Agoraphobia and panic attacks: What really helps

Agoraphobia and Panic Attacks: These Therapies help

Klaus Bernhardt
by Klaus Bernhardt

People suffering from agoraphobia often react with fear or even panic in the following situations:

  • When crossing large squares
  • When riding on public transportation
  • When being in large crowds
  • When driving in heavy traffic or on the highway
  • When waiting in long lines at supermarket checkout counters

Good to know:

In agoraphobia, the fear is NOT triggered by a real threat, but only by constantly brooding about what COULD happen.

In severe agoraphobia, even a brief thought of possibly being confronted with a fearful situation is often enough to trigger a whole range of anxiety symptoms. These include:

  • Sweating or shivers of cold
  • An unbearable feeling of helplessness
  • Sudden tingling sensations in arms and legs
  • Pressure on the chest, lump in the throat up to shortness of breath
  • Drowsiness up to the feeling of fainting
  • Heart palpitations, often associated with the thought that one is about to have a heart attack
  • Panic attacks, associated with acute fear of death. Those affected have the feeling that they will die at any moment.

How agoraphobia is treated depends, among other things, on whether those affected “only” experience strong fears or whether increased panic attacks have already occurred in fearful situations.

While agoraphobia without panic attacks is often still treated without the use of psychotropic drugs, antidepressants and/or strong tranquilizers are often used for agoraphobia with panic attacks. However, drug treatment of anxiety disorders is not without risks. Because such pharmacotherapy can be both addictive and lead to severe side effects. Fortunately, a new form of therapy has been available for a few years now that does not require any psychotropic drugs at all and yet usually leads to a significant reduction in the feeling of anxiety. Learn more about this new therapy against agoraphobia.

Do not replace one evil with another!

Which therapy helps best against agoraphobia?

For a long time, exposure therapy was considered the treatment of choice for agoraphobia. This is usually carried out as part of cognitive behavioral therapy. If those affected also suffer from recurring panic attacks, antidepressants and/or strong tranquilizers, so-called benzodiazepines, are usually used.

This combination of psychotherapy and pharmacotherapy is still the treatment most often used. But it is by no means the only way to get rid of agoraphobia. A much gentler and faster way is, for example, Solution-Focused Therapy (SFT) or the Bernhardt Method, which we will introduce to you in a moment.

Exposure therapy: what affected persons can expect

By regularly “facing their fears”, anxiety patients should learn that neither the situation is threatening nor they themselves are helpless, but that the phobia is only a product of their own fears of expectation. All the feared symptoms, such as palpitations, tingling sensations, breathing difficulties or the unbearable feeling of helplessness may seem life-threatening, but in reality they do not pose a threat to life and limb at any time.

So much for the theory. Unfortunately, even the relevant professional literature points out that the implementation of exposure therapy often proves difficult.

In practice, however, true freedom from anxiety is rarely achieved through exposure therapy. Although those affected are able to function within society again, the oppressive feelings are usually still present subliminally. Therefore, for many agoraphobics, it is only a matter of time before they gradually return to avoidance behavior. After all, no one likes to voluntarily stay in situations that still trigger unpleasant feelings, even if they have learned not to take them quite so seriously anymore.

What does avoidance behavior lead to in agoraphobia?

Avoidance behavior is always present when a fear-inducing situation, such as attending public events or crossing large squares, is completely avoided. Unfortunately, such avoidance strategies do not reduce the symptoms of anxiety in sufferers, but rather ensure that the phobia spreads to more and more areas of life. This is one of the reasons why sufferers often try to regain at least a little bit of normality from time to time with the help of strong tranquilizers.

