Agoraphobia has two different definitions. Some describe it as the fear of going outside or to unfamiliar places. Others describe it as the fear of being "unable to escape" to a place of comfort. They're both related to the same issue - feeling uncomfortable in unrecognized places - and they are both caused by panic attacks.
When psychologists and doctors diagnose panic disorder, they use one of two terms: Panic disorder with agoraphobia and panic disorder without agoraphobia. Those without agoraphobia have a slight advantage, because they haven't yet developed habits that may make it more difficult to treat anxiety.
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Agoraphobia is Called More Severe Panic Disorder
Some claim that those with agoraphobia have "severe" panic disorder, while those without agoraphobia have less severe panic disorder. This is fairly misleading though because many of those with panic experience profound panic attacks that simply don't cause the same ultimate reaction in their life.
A good way of testing the severity of your panic attacks is with my free anxiety test. But regardless, it is clear that those that have panic disorder without agoraphobia can still experience severe anxiety and panic - arguably as severe as those with agoraphobia.
However, panic disorder without agoraphobia may be slightly easier to treat. That's because the willingness and ability to be out and do things necessary to control your panic can be extremely advantageous. Both can be treated, but those without agoraphobia may have the upper hand slightly.
Panic Disorder Treatments
Treatments for panic disorder without agoraphobia vary. There are many alternative treatments available, although most are ineffective and possibly counterproductive. There are also many medical treatments, but some have side effects and are certainly not for everyone. Below is a list of potential treatments, along with more information about their efficacy:
Therapy is, by far, the most effective treatment available. It's 100% natural, and it's been researched thoroughly. This is especially true of cognitive behavioral therapy, which is believed to be the most effective type of therapy available.
Of course, even CBT is not for everyone. It's extremely expensive and time consuming, and you need to find a therapist that you trust. No therapeutic option is a guarantee either, and therapy can never be done in the comfort of your own home. This is not a knock on therapy - it is still arguably the best choice - it's just not one that everyone can use.
The demonization of medications is not entirely fair. There are many very effective medicines for anxiety, and while almost all of them have some upsetting side effects, often those side effects are worth the risk. Benzodiazepines and antidepressants are the most common medications for panic attacks.
The problem with these medications isn't the side effects or the fact that they're unnatural. The problem is that they don't actually address the panic attacks, and someday you'll need to still learn how to control them:
- Benzodiazepines and other anxiety medications can grow ineffective over time.
- Panic attacks can be caused by fearing panic attacks, which is inevitable if you ever quit the medication.
- Time spent on medicine is time not spent learning new coping tools, which may cause setbacks in the future.
- Medications can cause personality changes and fatigue that may mean that you're still living a lower quality of life.
If your doctor says that you need to take a medication for anxiety to treat your panic disorder, then you may want to take the medicine. But you should note that it's crucial that you combine any medication with a long term, non-medicinal treatment, otherwise the medication may do more harm than good in the end.
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Herbal medicines may be "natural" but they have the same problems as traditional medicines. There may be some side effects (although these tend to be weaker than pharmaceutical medications), the effects tend to be less strong, and if you stop taking the herbs it's possible that the panic attacks will come back. Still, they represent an interesting and potentially effective solution for those that prefer to avoid modern medications. The most popular include:
Kava appears to have the most research support. Talk to your doctor before trying any herbal medications for anxiety, as they may interact with any other medicines you may be taking. Never double up.
Exposure therapy - which can be done in the comfort of your own home - is another tool that some people use as a treatment for panic disorder without agoraphobia. Exposure is when you take the triggers that cause your anxiety and perform them on purpose until you eventually stop fearing the triggers. Some examples include:
- Forced Hyperventilation Since most of the symptoms of panic disorder are the result of hyperventilation, hyperventilating on purpose is a possible tool to get used to the feeling. It's not pleasant by any means and can actually trigger a panic attack, but if you try hyperventilating on purpose you can get used to the symptoms and if you find yourself hyperventilating it should cause less anxiety.
- Dizziness Dizziness and lightheadedness are also panic attack triggers. Spinning in a circle can get you more used to dizziness. If you do it often enough, it may cause no fear, and possibly limit or even prevent any panic attack from becoming triggered by the experience.
- Forced Thoughts It's not that common for recurring thoughts to create panic attacks, with the exception of a fear of panic attacks themselves (or health conditions because of health anxiety). But if you seem to have thoughts that cause you distress that ultimately trigger attacks, you can try thinking those thoughts on purpose until they no longer bother you.
These are examples of ways to get used to your anxiety triggers, and if you can get used to your triggers you can potentially reduce the frequency and severity of your panic attacks.
A sad statistic about panic disorder is that only 24% of those suffering are receiving what's known as "minimally effective treatment." That's because only 60% of those with panic attacks even seek treatment, and of those most try alternative therapies that have been proven ineffective.
Many people seek out alternative therapies as a way to reduce panic disorder. In some cases these therapies can be very helpful. In other cases they can be harmful or do nothing.
Alternative therapies can be fairly risky because many are the result of the placebo effect. The placebo effect is far more powerful than many realize, and is often used as a tool of marketing. Find enough people that tell you a product works, and it vastly increases the probability the product works.
Alternative panic disorder treatments are problematic. On the one hand, if it cures your panic attacks, then who cares if it is a placebo? What harm is there to a fake treatment if it works? But on the other hand:
- Placebo treatments generally do not work for very long, and in some cases the time you spend on an alternative treatment is time not spent on a panic disorder treatment that actually works.
- Those that try one alternative treatment are more likely to try other alternative treatments, which means that they may be delaying their treatment for such an extensive period of time that treating panic attacks in the future becomes more difficult.
- Those that are cured of their panic because of placebo are more prone to telling others about its success. That spreads the idea that the treatment works, which can cause setbacks for other people that don't receive the placebo benefits.
- Many panic treatments claim to be essentially miracle cures that work right away. Depending on some type of instantly effective treatment and not making the necessarily life changes to keep panic attacks away can be harmful for your long term mental health.
- Some of these treatments may be genuinely dangerous, like depending on an herb that hasn't been tested or using it in large quantities with other herbs.
This is not to say you should avoid alternative treatments. Rather, view them as a skeptic, and remember that there are always traditional and effective approaches for anxiety reduction available.
Finding the Right Treatment for Your Panic Disorder w/o Agoraphobia
As mentioned, those that don't have agoraphobia have an extra advantage. They can look at attacking their panic attacks without the setbacks that come from agoraphobic problems.
But you still need to take a complete approach to reducing your panic disorder and you need to make sure that you're actively committed to your treatments and focused on your recovery. Panic disorder is treatable, and those that seek out the right treatment and focus on coping tools are more likely to find success in treating their anxiety in the long run.
I've helped many people with panic disorder without agoraphobia reduce their anxiety symptoms forever. Start with my free anxiety test, that will look at your symptoms and then recommend the appropriate treatment response.
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Barlow, David H., et al. Behavioral treatment of panic disorder. Behavior Therapy 20.2 (1989): 261-282.
van Balkom, Anton JLM, et al. A meta-analysis of the treatment of panic disorder with or without agoraphobia: a comparison of psychopharmacological, cognitive-behavioral, and combination treatments. The Journal of nervous and mental disease 185.8 (1997): 510-516.