Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Psychotherapy for panic disorder in adults

Michelle Craske, PhD
Section Editor
Murray B Stein, MD, MPH
Deputy Editor
Richard Hermann, MD


Panic disorder (PD) and agoraphobia (A) are common and chronic mental disorders that frequently co-occur [1,2]. They are associated with high levels of social, occupational, and physical disability [3,4], considerable economic costs [5-7], and the highest number of medical visits among the anxiety disorders [8]. Panic disorder can occur alone or with agoraphobia.  

The psychotherapy for PD/A with the most empirical support is cognitive behavioral therapy (CBT). CBT is based on a well-developed conceptualization of panic disorder as an acquired fear of certain bodily sensations, and agoraphobia as a behavioral response to the anticipation of such bodily sensations or their crescendo into a full-blown panic attack.

This topic addresses psychotherapy for panic disorder. Pharmacotherapy for panic disorder is addressed separately. The epidemiology, pathogenesis, clinical manifestations, course, and diagnosis of panic disorder and of agoraphobia are addressed separately. (See "Pharmacotherapy for panic disorder in adults" and "Panic disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Agoraphobia in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis".)


Theoretical foundation — Cognitive and behavioral theories generally conceptualize panic disorder as an acquired fear of bodily sensations, particularly sensations associated with autonomic arousal, in individuals with certain psychological and biological predispositions for the disorder [9-12].

Panic attacks — From an evolutionary standpoint, fear is a natural and adaptive response to threatening stimuli. However, an initial panic attack is often unjustified, or lacks an identifiable trigger, and hence represents a “false alarm” [11,13]. After the occurrence of an unexpected panic attack, individual vulnerabilities such as neuroticism (or, emotionality) and anxiety sensitivity (or, beliefs that anxiety is harmful) seem to play a role in determining whether or not an individual then develops anxiety about further panic attacks [14-17]. Furthermore, the anxiety typically becomes acutely focused on somatic sensations associated with panic attacks. As an example, individuals with PD/A are particularly likely to become anxious during procedures that elicit sensations similar to those experienced during panic attacks, such as spinning in a circle, hyperventilating, and inhalations of carbon dioxide [18-20]. Thus, procedures that reduce levels of CO2, as well as elevated levels of CO2, produce sensations that are feared by persons with panic disorder. These individuals also fear signals that ostensibly reflect heightened bodily arousal when given biofeedback to indicate changes in bodily state independent of actual changes in bodily state (ie, false physiological feedback) [21,22], and over-attend to heart beat stimuli [23].


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Sep 15, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Katschnig H, Amering M. The long-term course of panic disorder and its predictors. J Clin Psychopharmacol 1998; 18:6S.
  2. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:617.
  3. Klerman GL, Weissman MM, Ouellette R, et al. Panic attacks in the community. Social morbidity and health care utilization. JAMA 1991; 265:742.
  4. Keller MB, Yonkers KA, Warshaw MG, et al. Remission and relapse in subjects with panic disorder and panic with agoraphobia: a prospective short-interval naturalistic follow-up. J Nerv Ment Dis 1994; 182:290.
  5. Leon AC, Portera L, Weissman MM. The social costs of anxiety disorders. Br J Psychiatry Suppl 1995; :19.
  6. Roy-Byrne PP, Stein MB, Russo J, et al. Panic disorder in the primary care setting: comorbidity, disability, service utilization, and treatment. J Clin Psychiatry 1999; 60:492.
  7. Katon W, Von Korff M, Lin E, et al. Distressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs. Gen Hosp Psychiatry 1990; 12:355.
  8. Deacon B, Lickel J, Abramowitz JS. Medical utilization across the anxiety disorders. J Anxiety Disord 2008; 22:344.
  9. Clark DM. A cognitive approach to panic. Behav Res Ther 1986; 24:461.
  10. Ehlers, A, Margraf, J. The psychophysiological model of panic attacks. In: Fresh Perspectives on Anxiety Disorders, Emmelkamp, PMG, Everaerd, W, Kraaimaat, F, van Sons, M (Eds), Swets & Zeitlinger, Amsterdam 1989.