A mistake many don't even know they are making

Agoraphobia: The problem with safety signals

Another problem is the use of so-called safety signals. For an agoraphobic, this can be, for example, the presence of another person whom they trust, such as their partner or even a therapist. But also calming tablets or a lucky charm are suitable as a safety signal. If this is present during exposure therapy, the feeling of anxiety may be significantly reduced, since there is something or someone within reach who gives one a sense of security. On the other hand, the absence of a safety signal can actually fuel the anxiety. It is not uncommon for sufferers to have a panic attack precisely when they realize that they have left the house without having a tranquilizer tablet with them for emergencies. In this respect, the long-term goal of any therapy should be to enable patients to do without safety signals altogether.

New therapy for agoraphobia: gentler and faster freedom from anxiety

One form of therapy with which anxiety patients are usually very quickly able to significantly reduce all symptoms of agoraphobia and even completely overcome them in the long term is the so-called Bernhardt-Method. Without confrontation and without medication, those affected learn special mental techniques through which the neuronal programming of the fear is literally erased. One of the reasons why this works so well is that agoraphobics usually do not want to avoid real threats, but only the thought of what could happen triggers the fear reaction and even a panic attack.

However, if pure fantasies can turn healthy people into anxiety patients, then logically there must be other fantasies that reverse this process. And this is exactly what the Bernhardt Method is about, which was developed a few years ago at the Institute for Modern Psychotherapy in Berlin, Germany. For those who want to learn more about this innovative self-therapy, we recently launched our online video course “The Anxiety Cure”. Get started right now, the first episode is free.

Recognizing and making the most of the power of neuroplasticity

Targeting neuroplasticity against anxiety disorders

Neuroplasticity is the ability of the human brain to form new networks even at an advanced age. Literally every single thought in the brain gives rise to new connections. Things that we think often can be recalled more and more easily, while thoughts that are rarely or never thought are neurally degraded.

Good to know:

Anyone who constantly thinks about what could happen in the worst case scenario will sooner or later have their brain automate the occurrence of fear in situations that are actually completely harmless.

What the brain of an agoraphobic has largely unlearned, however, are thoughts with the following content:

  • Staying relaxed in large crowds of people
  • Ride unaccompanied on public transportation
  • Drive even on the highway in heavy traffic
  • Participate in everyday life again without avoidance behavior
  • Fly relaxed on vacation
  • Cross large squares without claustrophobia
  • Go to parties or take part in family celebrations in a relaxed manner
  • Wait relaxed at the checkout in the supermarket

Good to know:

Stimulating neuroplasticity in a targeted way, so that a brain trained for anxiety reconnects in such a way that it responds with ease instead of panic, is one of the most promising avenues in psychotherapy.

And in fact this approach (e.g. in cognitive behavioral therapy) has been around for a long time, but with a crucial difference to the Bernhardt Method. In the Bernhardt Method, thanks to the latest findings in brain research, it was possible to develop mental exercises that maximally accelerate the positive rewiring of the brain. In concrete terms, this means that a significant reduction in anxiety does not require 25 or even 50 hours of therapy, as is usually the case, but that the same result can be achieved after just 7 or 8 hours. Since this method is also suitable for self-therapy and can be learned quite comfortably from home with the help of an online video course, there is also no need to wait months for a therapy place – a not inconsiderable advantage, especially for people with agoraphobia.

Online video course THE ANXIETY CURE start now for free

How to recognize an agoraphobic

Agoraphobia leads to pronounced avoidance behavior. This is because the longer someone suffers from this panic disorder, the greater the fear of a possible loss of control. Therefore, agoraphobics usually develop very sophisticated avoidance strategies in order not to be confronted with fearful situations. In this way, many also try to keep their anxiety disorder a secret for as long as possible. This creates a vicious circle that is often difficult for outsiders to understand. Anxious situations such as air travel are avoided because those affected can no longer seem to reconcile boarding an airplane with their ecological conscience. Large gatherings of people, such as family celebrations or company parties, are also no longer attended because people are supposedly still angry with some uncle or colleague.

