Psychological therapy for agoraphobia: what is it and how does it work?

Agoraphobia is an anxiety disorder characterized by anticipatory anxiety for fear of having a panic attack in public. The person is also afraid of being in a public place and not being able to “run away”. Therefore, psychological therapy for agoraphobia must be very focused on treating the cognitive variables that influence the perpetuation of the disorder..

In this article, in addition to explaining the general characteristics of agoraphobia, we will learn what cognitive behavioral therapy for agoraphobia (considered to be a first-choice treatment) is, how it works and what are its six components. fundamentals.

Agoraphobia: what is it?

Agoraphobia is an anxiety disorder that involves the fear of being in public places or in situations where it is difficult or compromised to escape.. There are also concerns about being in places where it is difficult to get help with a panic attack or similar symptoms. In other words, fear occurs in public places, and not as open as it is often thought.

Thus, because of this fear, situations involving being in these places are avoided or resisted with great discomfort; in the event of a confrontation, the agoraphobic person is generally accompanied. On the other hand, two characteristic elements which generally include the concept of agoraphobia are: multifobia (having several phobias at the same time) and phobophobia (being “afraid of fear” or afraid of one’s own anxiety).

Classification in textbooks

As for its location in the various reference manuals, agoraphobia is a disorder that has undergone certain changes in the editions of the DSM (Diagnostic Manual of Mental Disorders). Thus, in the third edition of the same (DSM-III) and in ICD-10 (International Classification of Diseases), agoraphobia has been classified as an independent disorder, and may or may not be accompanied by panic disorder (usually in severe cases). case).

In DSM-III-R and DSM-IV-TR, however, agoraphobia is part of a larger panic disorder.. Finally, in the current DSM-5, agoraphobia and panic disorder become independent of each other for the first time, and become two differentiated disorders.

Psychological therapy for agoraphobia

There are three treatments of choice for treating agoraphobia: live exposure, cognitive behavioral therapy and pharmacotherapy (Use of selective serotonin reuptake inhibitors [ISRS]). In this article, we will focus on the psychological therapy of agoraphobia from a cognitive behavioral perspective, which is why we will talk about the second treatment of choice mentioned: cognitive behavioral therapy.

This type of therapy is considered well established for treating agoraphobia, according to reference textbooks on treatment effectiveness; that is, the research results support it as an effective and safe therapy. Thus, it provides positive results to treat this disorder.


Psychological therapy for agoraphobia from a cognitive-behavioral orientation usually includes a number of specific components. Let’s see what they are and what they consist of.

1. Psychoeducation

Psychoeducation consists in “educating” the patient in his pathologyThat is, to provide you with the right information so that you can understand your disorder, its etiology, the factors that encourage you to stay, etc. So, in the psychological therapy of agoraphobia, this education will mainly focus on anxiety and panic.

The aim is for the patient to have the information necessary to understand why this is happening to him and for him to learn to differentiate certain concepts which can sometimes be confusing. This information can help you reduce your uncertainty as you feel calmer.

2. Respiratory techniques

Breathing is an essential factor in anxiety disordersLike learning to control, it can greatly help reduce anxiety symptoms. In agoraphobia, this is particularly important, because precisely what one fears is having a panic attack in places where it is difficult to receive help; these panic attacks are characterized by the presentation of a large number of physical and neurophysiological symptoms associated with anxiety.

This is why having strategies for better breathing and being able to exercise controlled breathing can help the patient to prevent the anxiety symptoms characteristic of not only panic attack, but also agoraphobia itself, as patients with agoraphobia begin. to think that they will have a panic attack and this is causing them anxiety symptoms.

3. Cognitive restructuring

Cognitive restructuring is another key part of psychological therapy for agoraphobia, as it helps to change the patient’s dysfunctional and unrealistic thoughts, into the belief that they can experience a panic attack at any time (or when they are is on display in a public place).

In other words, cognitive restructuring will focus on modifying these thoughts and beliefs., And also to correct the cognitive distortions of the patient (for example by thinking “if I take the bus and it gives me a panic attack, I will die right here, because no one will be able to help me”, or “if I leave at the party and it gives me a panic attack, I’m going to be very embarrassed, because I’m going to be overwhelmed and I won’t be able to get out of here.

The goal is for the patient to learn to develop more realistic alternative thoughts that help them cope with situations in a more adaptive way and that help reduce their anxiety or anticipatory discomfort.

4. Interoceptive exposure

Interoceptive exposure involves the patient being exposed to anxiety symptoms that cause a panic attack., But by other mechanisms (ie produced artificially, by simulating them). These symptoms are induced in the patient (in fact, he is usually induced himself) by different strategies, such as turning in a chair (to feel dizziness), performing cardiovascular exercises (to increase the pace). Cardiac), inhale carbon dioxide, hyperventilate, etc.

The goal of interoceptive exposure is to weaken the association between the patient’s specific body signals in relation to their body and the panic reactions (panic symptoms) that they manifest. This type of exposure is based on the theoretical basis which considers panic attacks as alarms actually learned or conditioned in the face of certain physical signals.

5. Live self-exposure

Live self-exposure, the fifth component of psychological therapy for agoraphobia, it consists in exposing the patient to the real situation generated by fear or anxiety. That is, going to public places where “it is difficult to escape” and doing it alone.

In addition, you should not run away from the situation (unless the anxiety you are feeling is exaggerated). The objective is, on the one hand, to empower the patient to resolve his disorder and, on the other hand, to “learn” that he can cope with these situations without suffering panic attacks. This type of exposure will also help the patient to understand that being ashamed to “run away” from a place is not so relevant, and that this can be put into perspective.

6. Records

Finally, the last element of psychological therapy for agoraphobia is the record; in them (self-registrations), the patient will have to note different aspects depending on what the therapist asks him and the technique used.

These are usually daily records that aim to collect relevant information from the patient, in relation to the times when they experience anxiety (with their history and consequences), the number of panic attacks that they experience. he experiences, the dysfunctional thoughts, the degree of discomfort associated with them. , alternative thoughts, etc. Logs can be of different types and are a very important tracking tool.


As for the effectiveness of agoraphobia psychological therapy, it can be affected and decreased if the time spent on the live exposure component is reduced.

On the other hand, an advantage of the cognitive behavioral therapy we are talking about, aimed at treating agoraphobia, is that tends to produce fewer dropouts and relapses in terms of panic attacks, compared to live exposure.

This is due to the fact that the direct exposure is a more “aggressive” type of therapy, where the patient is really exposed to the situation or situations that he fears; in psychotherapy, on the other hand, the operation is different and much less invasive or disturbing for the patient.

Bibliographical references:

  • American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Panamericana.

  • Horse (2002). Manual for the cognitive-behavioral treatment of psychological disorders. Flight. 1 and 2. Madrid. 21st century.

  • Pérez, M., Fernández, JR, Fernández, C. and Amic, I. (2010). Guide to effective psychological treatments I and II :. Madrid: Pyramid.

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