Panic Disorder
- Panic Attack
- Panic Disorder
- Recurrent Panic Attacks
- Anticipatory Anxiety
- Agoraphobia
- Hypochondriasis
- Demoralisation
- Epidemiology
- Age of Onset
- Situation of Onset
- Stressful Life Events
- Early Life Events
- Maternal Over-Protection
- Separation Anxiety
- Short and Long-term Outcomes
- Comorbidity
- Panic Disorder: Pathogenesis
- Biological Findings
- Provocative Agents
- Neurotransmitter Systems
- Neuroanatomical Models
- Brain Imaging
- Psychological Models
- Psychodynamic Models
- Behavioural Models
- Cognitive Models
- Areas of Controversy and Debate
- The Evolutionary Perspective
- Panic Disorder: Treatment
- Pharmacotherapy
- Benzodiazepines
- Tricyclic Antidepressants
- Monoamine Oxidase Inhibitors
- Selective Serotonin Re-uptake Inhibitors
- Other Drugs
- Psychotherapy
Definition and Termination of Psychotherapy
Overall, psychological approaches have proved effective in the treatment of PD and PD with agoraphobia. Psychological treatment of PD has been shown to be more effective than no treatment, psychosocial ‘‘placebo’’ intervention and even some psychopharmacological interventions. Behavioural, cognitive and cognitive-behavioural approaches in particular have been shown to be useful in the treatment of PD. Psychodynamic interventions have not been evaluated in controlled studies, although in 1996 it was still the more frequently used form of psychotherapy.
Behavioural, cognitive and cognitive-behavioural therapies are empirically validated for PD treatment. The rationale for the cognitive and cognitive-behavioural treatment of panic stems from the cognitive and behavioural theories of panic, respectively. Cognitive approaches to treatment assume that teaching patients to examine and modify their cognitive misconceptions can directly change cognition and cognitive schemata. In the cognitive therapy of PD, the therapist explains the nature of panic, anxiety and anxiety-related symptoms and identifies, or helps the patient to identify, ‘‘automatic thoughts’’, the central misinterpretations of panic symptoms and their consequences.
- The therapist then shows the patients some strategies to correct or evaluate their cognitive errors:
- self-statement training, in which a neutral or more accurate statement is practised in place of the former negative statement;
- Probability revaluation, in which the actual probabilities of catastrophic consequences are more realistically examined;
- Decatastophising, in which the feared impact of consequences of panic are assessed more rationally
- Homework assignments are designed to help patients first identify and subsequently challenge the maladaptive cognition.
There are many studies evaluating the effectiveness of the cognitive treatment of PD. Two influential treatment protocols are the Panic Control Treatment, developed by Barlow, and the cognitive approach developed by Clark. These protocols have been evaluated in controlled treatment studies. Recently , Bakker et al. compared paroxetine, clomipramine and cognitive therapy based on the model of Clark; in this study, the drugs induced significant improvement, whereas cognitive therapy did not differ significantly from placebo. PD is one of the most active research areas of clinical psychology, providing competing theories and new treatments. The relationship between psychological and physical treatments of PD is often a source of discussion. Drugs are easier to use, faster in the onset of attack, more available, but their effect does not seem to persist after treatment discontinuation. A combined approach seems to be the preferred choice in clinical practice. Certainly, essential elements in psychological approaches, such as explanation of clinical and pathogenetic issues and engaging the patient in a therapeutic alliance, are critical in maximising the value of drug treatment.