However, at first hardly anyone suspects that these are usually just pretextual reasons for not having to admit publicly that one suffers from a panic disorder. However, if you stay away from social events for too long, you become more and more socially isolated. As a result, there is a risk that agoraphobia will be joined by depressive moods, because regular social contact is an essential component of a healthy psyche.

Agoraphobia: Take first warning signs first

Particularly in the initial phase of agoraphobia (whether with or without panic attacks), the reasons why people avoid the feared situations usually sound quite plausible. But if the avoidance behavior expands over time to such an extent that, for example, buses and trains are avoided in addition to airplanes, then all alarm bells should be ringing.

Even if invitations to parties are gratefully accepted, but the person repeatedly fails to appear, it is likely that someone has been suffering from a panic disorder for some time. Talking to someone in private about their suspicions and showing understanding has helped many an agoraphobic to get out of their self-imposed isolation.

the truth about agoraphobia

What exactly does agoraphobia mean?

The word agoraphobia is composed of the ancient Greek word for marketplace “agora” and the word “phóbos”, which also comes from ancient Greek and means fear or anxiety. Agoraphobia therefore literally means: fear of places where there are many people.

But the term is actually misleading. As a rule, sufferers do not really fear other people or public spaces. Agoraphobics are only constantly afraid of having another anxiety attack and then being observed or even prevented from escaping the situation. 

Medication for agoraphobia: why caution is advised

Until now, both sufferers and many psychotherapists and psychiatrists assumed that the treatment of agoraphobia was usually protracted and had to be supported by medication. This was especially true when severe panic attacks pushed patients more and more into avoidance behavior. If those affected then try (often out of shame) to somehow cope with fearful situations with the help of tranquilizers (benzodiazepines), they often end up in a dangerous vicious circle.

But this strategy unfortunately has a huge catch: these drugs do not change the cause of the problem, they only suppress the feeling of fear for a short time. In addition, this usually delays real therapy for an unnecessarily long time, which means that the agoraphobia can become more and more widespread. This means that more and more situations, which used to be mastered without any problems, suddenly feel threatening and unreal. Whereas in the past people only took tranquilizers now and then, they now take the medication every day in order to at least do something about the drowsiness, the breathing difficulties and the increased heart rate.

But this neither reduces the frequency of anxiety attacks nor the feeling of fainting. Rather, there is a risk that the anxiety disorder will be joined by another problem, namely a physical dependence on medication. If you then want to stop taking the tranquilizers abruptly (which we urgently warn against, as they should always be discontinued under medical supervision!), your body and psyche will react with severe withdrawal symptoms in the form of dizziness, rapid heartbeat, drowsiness, shortness of breath as well as extreme panic attacks and the feeling of going crazy.

To take or not to take, that is the question here

Antidepressants for agoraphobia: major problems due to discontinuation syndrome

Antidepressants, which are also frequently used for agoraphobia and panic attacks, are also coming under increasing criticism. Although pharmaceutical companies still vehemently refuse to admit that these drugs also pose the risk of psychological dependence, the so-called “discontinuation syndrome” can no longer be denied. Those affected then suffer from anxiety attacks again during the discontinuation phase, although the anxiety disorder has actually already been overcome. However, since the rekindled anxiety may last for several weeks or even months, many sufferers believe that the missing medication is the cause for the renewed appearance of anxiety and panic, and return to their original medication. This is a vicious circle that often causes agoraphobics to take antidepressants unnecessarily, sometimes for decades. In fact, they only suffer from a discontinuation syndrome, i.e. temporary psychological withdrawal symptoms triggered by stopping the medication.


To avoid a discontinuation syndrome as far as possible, antidepressants (as well as benzodiazepines) should be phased out very slowly and under medical supervision.

Of course, it is even better if they do not become dependent on psychotropic drugs in the first place. Instead, choose a form of therapy that does not use medication at all. Medication only suppresses the symptoms of an anxiety disorder anyway. You can only find and overcome the real triggers, however, if you find the form of psychotherapy that suits you and work with it.