Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-27T14:58:38.542Z Has data issue: false hasContentIssue false

4 - CBT for Panic Disorder

from Part One - Cognitive Behavioral Therapy for Anxiety Disorders

Published online by Cambridge University Press:  06 January 2022

By
Robin D. Bailey
Edited by
Gillian Todd  and
Rhena Branch
Gillian Todd
Affiliation:
University of East Anglia
Rhena Branch
Affiliation:
University of East Anglia
Get access

Summary

Panic disorder is an anxiety disorder where people experience recurrent, unexpected panic attacks. The evidence-based CBT model of panic disorder developed by Clark still remains the dominant treatment for this disorder. This chapter explores some of the theory around panic disorder, looking at the underlying mechanisms that maintain this disorder. It will also provide guidance on assessment and formulation. Evidence-based treatment techniques are presented and direction on how to implement these, as well as strategies to prevent future relapse.

Keywords

panic disorderassessmentformulationtreatmentrelapse prevention
Type
Chapter
Information
Evidence-Based Treatment for Anxiety Disorders and Depression
A Cognitive Behavioral Therapy Compendium
 , pp. 50 - 74
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Recommended Reading

Bennett-Levy, J. E., Butler, G. E., Fennell, M. E., Hackman, A. E., Mueller, M. E., & Westbrook, D. E. (2004). Oxford guide to behavioral experiments in cognitive therapy. Oxford University Press.Google Scholar
Bennett-Levy, J., Turner, F., Beaty, T., Smith, M., Paterson, B., & Farmer, S. (2001). The value of self-practice of cognitive therapy techniques and self-reflection in the training of cognitive therapists. Behavioral and Cognitive Psychotherapy, 29(2), 203–220.Google Scholar
Clark, D. M. (1996). Panic disorder: From theory to therapy. In Salkovskis, P. M. (Ed.), Frontiers of cognitive therapy. Guilford Publications, 318–344.Google Scholar
Hackmann, A. (1998). Cognitive therapy with panic and agoraphobia: Working with complex cases. In Tarrier, N., Wells, A., & Hoddock, G. (Eds.), Treating complex cases. Wiley, 27–43.Google Scholar
Livermore, N., Sharpe, L., & McKenzie, D. (2010). Panic attacks and panic disorder in chronic obstructive pulmonary disease: A cognitive behavioral perspective. Respiratory Medicine, 104(9), 1246–1253.Google Scholar
Tully, P. J., Sardinha, A., & Nardi, A. E. (2017). A new CBT model of panic attack treatment in comorbid heart diseases (PATCHD): How to calm an anxious heart and mind. Cognitive and Behavioral Practice, 24(3), 329–341.Google Scholar
Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. John Wiley and Sons.Google Scholar