  11. Barlow, D. Anxiety and its disorders: The nature and treatment of anxiety and panic, 2nd ed, Guilford Press, New York 2002.
  12. Craske, M. The origins of phobias and anxiety disorders: Why more women than men?, Elsevier Science, Oxford 2003.
  13. Barlow, D. Office-based behavioural treatment of panic attack. In: Panic Disorder: Relative merits of pharmacotherapy and psychotherapy, The Medicine Group, Ontario 1988. p.6.
  14. Hayward C, Killen JD, Kraemer HC, Taylor CB. Predictors of panic attacks in adolescents. J Am Acad Child Adolesc Psychiatry 2000; 39:207.
  15. Ehlers A. A 1-year prospective study of panic attacks: clinical course and factors associated with maintenance. J Abnorm Psychol 1995; 104:164.
  16. Schmidt NB, Lerew DR, Jackson RJ. The role of anxiety sensitivity in the pathogenesis of panic: prospective evaluation of spontaneous panic attacks during acute stress. J Abnorm Psychol 1997; 106:355.
  17. Schmidt NB, Lerew DR, Jackson RJ. Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension. J Abnorm Psychol 1999; 108:532.
  18. Antony MM, Ledley DR, Liss A, Swinson RP. Responses to symptom induction exercises in panic disorder. Behav Res Ther 2006; 44:85.
  19. Gorman JM, Papp LA, Coplan JD, et al. Anxiogenic effects of CO2 and hyperventilation in patients with panic disorder. Am J Psychiatry 1994; 151:547.
  20. Perna G, Gabriele A, Caldirola D, Bellodi L. Hypersensitivity to inhalation of carbon dioxide and panic attacks. Psychiatry Res 1995; 57:267.
  21. Craske MG, Lang AJ, Rowe M, et al. Presleep attributions about arousal during sleep: nocturnal panic. J Abnorm Psychol 2002; 111:53.
  22. Ehlers A, Margraf J, Roth WT, et al. Anxiety induced by false heart rate feedback in patients with panic disorder. Behav Res Ther 1988; 26:1.
  23. Kroeze S, van den Hout MA. Selective attention for cardiac information in panic patients. Behav Res Ther 2000; 38:63.
  24. RAZRAN G. The observable unconscious and the inferable conscious in current Soviet psychophysiology: interoceptive conditioning, semantic conditioning, and the orienting reflex. Psychol Rev 1961; 68:1.
  25. Bouton ME, Mineka S, Barlow DH. A modern learning theory perspective on the etiology of panic disorder. Psychol Rev 2001; 108:4.
  26. Dworkin BR, Dworkin S. Heterotopic and homotopic classical conditioning of the baroreflex. Integr Physiol Behav Sci 1999; 34:158.
  27. Sokolowska M, Siegel S, Kim JA. Intraadministration associations: conditional hyperalgesia elicited by morphine onset cues. J Exp Psychol Anim Behav Process 2002; 28:309.
  28. Block RI, Ghoneim MM, Fowles DC, et al. Effects of a subanesthetic concentration of nitrous oxide on establishment, elicitation, and semantic and phonemic generalization of classically conditioned skin conductance responses. Pharmacol Biochem Behav 1987; 28:7.
  29. Clark, D. A cognitive model of panic attacks. In: Psychological perspectives, Rachman, S, Maser, J (Eds), Lawrence Eribaum Associates, Inc, Hillsdale 1988. p.71.
  30. Teachman BA, Smith-Janik SB, Saporito J. Information processing biases and panic disorder: relationships among cognitive and symptom measures. Behav Res Ther 2007; 45:1791.
