Behavioral treatment of panic disorder

doi:10.1016/S0005-7894(89)80073-5

Behavior Therapy

Volume 20, Issue 2, Spring 1989, Pages 261-282

https://doi.org/10.1016/S0005-7894(89)80073-5 Get rights and content

We report the results of a long-term clinical outcome study testing variations of behavioral treatments for panic disorder without agoraphobic avoidance. Exposure to somatic cues combined with cognitive therapy was compared to relaxation therapy designed specifically for panic disorder. In a third treatment condition, these techniques were combined. All three treatments were superior on a variety of measures to a wait-list control group. In the two treatment conditions containing exposure to somatic cues and cognitive therapy, 85% or more of clients were panic free at posttreatment. These were the only groups significantly better than wait-list control on this measure. Relaxation, on the other hand, tended to effect greater reductions in generalized anxiety associated with panic attacks but was associated with high drop-out rates. These results suggest that we have a successful behavioral treatment for panic disorder, but leave questions on effective components and mechanisms of action unanswered.

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Managing emotions in panic disorder: A systematic review of studies related to emotional intelligence, alexithymia, emotion regulation, and coping
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Panic disorder is defined by recurring and unexpected panic attacks, accompanied by anticipatory anxiety about future attacks and their consequences. This generally involves avoiding situations and behaviors that can produce panic attacks (American Psychiatric Association [APA], 2013). Among anxiety disorders, panic disorder is associated with some of the greatest burdens in terms of personal suffering, occupational disability, and societal cost. The objective of this article is to systematically identify and review the empirical literature on emotional management processes and strategies associated with panic disorder, with the aim of evaluating their role in the development and maintenance of panic disorder, in order to better understand the pathogenesis of the disorder and guide clinicians to improve their current treatments.
Four databases were searched for studies which were based on self-reported questionnaires or a methodology based on an experimental procedure.
Of the 1719 articles identified, 61 referred to different aspects of emotional management. People living with PD are characterized by low emotional intelligence levels, excessive use of suppression, impaired cognitive reappraisal, high levels of alexithymia and maladaptive coping strategies.
Most of the reviewed studies used measures of emotional management in cross-sectional models and were based on self-assessment reports.
Improving emotional intelligence levels is key to increasing emotion regulation flexibility for people living with PD. Automatic cognitive reappraisal impairment in these people indicates low importance of cognitive restructuring in psychotherapeutic treatment.
The effect of information seeking behaviors in fear control
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Citation Excerpt :
This is the case of individuals undergoing panic attacks. Unlike people who are afraid of dogs, they cannot run away from aversive stimuli because interoceptive activation (their own bodily sensations) is precisely what they are fearful about (Deacon et al., 2010; Barlow, Craske, Cerny, & Klosko, 1989). Literature suggests that low-intensity physiological sensations may function as conditioned stimuli (CS) that trigger high-intensity physiological sensations (panic attacks) (Acheson et al., 2012).
Individuals experiencing conditioned fear reactions often resort to avoidance and escape behaviors as attempts to decrease fear. Nevertheless, these strategies are not always available. In such cases, people seek information to mitigate aversive events. This study aimed at evaluating the effect of information seeking behaviors on self-reported fear, predictability, and physiological responses.
Participants were randomly assigned to two groups. In group one, individuals were given the choice to perform an instrumental behavior which provided information about the occurrence of either an aversive or a neutral event (100% contingency). In group two, individuals were also allowed to perform an instrumental behavior. However, such behavior provided partial information (50% contingency).
Individuals in group one presented lower levels of fear compared to individuals assigned to group two.
The generalizability of the results may be restricted to undergraduate students.
The results suggests that when avoidance and escape are not available, individuals seek information that provides control over fear. Clinical implications are discussed.
Current theoretical models of panic disorder: Conceptual review and clinical implications
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Parmi les troubles anxieux, le trouble panique est associé à certains des plus grands fardeaux en termes de souffrance personnelle, de déficience professionnelle et de coût sociétal. Cet article passe en revue les modèles théoriques de ce trouble afin de déterminer leurs évolutions, leurs limites et les perspectives théoriques et cliniques qui en découlent. Pour ce faire, une revue de la littérature a été entreprise à partir de la base de données PsycINFO. Sur les 928 articles identifiés, 54 faisaient référence à 14 modèles théoriques du trouble panique. Les résultats montrent que la plupart des modèles ne sont pas empiriquement bien étayés et que peu ont été utilisés de manière cohérente pour guider le traitement de ce trouble. Bien que les traitements basés sur ces modèles bénéficient à un grand pourcentage de patients, au moins 25 % des patients sont classés comme résistants à ces traitements. De plus, les rechutes ne sont pas rares. La conclusion discute des limites des modèles existants et propose des recommandations pour améliorer les modèles actuels du trouble panique.
Panic disorder (PD) is defined by recurring and unexpected panic attacks accompanied by anticipatory anxiety about future attacks and their consequences. This generally involves avoiding situations and behaviors that can produce panic attacks (American Psychiatric Association [APA], 2013). Among anxiety disorders, PD is associated with some of the greatest burdens in terms of personal suffering, occupational disability, and societal cost. Since the introduction of PD in the DSM-III (1980) and the distinction of PD from generalized anxiety disorder following the work of Klein (1964), several biological and psychological theories of PD have been developed. These theories have highlighted several risk factors (for the onset, maintenance and relapse associated with the disorder) that have strongly influenced research on PD and have guided its treatment. However, a comprehensive and universally accepted theoretical framework of PD to guide its treatment is lacking. This article reviews the previously described theoretical frameworks of PD and related treatments while examining the strength of the scientific evidence supporting their validity as well as their limitations.
