Fast Five Quiz: Common Phobias

Stephen Soreff, MD

Disclosures

October 20, 2020

Treatment of phobic disorders usually consists of psychotherapy, pharmacotherapy, or some combination thereof. Controlled studies have found behavioral therapy and CBT to be effective in treating phobic disorders. Computerized CBT has been recommended for panic and phobia by the National Institute for Health and Clinical Excellence guidelines. In some specific phobias, behavioral therapy using desensitization techniques has been effective. In other cases of specific phobia, psychodynamic-orientated therapy has helped patients deal with past traumatic events.

Pharmacotherapy recommendations differ for social anxiety disorder and specific phobias. As a general rule, although both medication and psychotherapy are the first-line treatment for social anxiety disorder, pharmacotherapy is not first-line treatment for specific phobias. The efficacy of psychopharmacologic intervention for specific phobias has not yet been fully assessed.

Overall, SSRIs appear to be more effective than MAOIs for the treatment of social anxiety disorder. SSRIs and venlafaxine are generally considered first-line agents, whereas benzodiazepines, tricyclic antidepressants, and MAOIs are considered second-line agents. Self-exposure monotherapy has been shown to work as well as computer-based exposure training, clinician-led exposure, or combination therapies of self-exposure and CBT/self-help manual.

Agoraphobia has been shown to respond to treatment with SSRIs, venlafaxine and reboxetine, some tricyclic antidepressants, and some benzodiazepines. Agents with unproven efficacy in this setting include buspirone, propranolol, antihistaminic drugs, and antipsychotic agents. Treatment for agoraphobia should be started with an SSRI at a low dosage, which is then titrated to the minimum dosage that effectively controls the patient's panic. Benzodiazepines can be used either as an adjunct or as primary treatment; however, they are usually not chosen as first-line therapy because of the potential for abuse. A combination of exposure therapy, relaxation, and breathing retraining has shown success in panic disorder with and without agoraphobia.

Read more about the treatment of phobic disorders.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases article Phobic Disorders.

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