  31. Pauli P, Amrhein C, Mühlberger A, et al. Electrocortical evidence for an early abnormal processing of panic-related words in panic disorder patients. Int J Psychophysiol 2005; 57:33.
  32. Craske MG, Glover D, DeCola J. Predicted versus unpredicted panic attacks: acute versus general distress. J Abnorm Psychol 1995; 104:214.
  33. Maier, S, Laudenslager, M, Ryan, S. Stressor controllability, immune function, and endogenous opiates. In: Affect, conditioning, and cognition: Essays on the determinants of behavior, Brush, F, Overmier, J (Eds), Erlbaum, Hillsdale 1985. p.183.
  34. Salkovskis PM, Clark DM, Gelder MG. Cognition-behaviour links in the persistence of panic. Behav Res Ther 1996; 34:453.
  35. Craske, M. Cognitive behavior therapy, American Psychological Association, Washington, DC 2009.
  36. Hays, P, Iwamasa, G. Culturally responsive cognitive behavioral therapy: Assessment, practice, and supervision, American Psychological Association, Washington, DC 2006.
  37. Miranda J, Bernal G, Lau A, et al. State of the science on psychosocial interventions for ethnic minorities. Annu Rev Clin Psychol 2005; 1:113.
  38. Sanderson, W, Bruce, T. Causes and management of treatment-resistant panic disorder and agoraphobia: A survey of expert therapists. Cogn Behav Pract 2007; 14:26.
  39. Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5), Brown TA, Barlow DH. (Eds), Oxford University Press, New York 2014.
  40. Anxiety and Related Disorders Interview Schedule for DSM-5: Lifetime Version (ADIS-5L), Brown TA, Barlow DH. (Eds), Oxford University Press, New York 2014.
  41. Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5): Clinician's Manual, Brown TA, Barlow DH. (Eds), Oxford University Press, New York 2014.
  42. Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther 1986; 24:1.
  43. Chambless DL, Caputo GC, Bright P, Gallagher R. Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. J Consult Clin Psychol 1984; 52:1090.
  44. Chambless DL, Caputo GC, Jasin SE, et al. The Mobility Inventory for Agoraphobia. Behav Res Ther 1985; 23:35.
  45. Rapee RM, Craske MG, Barlow DH. Assessment instrument for panic disorder that includes fear of sensation-producing activities: the Albany Panic and Phobia Questionnaire. Anxiety 1994-1995; 1:114.
  46. Barlow, D, Craske, M. Mastery of your anxiety and panic, 4th ed, Oxford University Press, New York 2006.
  47. Barlow, D, Craske, M, Cerny, J, Klosko, J. Behavioral treatment of panic disorder. Behav Ther 1989; 20:261.
  48. Caldirola D, Bellodi L, Caumo A, et al. Approximate entropy of respiratory patterns in panic disorder. Am J Psychiatry 2004; 161:79.
  49. Garssen, B, de, Ruiter, C, van, Dyck, R. Breathing retraining: A rational placebo? Clin Psychol Rev 1992; 12:141.
  50. Meuret AE, Wilhelm FH, Roth WT. Respiratory biofeedback-assisted therapy in panic disorder. Behav Modif 2001; 25:584.
  51. Meuret AE, Wilhelm FH, Ritz T, Roth WT. Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder. J Psychiatr Res 2008; 42:560.
  52. Meuret AE, Rosenfield D, Seidel A, et al. Respiratory and cognitive mediators of treatment change in panic disorder: evidence for intervention specificity. J Consult Clin Psychol 2010; 78:691.
  53. Kim S, Wollburg E, Roth WT. Opposing breathing therapies for panic disorder: a randomized controlled trial of lowering vs raising end-tidal P(CO₂). J Clin Psychiatry 2012; 73:931.
  54. Feigenbaum, W. Long-term efficacy of ungraded versus graded massed exposure in agoraphobics. In: Panic and phobias: Treatments and variables affecting course and outcome, Hand, I, Wittchen, H (Eds), Springer-Verlag, Berlin 1988. p.87.