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5). American Psychiatric Association.Google Scholar
Barlow, D. H. (1988). Anxiety and its disorders. Guilford Press.Google Scholar
Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA, 283(19), 2529–2536.CrossRefGoogle ScholarPubMed
Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phoblas: A cognitive perspective. Basic Books.Google Scholar
Bennett-Levy, J. (2003). Mechanisms of change in cognitive therapy: The case of automatic thought records and behavioral experiments. Behavioral and Cognitive Psychotherapy, 31(3), 261–277.Google Scholar
Bennett-Levy, J. E., Butler, G. E., Fennell, M. E., Hackman, A. E., Mueller, M. E., & Westbrook, D. E. (2004). Oxford guide to behavioral experiments in cognitive therapy. Oxford University Press.Google Scholar
Bennett-Levy, J., Turner, F., Beaty, T., Smith, M., Paterson, B., & Farmer, S. (2001). The value of self-practice of cognitive therapy techniques and self-reflection in the training of cognitive therapists. Behavioral and Cognitive Psychotherapy, 29(2), 203–220.Google Scholar
Bernstein, A., Zvolensky, M. J., Sachs-Ericsson, N., Schmidt, N. B., & Bonn-Miller, M. O. (2006). Associations between age of onset and lifetime history of panic attacks and alcohol use, abuse, and dependence in a representative sample. Comprehensive Psychiatry, 47(5), 342–349.Google Scholar
Casey, L. M., Oei, T. P., & Newcombe, P. A. (2004). An integrated cognitive model of panic disorder: The role of positive and negative cognitions. Clinical Psychology Review, 24(5), 529–555.Google Scholar
Chambless, D. L., Caputo, G. C., Bright, P., & Gallagher, R. (1984). Assessment for fear of fear in agoraphobics: The Body Sensations Questionnaire and the Agoraphobia Cognitions Questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090–1097.Google Scholar
Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J., & Williams, C. (1985). The mobility inventory for agoraphobia. Behavior Research and Therapy, 23, 35–44.Google Scholar
Clark, D. M. (1986). A cognitive approach to panic. Behavior Research and Therapy, 24(4), 461–470.CrossRefGoogle ScholarPubMed
Clark, D. M. (1988). A cognitive model of panic attacks. In Rachman, S. & Maser, J. D. (Eds.), Panic: Psychological perspectives (pp. 71–89). Lawrence Erlbaum Associates.Google Scholar
Clark, D. M. (1996). Panic disorder: From theory to therapy. In: Salkovskis, P. M. (Ed.), Frontiers of cognitive therapy. Guilford Publications, 318–344.Google Scholar
Clark, D. M., & Salkovskis, P. (2009). Cognitive therapy for panic disorder: Manual for IAPT high intensity therapists.Google Scholar
Clark, D. M., Salkovskis, P. M., Hackmann, A., Wells, A., Ludgate, J., & Gelder, M. (1999). Brief cognitive therapy for panic disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 67(4), 583.Google Scholar
De Cort, K., Hermans, D., Noortman, D., Arends, W., Griez, E. J., & Schruers, K. R. (2013). The weight of cognitions in panic: The link between misinterpretations and panic attacks. PloS One, 8(8).Google Scholar
De Jonge, P., Roest, A. M., Lim, C. C., Florescu, S. E., Bromet, E. J., Stein, D. J., & Al‐Hamzawi, A. O. (2016). Cross‐national epidemiology of panic disorder and panic attacks in the world mental health surveys. Depression and Anxiety, 33(12), 1155–1177.CrossRefGoogle ScholarPubMed
Deacon, B., & Abramowitz, J. S. (2008). Is hypochondriasis related to obsessive-compulsive disorder, panic disorder, or both? An empirical evaluation. Journal of Cognitive Psychotherapy, 22(2), 115–127.Google Scholar
Flynn, D., Ford, G. A., Rodgers, H., Price, C., Steen, N., & Thomson, R. G. (2014). A time series evaluation of the FAST national stroke awareness campaign in England. PLoS One, 9(8).Google Scholar
Furukawa, T. A., Watanabe, N., & Churchill, R. (2007). Combined psychotherapy plus antidepressants for panic disorder with or without agoraphobia. Cochrane Database of Systematic Reviews, (1).Google Scholar
Goodwin, R. D., Brook, J. S., & Cohen, P. (2005). Panic attacks and the risk of personality disorder. Psychological Medicine, 35(2), 227–235.Google Scholar
Goodwin, R. D., Fergusson, D. M., & Horwood, L. J. (2004a). Panic attacks and psychoticism. American Journal of Psychiatry, 161(1), 88–92.Google Scholar
Goodwin, R. D., Fergusson, D. M., & Horwood, L. J. (2004b). Panic attacks and the risk of depression among young adults in the community. Psychotherapy and Psychosomatics, 73(3), 158–165.Google Scholar
Goodwin, R. D., & Gotlib, I. H. (2004). Panic attacks and psychopathology among youth. Acta Psychiatrica Scandinavica, 109(3), 216–221.Google Scholar
Hiller, W., Leibbrand, R., Rief, W., & Fichter, M. M. (2005). Differentiating hypochondriasis from panic disorder. Journal of Anxiety Disorders, 19(1), 29–49.Google Scholar
Hoffart, A. (2016). Cognitive models for panic disorder with agoraphobia: A study of disaggregated within-person effects. Journal of Consulting and Clinical Psychology, 84(9), 839.CrossRefGoogle ScholarPubMed
Hoffart, A., Sexton, H., Hedley, L. M., & Martinsen, E. W. (2008). Mechanisms of change in cognitive therapy for panic disorder with agoraphobia. Journal of Behavior Therapy and Experimental Psychiatry, 39(3), 262–275.CrossRefGoogle ScholarPubMed
Houck, P. R., Spiegel, D. A., Shear, M. K., & Rucci, P. (2002). Reliability of the self‐report version of the panic disorder severity scale. Depression and Anxiety, 15(4), 183–185.Google Scholar
