restructuring, breathing retraining to curtail panic symptoms, strategies to reduce general physical symptoms of anxiety, exposure to interoceptive anxiety-provoking stimuli, and, crucially, gradual in vivo exposure to overcome avoidance. Medications, particularly the SSRI class of drugs, may add to the effects of CBT in some patients. Sole treatment with SSRIs may be necessary where patients are unable or unwilling to pursue CBT. Treatment outcomes are more favorable when a management plan is developed collaboratively with a motivated patient and with partners and family involved in treatment. Booster CBT sessions may improve treatment outcomes. Recent developments include online programs, apps, and virtual reality platforms to facilitate exposure to anxiety-provoking situations within a CBT framework. Alternative forms of psychotherapy should be considered if CBT has little impact.

Keywords

agoraphobiacognitive behavior therapyanxiety disorderpanic avoidance behaviorsfearfear of fearexposure hierarchycognitive restructuring
Type
Chapter
Information
Evidence-Based Treatment for Anxiety Disorders and Depression
A Cognitive Behavioral Therapy Compendium
 , pp. 75 - 92
Publisher: Cambridge University Press
Print publication year: 2022

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