  55. Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry 2008; 69:621.
  56. Norton PJ, Price EC. A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. J Nerv Ment Dis 2007; 195:521.
  57. Haby MM, Donnelly M, Corry J, Vos T. Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: a meta-regression of factors that may predict outcome. Aust N Z J Psychiatry 2006; 40:9.
  58. Brown TA, Antony MM, Barlow DH. Diagnostic comorbidity in panic disorder: effect on treatment outcome and course of comorbid diagnoses following treatment. J Consult Clin Psychol 1995; 63:408.
  59. Vos SP, Huibers MJ, Diels L, Arntz A. A randomized clinical trial of cognitive behavioral therapy and interpersonal psychotherapy for panic disorder with agoraphobia. Psychol Med 2012; 42:2661.
  60. Gloster AT, Wittchen HU, Einsle F, et al. Psychological treatment for panic disorder with agoraphobia: a randomized controlled trial to examine the role of therapist-guided exposure in situ in CBT. J Consult Clin Psychol 2011; 79:406.
  61. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev 2006; 26:17.
  62. Cerny J, Barlow D, Craske M, Himaldi W. Couples treatment of agoraphobia: A two-year follow-up. Behav Ther 1987; 18:401.
  63. Craske MG, Roy-Byrne P, Stein MB, et al. CBT intensity and outcome for panic disorder in a primary care setting. Behav Ther 2006; 37:112.
  64. White KS, Payne LA, Gorman JM, et al. Does maintenance CBT contribute to long-term treatment response of panic disorder with or without agoraphobia? A randomized controlled clinical trial. J Consult Clin Psychol 2013; 81:47.
  65. Roy-Byrne PP, Craske MG, Stein MB, et al. A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Arch Gen Psychiatry 2005; 62:290.
  66. Craske MG, Golinelli D, Stein MB, et al. Does the addition of cognitive behavioral therapy improve panic disorder treatment outcome relative to medication alone in the primary-care setting? Psychol Med 2005; 35:1645.
  67. Roy-Byrne P, Craske MG, Sullivan G, et al. Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. JAMA 2010; 303:1921.
  68. Craske MG, Stein MB, Sullivan G, et al. Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care. Arch Gen Psychiatry 2011; 68:378.
  69. Lessard MJ, Marchand A, Pelland MÈ, et al. Comparing two brief psychological interventions to usual care in panic disorder patients presenting to the emergency department with chest pain. Behav Cogn Psychother 2012; 40:129.
  70. Brown TA, Barlow DH. Long-term outcome in cognitive-behavioral treatment of panic disorder: clinical predictors and alternative strategies for assessment. J Consult Clin Psychol 1995; 63:754.
  71. Schneider AJ, Mataix-Cols D, Marks IM, Bachofen M. Internet-guided self-help with or without exposure therapy for phobic and panic disorders. Psychother Psychosom 2005; 74:154.
  72. Spek V, Cuijpers P, Nyklícek I, et al. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med 2007; 37:319.
  73. Andrews G, Cuijpers P, Craske MG, et al. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One 2010; 5:e13196.
  74. Allen, L, Barlow, D. Treatment of panic disorder: outcomes and basic processes. In: Pathological anxiety: Emotional processing in etiology and treatment, Rothbaum, B (Eds), Guilford Press, New York 2006. p.166.
  75. McLean PD, Woody S, Taylor S, Koch WJ. Comorbid panic disorder and major depression: implications for cognitive-behavioral therapy. J Consult Clin Psychol 1998; 66:240.
  76. Laberge B, Gauthier JG, Côté G, et al. Cognitive-behavioral therapy of panic disorder with secondary major depression: a preliminary investigation. J Consult Clin Psychol 1993; 61:1028.
  77. Maddock RJ, Blacker KH. Response to treatment in panic disorder with associated depression. Psychopathology 1991; 24:1.
