What is the role of cognitive-behavioral therapy (CBT) in the management of panic disorder?

Updated: Mar 21, 2018
  • Author: Mohammed A Memon, MD; Chief Editor: Randon S Welton, MD  more...
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Cognitive-behavioral therapy (CBT) helps patients to understand how automatic thoughts and false beliefs/distortions lead to exaggerated emotional responses, such as anxiety, and how they can lead to secondary behavioral consequences. CBT can be used alone or in addition to pharmacotherapy. However, the combination approach yields superior results for most patients, compared with results from the use of either modality alone, [33, 36] by enhancing long-term outcomes through reduction in the likelihood of relapse when pharmacologic therapy is stopped. [55] Combination therapy should be considered for patients in whom standard monotherapies have not been successful. [55]

CBT is most effective when started early after symptom onset and in patients with few psychological comorbidities. [38] Therapy is generally limited to 10-15 weekly sessions and can be conducted either individually or in a group. [55] The National Collaborating Centre for Mental Health recommends CBT take the form of weekly sessions of 1-2 hours and be completed within a maximum of 4 months of commencement. [56]

Cognitive restructuring involves substituting positive thoughts (e.g., patients can tell themselves that they are only feeling a little uneasiness or that their feelings will soon be gone) for the maladaptive thoughts that accompany panic (e.g., feeling that they are going to die or are having a heart attack).

Behavioral therapy involves sequentially greater exposure of the patient to anxiety-provoking stimuli. Over time, the patient becomes desensitized to the experience. Relaxation techniques also help to control patients' levels of anxiety. [37, 38]

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