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Home-Based CBT for Agoraphobia — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersHome-Based CBT for AgoraphobiaMRCPsych Paper B

A 34-year-old with panic disorder and marked agoraphobic avoidance continues to have significant symptoms despite two previous treatment interventions. Following specialist reassessment, they agree to cognitive behavioural therapy but cannot attend the clinic because leaving home provokes severe anxiety. According to NICE guidance, which approach is most appropriate?

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Reveal the answer and explanation

Correct answer: A — Offer home-based CBT with an experienced therapist

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · C = shown as D

B is correct. NICE CG113 recommends that specialist management of persistent panic disorder should be individualised and may include CBT with an experienced therapist, including home-based CBT when clinic attendance is difficult. Severe agoraphobic avoidance is therefore an engagement barrier around which treatment should be adapted, rather than a reason to withhold therapy. A and D incorrectly make clinic attendance a prerequisite. C is unnecessarily restrictive because group treatment at a clinic is not the only acceptable format. Self-help can have a role, particularly in less severe presentations, but E is inappropriate as the sole intervention in this persistent, functionally impairing presentation. The relevant NICE recommendation specifically supports home-based CBT; it does not specifically endorse telephone or video CBT in this context.

Reference: National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113), recommendation 1.3.38. Published 2011; last updated 2020. https://www.nice.org.uk/guidance/cg113/chapter/Recommendations