Advertisement

Psychiatric Quarterly

, Volume 69, Issue 1, pp 23–44 | Cite as

Cognitive-Behavioral Therapy for Panic: Effectiveness and Limitations

  • Carlos Goldberg
Article

Abstract

The cognitive model of panic and cognitive-behavioral therapy were evaluated. It was argued that the cognitive model is not clear about the definition of threat, and that panic is evoked by the fear of the dissolution of the self. Furthermore, panic attacks will not lead to panic disorder unless the individual is experiencing general anxiety and is concerned with his/her physical or mental state. Controlled studies have demonstrated that cognitive-behavioral therapy is superior to other treatments for panic—85% of patients are panic-free at posttreatment and improvements are maintained at follow-up. However, 26% of waiting-list controls are also panic-free making the net percentage of panic-free treated patients 59%. There is room for improvement in at least 50% of patients, and a substantial number of patients continue to take medication and seek additional treatment. There is a need to determine the essential components of cognitive-behavioral therapy. It was predicted that exposure will prove to be the most crucial component. Exposure to phobic situations and interoceptive cues should be extended to the underlying causes of panic disorder, such as concerns with identity and dependency needs.

Keywords

Public Health Mental State Treated Patient Additional Treatment Panic Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Clark DM: A cognitive approach to panic. Behavior Research and Therapy 24:461–470, 1986.Google Scholar
  2. 2.
    Clark DM: Anxiety states: Panic and generalized anxiety, in Cognitive Behavior Therapy for Psychiatric Problems: A Practical Guide. Edited by Hawton K, Salkovskis P, Kirk J, et al. Oxford, England, Oxford University Press, 1989.Google Scholar
  3. 3.
    Barlow DH, Cerny JA: Psychological Treatment of Panic. New York, Guilford Press, 1988.Google Scholar
  4. 4.
    Chambless DL, Gracely EJ: Fear of fear and the anxiety disorders. Cognitive Therapy and Research 13:9–20, 1989.Google Scholar
  5. 5.
    Clark DM, Salkovskis PM, Gelder MG, et al.: Tests of a cognitive theory of panic, in Panic and Phobias 2: Treatments and Variables Affecting Course and Outcome. Edited by Hand I, Wittchen H. New York, Springer-Verlag, 1988.Google Scholar
  6. 6.
    Foa EB: What cognitions differentiate panic disorder from other anxiety disorders, in Panic and Phobias 2: Treatments and Variables Affecting Course and Outcome. Edited by Hand I, Wittchen H. New York, Springer-Verlag, 1988.Google Scholar
  7. 7.
    Clark DM, Gelder MG, Salkovskis PM, et al.: Cognitive mediation of lactate-induced panic. Paper presented at the annual meeting of the American Psychiatric Association, New Orleans, May 14, 1991.Google Scholar
  8. 8.
    Sanderson WC, Rapee RM, Barlow DH: The influence of an illusion of control on panic attacks induced via inhalation of 5.5% carbon dioxide enriched air. Archives of General Psychiatry 46:157–162, 1989.Google Scholar
  9. 9.
    Clark DM, Salkovskis PM, Hackmann A, et al.: A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. British Journal of Psychiatry 164:759–769, 1994.Google Scholar
  10. 10.
    Goldberg C: The cognitive-behavioral approach to panic and agoraphobia: An evaluation. Integrative Psychiatry 8:54–64, 1992.Google Scholar
  11. 11.
    McNall RJ: Psychological approaches to panic disorder: A review. Psychological Bulletin 108:403–419, 1990.Google Scholar
  12. 12.
    Kohut H: Restoration of the Self. New York, International Universities Press, 1977.Google Scholar
  13. 13.
    Horney K: Neurosis and Human Growth. New York, Norton, 1950.Google Scholar
  14. 14.