Huppert, J. D., Kivity, Y., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2014). Therapist effects and the outcome–alliance correlation in cognitive behavioral therapy for panic disorder with agoraphobia. Behavior Research and Therapy, 52, 26–34.Google Scholar
Kim, Y. W., Lee, S. H., Choi, T. K., Suh, S. Y., Kim, B., Kim, C. M., … & Song, S. K. (2009). Effectiveness of mindfulness‐based cognitive therapy as an adjuvant to pharmacotherapy in patients with panic disorder or generalized anxiety disorder. Depression and Anxiety, 26(7), 601–606.Google Scholar
King, M., Nazareth, I., Levy, G., Walker, C., Morris, R., Weich, S., … & Rifel, J. (2008). Prevalence of common mental disorders in general practice attendees across Europe. The British Journal of Psychiatry, 192(5), 362–367.Google Scholar
Lewis-Fernández, R., Hinton, D. E., Laria, A. J., Patterson, E. H., Hofmann, S. G., Craske, M. G., … & Liao, B. (2011). Culture and the anxiety disorders: Recommendations for DSM-V. Focus, 9(3), 351–368.Google Scholar
Livermore, N., Sharpe, L., & McKenzie, D. (2010). Panic attacks and panic disorder in chronic obstructive pulmonary disease: A cognitive behavioral perspective. Respiratory Medicine, 104(9), 1246–1253.Google Scholar
NICE. (2011). Common Mental Health Disorders: Identification and Pathways to Care. Clinical Guideline 123. National Institute for Health and Care Excellence.Google Scholar
Noyes, R., Reich, J., Clancy, J., & O’Gorman, T. W. (1986). Reduction in hypochondriasis with treatment of panic disorder. The British Journal of Psychiatry, 149(5), 631–635.Google Scholar
Olatunji, B. O., Deacon, B. J., Abramowitz, J. S., & Valentiner, D. P. (2007). Body vigilance in nonclinical and anxiety disorder samples: Structure, correlates, and prediction of health concerns. Behavior Therapy, 38(4), 392–401.Google Scholar
Pergamin-Hight, L., Naim, R., Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., & Bar-Haim, Y. (2015). Content specificity of attention bias to threat in anxiety disorders: A meta-analysis. Clinical Psychology Review, 35, 10–18.Google Scholar
Pompoli, A., Furukawa, T. A., Efthimiou, O., Imai, H., Tajika, A., & Salanti, G. (2018). Dismantling cognitive-behavior therapy for panic disorder: A systematic review and component network meta-analysis. Psychological Medicine, 48(12), 1945–1953.Google Scholar
Pompoli, A., Furukawa, T. A., Imai, H., Tajika, A., Efthimiou, O., & Salanti, G. (2016). Psychological therapies for panic disorder with or without agoraphobia in adults: A network meta‐analysis. Cochrane Database of Systematic Reviews, (4).Google Scholar
Reinecke, A., Cooper, M., Favaron, E., Massey-Chase, R., & Harmer, C. (2011). Attentional bias in untreated panic disorder. Psychiatry Research, 185(3), 387–393.Google Scholar
Reiss, S., & McNally, R. J. (1985). The expectancy model of fear. In Reiss, S. & Bootzin, R. R. (Eds.), Theoretical issues in behavior therapy (pp. 107–122). Academic Press.Google Scholar
Salkovskis, P. M. (1991). The importance of behavior in the maintenance of anxiety and panic: A cognitive account. Behavioral and Cognitive Psychotherapy, 19(1), 6–19.CrossRefGoogle Scholar
Salkovskis, P. M., & Clark, D. M. (1993). Panic disorder and hypochondriasis. Advances in Behavior Research and Therapy, 15(1), 23–48.Google Scholar
Salkovskis, P. M., Clark, D. M., & Gelder, M. G. (1996). Cognition-behavior links in the persistence of panic. Behavior Research and Therapy, 34(5–6), 453–458.Google Scholar
Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A., & Gelder, M. G. (1999). An experimental investigation of the role of safety-seeking behaviors in the maintenance of panic disorder with agoraphobia. Behavior Research and Therapy, 37(6), 559–574.Google Scholar
Salkovskis, P. M., Hackmann, A., Wells, A., Gelder, M. G., & Clark, D. M. (2007). Belief disconfirmation versus habituation approaches to situational exposure in panic disorder with agoraphobia: A pilot study. Behavior Research and Therapy, 45(5), 877–885.Google Scholar
Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., … & Papp, L. A. (1997). Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry, 154(11), 1571–1575.Google Scholar
Teachman, B. A., Marker, C. D., & Clerkin, E. M. (2010). Catastrophic misinterpretations as a predictor of symptom change during treatment for panic disorder. Journal of Consulting and Clinical Psychology, 78(6), 964.Google Scholar
Tully, P. J., Sardinha, A., & Nardi, A. E. (2017). A new CBT model of panic attack treatment in comorbid heart diseases (PATCHD): How to calm an anxious heart and mind. Cognitive and Behavioral Practice, 24(3), 329–341.Google Scholar
Vroom, V. H. (1964). Work and motivation. Wiley & Sons.Google Scholar
Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. John Wiley and Sons.Google Scholar
Williams, P. G. (2004). The psychopathology of self-assessed health: A cognitive approach to health anxiety and hypochondriasis. Cognitive Therapy and Research, 28(5), 629–644.Google Scholar
Wolpe, J., & Rowan, V. C. (1988). Panic disorder: A product of classical conditioning. Behavior Research and Therapy, 26(6), 441–450.Google Scholar
Zickgraf, H. F., Chambless, D. L., McCarthy, K. S., Gallop, R., Sharpless, B. A., Milrod, B. L., & Barber, J. P. (2016). Interpersonal factors are associated with lower therapist adherence in cognitive-behavioral therapy for panic disorder. Clinical Psychology and Psychotherapy, 23(3), 272–284.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×