  78. Wade WA, Treat TA, Stuart GL. Transporting an empirically supported treatment for panic disorder to a service clinic setting: a benchmarking strategy. J Consult Clin Psychol 1998; 66:231.
  79. Reich J, Perry JC, Shera D, et al. Comparison of personality disorders in different anxiety disorder diagnoses: panic, agoraphobia, generalized anxiety, and social phobia. Ann Clin Psychiatry 1994; 6:125.
  80. Hoffart A, Hedley LM. Personality traits among panic disorder with agoraphobia patients before and after symptom-focused treatment. J Anxiety Disord 1997; 11:77.
  81. Marchand, A, Goyer, L, Dupuis, G, Mainguy, N. Personality disorders and the outcome of cognitive-behavioral treatment of panic disorder with agoraphobia. Can J Behav Sci 1998; 30:17.
  82. Dreessen L, Arntz A, Luttels C, Sallaerts S. Personality disorders do not influence the results of cognitive behavior therapies for anxiety disorders. Compr Psychiatry 1994; 35:265.
  83. van den, Hout M, Brouwers C, Oomen J. Clinically diagnosed Axis II comorbidity and the short term outcome of CBT for Axis I disorders. Clin Psychol Psychother 2006; 13:56.
  84. Hofmann SG, Barlow DH, Papp LA, et al. Pretreatment attrition in a comparative treatment outcome study on panic disorder. Am J Psychiatry 1998; 155:43.
  85. Lehrer PM, Karavidas MK, Lu SE, et al. Psychological treatment of comorbid asthma and panic disorder: a pilot study. J Anxiety Disord 2008; 22:671.
  86. Grilo CM, Money R, Barlow DH, et al. Pretreatment patient factors predicting attrition from a multicenter randomized controlled treatment study for panic disorder. Compr Psychiatry 1998; 39:323.
  87. Keijsers, G, Kampman, M, Hoogduin, C. Dropout prediction in cognitive behavior therapy for panic disorder. Behav Ther 2001; 32:739.
  88. Kazantzis N, Ronan KR, Deane FP. Concluding causation from correlation: comment on Burns and Spangler (2000). J Consult Clin Psychol 2001; 69:1079.
  89. Schmidt NB, Woolaway-Bickel K. The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: quality versus quantity. J Consult Clin Psychol 2000; 68:13.
  90. Craske MG, Maidenberg E, Bystritsky A. Brief cognitive-behavioral versus nondirective therapy for panic disorder. J Behav Ther Exp Psychiatry 1995; 26:113.
  91. Clark DM, Salkovskis PM, Hackmann A, et al. Brief cognitive therapy for panic disorder: a randomized controlled trial. J Consult Clin Psychol 1999; 67:583.
  92. Deacon B, Abramowitz J. A pilot study of two-day cognitive-behavioral therapy for panic disorder. Behav Res Ther 2006; 44:807.
  93. Mitte K. A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia. J Affect Disord 2005; 88:27.
  94. Barlow DH, Gorman JM, Shear MK, Woods SW. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA 2000; 283:2529.
  95. Kampman M, Keijsers GP, Hoogduin CA, Hendriks GJ. A randomized, double-blind, placebo-controlled study of the effects of adjunctive paroxetine in panic disorder patients unsuccessfully treated with cognitive-behavioral therapy alone. J Clin Psychiatry 2002; 63:772.
  96. Heldt E, Blaya C, Isolan L, et al. Quality of life and treatment outcome in panic disorder: cognitive behavior group therapy effects in patients refractory to medication treatment. Psychother Psychosom 2006; 75:183.
  97. Wang PS, Berglund P, Olfson M, et al. Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:603.
  98. Heuzenroeder L, Donnelly M, Haby MM, et al. Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder. Aust N Z J Psychiatry 2004; 38:602.
