Treatment of Phobias: Agoraphobia, Social Phobia, Specific Phobias

Discover how therapy and medications are used in the treatment of phobias - agoraphobia, social phobia, specific phobias.

Treatment of phobias involves behavior therapy, medication, and counseling.

Agoraphobia

Treatment of agoraphobia involves

• patient education,
• behavior therapy (exposure with response prevention), and
• medication.

Patients need to understand their condition and receive reassurance that they are not "going crazy" and that their condition can be managed. Because they may have received some explanation that their symptoms are caused by a medical disease, they need to be educated about agoraphobia.

Exposure with response prevention is a very effective behavior therapy for people with agoraphobia. In this treatment, the patient (1) is exposed to a situation that causes anxiety or panic and then (2) learns to "ride out" the distress until the anxiety or attack passes. The duration of exposure gradually increases with each session. This treatment works best if the patient is not taking tranquilizers because tranquilizers can prevent the experience of anxiety.

Antidepressant medications (except bupropion, Wellbutrin ®) have been shown to reduce the occurrence of panic attacks. Some studies have shown paroxetine (Paxil ®) to be quite effective.

Benzodiazepines are effective in treating anticipatory anxiety as well as symptoms of panic attacks.

Social Phobia

Treatment of social phobia involves

• behavior therapy (exposure with response prevention)
• social skills training, and
• medication.

Most people benefit from combining medication with supportive counseling or group therapy. Also, avoiding alcohol and drugs is of particular importance for people with social phobia, because social withdrawal and isolation typically accompany substance abuse.

Exposure with response prevention is an effective treatment for social phobia. It is particularly useful in a group therapy setting, which can provide a social or performance situation for the patient.

In social skills training, first, the sills lacking are identified. The patient is then taught appropriate skills. They practice skills in a group therapy setting and then practice them in social situations they encounter in their daily activities.

Medications used to treat social phobia include:

• Paroxetine and other SSRIs
• Beta-blockers
• Monoamine oxidase inhibitors (MAOIs)
• Benzodiazepines

Paroxetine (Paxil ®), an SSRI antidepressant, has been shown to be particularly beneficial to adults with social phobia. This class of drugs is also used to treat generalized anxiety disorder and panic disorder. These drugs work by altering levels of serotonin (a neurotransmitter that affects many behavioral states), which helps reduce anxiety.

Beta-blockers prevent norepinephrine from binding to nerve receptors in many areas of the body. They slow the heart rate and are effective in reducing physical symptoms such as nervous tension, sweating, panic, high blood pressure and shakiness. Although the FDA (food and drug administration) has not approved beta-blockers for the treatment of social phobia, psychiatrists may prescribe them. They are effective in reducing symptoms performers experience with "stage fright."

Some small studies have shown monoamine oxidase inhibitors (MAOIs) to be helpful in treating social phobia. They are used to treat other psychiatric disorders, including major depressive disorder.

Benzodiazepines may also help control social phobia. They are used frequently to treat many anxiety disorders, including generalized anxiety disorder.

Specific Phobias

Treatment of specific phobias involves:

• exposure and response prevention,
• progressive desensitization, and
• medication.

There is a wealth of evidence that suggests that exposure and response prevention is the most effective treatment for specific phobias. This form of treatment is used to treat other anxiety disorders, including obsessive-compulsive disorder.

Progressive desensitization is not as effective as exposure and response prevention, but is used in people with specific phobias who have great difficulty facing the object or situation that causes their fear. This treatment involves learning relaxation and visualization techniques. The patient is exposed to the source of fear gradually. For instance, a person with fear of heights looks down from a second-story window of a skyscraper. Once the person begins to experience anxiety, they are removed from the situation. They then learn to visualize being in the situation without experiencing anxiety. Once they are able to look out that window without experiencing anxiety, they move up to the third-story window, and so on.

Benzodiazepines have been known to reduce anticipatory anxiety in people with specific phobia. For example, people who are afraid of flying may find that these drugs help control their fear and make flying possible.

SSRIs, like Paxil (Paroxetine), can be effective in controlling specific phobias. These drugs may be particularly helpful in people whose phobia interferes with their ability to function in normal daily activities, like riding the train to work or speaking in front of groups.

Sources:

• Hahlweg, K., W. Fiegenbaum, M. Frank, and others. "Shortand Long-Term Effectiveness of an Empirically Supported Treatment for Agoraphobia." Journal of Consultative Clinical Psychology 69 (June 2001): 375-382.
• Walling, Anne D. "Management of Agoraphobia." American Family Physician 62 (November 2001): 67.
• National Institute of Mental Health (NIMH). Anxiety Disorders. NIH Publication No. 00-3879 (2000).
• Zoler, Mitchel L. "Drug Update: SSRIs in Social Phobia." Family Practice News31 (February 1, 2001): 28.
• Bourne, Edmund J., Ph.D. Beyond Anxiety and Phobia: A Step-by-Step Guide to Lifetime Recovery.Oakland, CA: New Harbinger Publications, 2001.
• Antony, Martin, M., Ph.D., and Richard P. Swinson. Phobic Disorders and Panic in Adults: A Guide to Assessment and Treatment.Washington, DC: American Psychological Association, 2000.

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