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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 and agoraphobia 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].


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Literature review current through: Mar 2017. | This topic last updated: Sep 15, 2015.
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