DIAGNOSIS: Panic Disorder
2015 EST Status: Treatment pending re-evaluation
Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings
Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources
Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved
Insufficient Evidence: No meta-analytic study could be identified
Insufficient Evidence: Existing meta-analyses are not of sufficient quality
Treatment pending re-evaluation
1998 EST Status: Strong Research Support
Strong: Support from two well-designed studies conducted by independent investigators.
Modest: Support from one well-designed study or several adequately designed studies.
Controversial: Conflicting results, or claims regarding mechanisms are unsupported.
Strength of Research Support
(Tolin et al. Recommendation)
Find a Therapist specializing in Cognitive Behavioral Therapy for Panic DisorderList your practice
Brief Summary
- Basic premise: Thoughts, feelings and behaviors are inter-related, so altering one can help to alleviate problems in another.
- Essence of therapy: Cognitive therapy aims to help the person identify, challenge, and modify dysfunctional ideas related to panic symptoms (e.g., catastrophic consequences of bodily sensations). Avoidance of panic and panic-cues is targeted through exposure exercises, including both in vivo (e.g., going to crowded places or driving in traffic) and interoceptive (e.g., bodily sensations) exposures.
- Length: Approx. 12-16 sessions
Treatment Resources
Editors:Evan Forman, PhD; Joanna Kaye, BA
Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice
Treatment Manuals / Outlines
Treatment Manuals
- Anxiety and Panic Disorder: Patient Treatment Manual (Andrews et al.)
Books Available for Purchase Through External Sites
- Phobic Disorders and Panic in Adults: A Guide to Assessment and Treatment (Antony & Swinson)
- Mastery of Your Phobia and Panic: Therapist Guide (Craske & Barlow)
- Understanding and Treating Panic Disorder: Cognitive-Behavioural Approaches (Taylor)
Training Materials and Workshops
Measures, Handouts and Worksheets
- Panic Disorder Severity Scale – Self Report Form
- Agoraphobic Cognitions Questionnaire
- Body Sensations Questionnaire
- Anxiety Sensitivity Index
Self-help Books
- 10 Simple Solutions to Panic: How to Overcome Panic Attacks, Calm Physical Symptoms, and Reclaim Your Life (Antony & McCabe)
- Mastery of Your Anxiety and Panic: Workbook (Barlow & Craske)
- Don’t Panic: Taking Control of Anxiety Attacks (Wilson)
- An End to Panic: Breakthrough Techniques for Overcoming Panic Disorder (Zuercher-White)
Important Note: The books listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.
Smartphone Apps
- iCBT (Bonfire Development Advisors)
- Stop Panic & Anxiety Self-Help (Excel at Life)
Important Note: The apps listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.
Video Demonstrations
Videos Available for Purchase Through External Sites
- Cognitive Therapy for Panic Disorder (Clark)
- Cognitive Therapy Over Time (Dobson)
- Evidence-Based Treatment Planning for Panic Disorder (Bruce & Jongsma)
- Cognitive-Behavioral Therapy for Clients with Anxiety and Panic (Olatunji)
Video Descriptions
Videos Available for Purchase Through External Sites
- Fight or Flight? Overcoming Panic and Agoraphobia (Rapee)
- Effectively Managing Panic Disorder (AnxietyBC)
Clinical Trials
- Group cognitive-behavioral treatment of panic disorder (Telch et al., 1993)
- Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial (Barlow, Gorman, Shear, & Woods, 2000)
- A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder (Roy-Byrne et al., 2005)
- Behavioral treatment of panic disorder: A two-year follow-up (Craske, Brown, & Barlow, 1991)
- Alprazolam and exposure alone and combined in panic disorder with agoraphobia (Marks et al., 1993)
- Brief cognitive-behavioral versus nondirective therapy for panic disorder (Craske, Maidenberg, & Bystritsky, 1995)
Meta-analyses and Systematic Reviews
- Cognitive-behavioral therapy and the treatment of panic disorder: Efficacy and strategies (Otto & Deveney, 2005)
- Treatment of panic (Schmidt & Keough, 2010)
- A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia (Mitte, 2005)
- A meta-analysis of treatment outcome for panic disorder (Gould, Otto, & Pollack, 1995)
- Cognitive-behavioral treatment for panic disorder: Current status (Landon & Barlow, 2004)
- A meta-analysis of the treatment of panic disorder with or without agoraphobia: A comparison of psychopharmacological, cognitive-behavioral and combination treatments (Van Balkom et al., 1997)
- Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis (Sánchez-Meca, Rosa-Alcázar, Marín-Martínez, & Gómez-Conesa, 2010)
Other Treatment Resources
- Cognitive-behavioral therapy for panic disorder: A review of treatment elements, strategies, and outcomes (Rayburn & Otto, 2003)
- The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: Quality versus quantity (Schmidt & Woolaway-Bickel, 2000)
- When anxiety symptoms masquerade as physical symptoms: What medical specialists know about panic disorder and available psychological treatments (Teng, Chaison, Hamilton, Bailey, & Dunn, 2008)
- Treatment of Panic Disorder: A Consensus Development Conference (Author: Wolfe; Editor: Maser)
- Panic Disorder and Its Treatment (Editors: Pollack & Rosenbaum)
- Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic (Barlow)
- Anxiety Disorders and Phobias: A Cognitive Perspective (Beck, Emery, & Greenberg, 2005)