A 23-year-old girl comes for evaluation in psychiatry outpatient. The patient repos that she has been facing increasing anxiety since she got promoted. Earlier her office was on 1st floor and now she had to shift to 10th floor. She repoed that she has always been uncomfoable of heights and had avoided many jobs in past as they were in high rise buildings. She also lives at ground floor. Since, she got promoted, she has been using alprazolam to keep herself calm, but she wants a proper solution to her problem. Which is the most appropriate treatment for her condition?

**Core Concept**
The patient described exhibits symptoms of panic disorder with agoraphobia, specifically acrophobia, which is an irrational fear of heights. This condition is characterized by panic attacks in situations where the individual perceives a threat of being in a situation where they may be unable to escape or be in a situation where they may be embarrassed.

**Why the Correct Answer is Right**
The patient's symptoms, including the use of alprazolam to manage anxiety, suggest a need for a more comprehensive treatment plan. Cognitive-behavioral therapy (CBT) is the most effective treatment for panic disorder with agoraphobia. CBT involves identifying and challenging negative thought patterns and behaviors that contribute to the anxiety. Exposure therapy, a type of CBT, is particularly effective in treating acrophobia by gradually exposing the individual to heights in a controlled and safe environment. This helps the individual learn to manage their anxiety and eventually overcome their fear.

**Why Each Wrong Option is Incorrect**
**Option A:** Medications like alprazolam may provide temporary relief but do not address the underlying causes of the anxiety. They may also lead to dependence and do not offer a long-term solution.

**Option B:** Avoidance behaviors, such as choosing jobs or living arrangements based on fear of heights, are actually a symptom of the disorder rather than a treatment. Encouraging avoidance may perpetuate the individual's phobia.

**Option C:** Social support from family and friends is essential for overall mental health, but it does not directly address the patient's specific symptoms of panic disorder with agoraphobia.

**Clinical Pearl / High-Yield Fact**
Exposure therapy, a type of CBT, is a highly effective treatment for anxiety disorders, including panic disorder with agoraphobia. This involves gradual and controlled exposure to the feared stimulus, in this case, heights, to help the individual learn to manage their anxiety and overcome their phobia.

**Correct Answer: D. Cognitive-behavioral therapy (CBT)**

✓ Correct Answer: C. Sta her on exposure based therapy