A review of the literature was undertaken by searching PsycINFO database to list all the articles published between January 2000 and November 2020 and referring to a theoretical model or a conceptual framework of PD. The conceptual frameworks identified were reviewed based on the recent scientific researches to determine the strength of the evidence supporting their validity.
Of the 928 articles initially identified, 54 referred to fourteen different conceptual frameworks relating to PD. Two models are exclusively biological: the false suffocation alarm and the neuroanatomical hypothesis of PD. Six models are psychological, one of which is psychodynamic and five are derived from the cognitive-behavioral paradigm. Finally, six models are integrative: triple vulnerability of Barlow, integrated cognitive vulnerability of Schmidt & Woolaway-Bickel, unified model of vulnerability of McGinn, causal model of Fava & Morton, causal model based on the evidence by Pilecki and integrated model of Busch. These models highlight biological, environmental, developmental and psychological vulnerability factors.
The analysis of these different models shows that few conceptual frameworks have been used consistently to guide the treatment of PD, and that not all frameworks are empirically well supported. The theoretical approaches that have strongly influenced the treatment of PD are the cognitive model of Clark, the expectation model of Reiss as well as the triple vulnerability model of Barlow. Although treatments based on these models benefit a large percentage of patients, at least 25% of patients are classified as resistant to these treatments. In addition, relapses and persistence of symptoms remain common results of these treatments. This suggests that other vulnerability factors such as emotional regulation skills should be taken into consideration and integrated into these models especially as several studies have suggested that research focused on emotion regulation may improve our understanding of panic.
New directions in research on somatic concerns in individuals with eating disorders
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Individuals with eating disorders (EDs) experience somatic deficits that may contribute to the maintenance of ED psychopathology. This paper proposes new directions to consider using in future research examining somatic concerns in EDs. We reviewed articles examining ED psychopathology and somatic sensations (e.g., interoception, exteroception, and proprioception) and propose methodologies extending upon existing methods. We identified several methodological limitations within the extant literature, such as sensations examined, measurement issues, and sample selection. As such, we posit that future work 1) considers a wider range of somatic sensations––with specific emphasis on ED specific somatic sensations, 2) develops measures with strong psychometric properties, and 3) examines somatic deficits transdiagnostically. The proposed future research directions are intended to advance scientific inquiry by increasing methodological rigor in studying somatic sensations and EDs to ultimately improve ED assessment and increase efficacy in ED treatment.
Interoceptive pathways to understand and treat mental health conditions
2022, Trends in Cognitive Sciences
An increasing recognition that brain and body are dynamically coupled has enriched our scientific understanding of mental health conditions. Peripheral signals interact centrally to influence how we think and feel, generating our sense of the internal condition of the body, a process known as interoception. Disruptions to this interoceptive system may contribute to clinical conditions, including anxiety, depression, and psychosis. After reviewing the nature of interoceptive disturbances in mental health conditions, this review focuses on interoceptive pathways of existing and putative mental health treatments. Emerging clinical interventions may target novel peripheral treatment mechanisms. Future treatment development requires forward- and back-translation to uncover and target specific interoceptive processes in mental health to elucidate their efficacy relative to interventions targeting other factors.
Maximizing the non-specific factors in brief cognitive behavioral therapy for panic disorder and agoraphobia: A multiple baseline case series documenting feasibility and initial efficacy
2022, Asian Journal of Psychiatry
There is evidence for non-specific factors impacting treatment outcomes, with pragmatic concerns regarding the need to popularize briefer formats of cognitive behavioral therapy (CBT). The need to have more culturally suitable and acceptable forms of CBT is also indicated. We evaluated the feasibility and efficacy of a brief 5 session CBT (bCBT) in participants (N = 4) with panic disorder (PD) and agoraphobia, using a non-concurrent multiple baseline design. In this case series, efforts were made to maximize non-specific factors of psychotherapy in bringing about treatment outcomes. Reliable and significant treatment effects were observed at post-intervention and follow-up assessments. The present study offers preliminary evidence of a bCBT protocol that comprises the efforts to maximize the non-specific factors in psychotherapy such as credibility, expectancy, and the therapeutic alliance in bringing treatment outcomes; however, further controlled evaluation is warranted. We also discuss the mechanisms contributing to these treatment outcomes in the present protocol.

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View full text

Behavioral treatment of panic disorder

Behavior Therapy

Journal of Behavior Therapy and Experimental Psychiatry

Journal of Behavior Therapy and Experimental Psychiatry

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Behavioral and Experimental Psychiatry

Behaviour Research and Therapy

The use of modified relaxation in the experimental induction of anxiety and panic

Relaxation-induced panic (RIP): When resting isn't peaceful

Integrative Psychiatry

Biological aspects of panic disorder

American Journal of Psychiatry

Alprazolam in panic disorder and agoraphobia; results from a multi center trial. I. Efficacy in short term treatment

Archives of General Psychiatry

Anxiety and its disorders: The nature and treatment of anxiety and panic

Psychological treatment of panic

Mastery of your anxiety and panic

Couples treatment of agoraphobia

Behavior Therapy

Cognitive approaches to panic disorder: Theory and therapy

Cognitive therapy of anxiety and phobic disorders

Anxiety disorders and phobias: A cognitive perspective

An inventory for measuring depression

Archives of General Psychiatry