  99. Furukawa TA, Watanabe N, Churchill R. Combined psychotherapy plus antidepressants for panic disorder with or without agoraphobia. Cochrane Database Syst Rev 2007; :CD004364.
  100. Marks IM, Başoğlu M, Noshirvani H, et al. Drug treatment of panic disorder. Further comment. Br J Psychiatry 1993; 162:795.
  101. Wardle J, Hayward P, Higgitt A, et al. Effects of concurrent diazepam treatment on the outcome of exposure therapy in agoraphobia. Behav Res Ther 1994; 32:203.
  102. Otto, M, Pollack, M, Sabatino, S. Maintenance of remission following cognitive-behavior therapy for panic disorder: possible deleterious effects of concurrent medication treatment. Behav Ther 1996; 27:473.
  103. van Balkom AJ, de Beurs E, Koele P, et al. Long-term benzodiazepine use is associated with smaller treatment gain in panic disorder with agoraphobia. J Nerv Ment Dis 1996; 184:133.
  104. Westra HA, Stewart SH, Conrad BE. Naturalistic manner of benzodiazepine use and cognitive behavioral therapy outcome in panic disorder with agoraphobia. J Anxiety Disord 2002; 16:233.
  105. Otto MW, Pollack MH, Sachs GS, et al. Discontinuation of benzodiazepine treatment: efficacy of cognitive-behavioral therapy for patients with panic disorder. Am J Psychiatry 1993; 150:1485.
  106. Milrod B, Leon AC, Busch F, et al. A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. Am J Psychiatry 2007; 164:265.
  107. Milrod, B, Busch, F, Cooper, A, Shapiro, T. Manual of panic-focused psychodynamic psychotherapy, American Psychiatric Press, Washington, DC 1997.
  108. Milrod B, Chambless DL, Gallop R, et al. Psychotherapies for panic disorder: a tale of two sites. J Clin Psychiatry 2015.
  109. Gelder MG, Marks IM, Wolff HH. Desensitization and psychotherapy in the treatment of phobic states: a controlled inquiry. Br J Psychiatry 1967; 113:53.
  110. Chambless, D, Goldstein, A, Gallagher, R, Bright, P. Integrating behavior therapy and psychotherapy in the treatment of agoraphobia. Psychotherapy 1986; 23:150.
  111. Wiborg IM, Dahl AA. Does brief dynamic psychotherapy reduce the relapse rate of panic disorder? Arch Gen Psychiatry 1996; 53:689.
  112. Hoffart, A, Martinsen, E. Exposure-based integrated vs. pure psychodynamic treatment of agoraphobic inpatients. Psychotherapy 1990; 27:210.
  113. Hayes, S, Pankey, J. Acceptance. In: Cognitive behavior therapy: Applying empirically supported techniques in your practice, O’Donohue, W, Fisher, J, Hayes, S (Eds), John Wiley & Sons, Hoboken, NJ 2003. p.4.
  114. Arch, J, Craske, M. ACT and CBT for anxiety disorders: Different treatments, similar mechanisms? Clin Psychol 2008; 15:263.
  115. Hayes, S, Strosahl, K, Wilson, K. Acceptance and commitment therapy: An experiential approach to behavior change, Guilford Press, New York 1999.
  116. Kabat-Zinn, J. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness, Delta, New York 1990.
  117. Kabat-Zinn J, Massion AO, Kristeller J, et al. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry 1992; 149:936.
  118. Miller JJ, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry 1995; 17:192.
  119. Arch JJ, Eifert GH, Davies C, et al. Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. J Consult Clin Psychol 2012; 80:750.
  120. Arch JJ, Ayers CR, Baker A, et al. Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders. Behav Res Ther 2013; 51:185.
  121. Gloster AT, Sonntag R, Hoyer J, et al. Treating Treatment-Resistant Patients with Panic Disorder and Agoraphobia Using Psychotherapy: A Randomized Controlled Switching Trial. Psychother Psychosom 2015; 84:100.