    Freud S: A reply to criticisms on the anxiety-neurosis. Standard Edition 3:123–139. London, Hogarth Press, 1962.Google Scholar
  15. 15.
    Gittelman R, Klein DF: Childhood separation anxiety and adult agoraphobia, in Anxiety and the Anxiety Disorders. Edited by Tuma A, Maser J. Hillsdale NJ, Erlbaum, 1985.Google Scholar
  16. 16.
    Klein DF: Anxiety reconceptualized, in Anxiety: New Research and Changing Concepts. Edited by Klein DF, Rabkin J. New York, Raven Press, 1981.Google Scholar
  17. 17.
    Barlow DH: Anxiety and its Disorders: The Nature and Treatment of Anxiety and Panic. New York, Guilford Press, 1988.Google Scholar
  18. 18.
    Norton GR, Harrison B, Hauch J, et al.: Characteristics of people with infrequent panic attacks. Journal of Abnormal Psychology 94:216–221, 1985.Google Scholar
  19. 19.
    Foa EB, Steketee G, Young MC: Agoraphobia: Phenomenological aspects, associated characteristics and theoretical considerations. Clinical Psychology Review 4:431–457, 1984.Google Scholar
  20. 20.
    Dohrenwend BS, Dohrenwend BP: Stressful Life Events: Their Nature and Effects. New York, Wiley, 1974.Google Scholar
  21. 21.
    Marks IM: Fears and Phobias. New York, Academic Press, 1969.Google Scholar
  22. 22.
    Clark DM: A cognitive model of panic attacks, in Panic: Psychological Perspectives. Edited by Rachman S, Maser J. Hillsdale NJ, Erlbaum, 1988.Google Scholar
  23. 23.
    Nelles WB, Barlow DH: Do children panic? Unpublished Manuscript, 1987.Google Scholar
  24. 24.
    Rachman S: Panics and their consequences: A review and prospect, in Panic: Psychological Perspectives. Edited by Rachman S, Maser J. Hillsdale NJ, Erlbaum, 1988.Google Scholar
  25. 25.
    Salkovskis PM, Clark DM: Cognitive therapy for panic disorder. Journal of Cognitive Psychotherapy 5:215–226, 1991.Google Scholar
  26. 26.
    Ley R: The many faces of Pan: Psychological and physiological differences amonng three types of panic attacks. Behavior Research and Therapy 30:347–357, 1992.Google Scholar
  27. 27.
    Rachman S, Levitt K, Lopatka C: The links between cognitions and bodily symptoms—1. Behavior Research and Therapy 25:411–424, 1987.Google Scholar
  28. 28.
    Wolpe J, Rowan VC: Panic disorder: A product of classical conditioning. Behavior Research and Therapy 26:441–450, 1988.Google Scholar
  29. 29.
    Seligman MEP: Competing theories of panic, in Panic: Psychological Perspectives. Edited by Rachman S, Maser J. Hillsdale NJ, Erlbaum, 1988.Google Scholar
  30. 30.
    Clark DM: Cognitive therapy for panic disorder, in Treatment of Panic Disorder: A consensus Development Conference. Edited by Wolfe B, Maser J. Washington D.C., American Psychiatric Press, 1994.Google Scholar
  31. 31.
    Beck AT, Sokol L, Clark DA, et al.: A crossover study of focused cognitive therapy for panic disorder. American Journal of Psychiatry 149:778–783, 1992.Google Scholar
  32. 32.
    Barlow DH, Craske MG, Cerny JA, et al.: Behavioral treatment of panic disorder. Behavior Therapy 20:261–282, 1989.Google Scholar
  33. 33.
    Craske MG, Brown TA, Barlow DH: Behavioral treatment of panic disorder: A two-year follow-up. Behavior Therapy 22:289–304, 1991.Google Scholar
  34. 34.
    Klosko JS, Barlow DH, Tassinari R, et al.: A comparison of alprazolam and behavior therapy in the treatment of panic disorder. Journal of Consulting and Clinical Psychology 58:77–84, 1990.Google Scholar
  35. 35.
    Telch MJ, Lucas JA, Schmidt NB, et al.: Group cognitive-behavioral treatment of panic disorder. Behavior Research and Therapy 31:279–287, 1993.Google Scholar
  36. 36.
    Chambless DL, Gillis MM: A review of psychosocial treatments for panic disorder, in Treatment of Panic Disorder: A Consensus Development Conference. Edited by Wolfe B, Maser J. Washington D.C., American Psychiatric Press, 1994.Google Scholar
  37. 37.
    Smith ML, Glass GV: Meta-analysis of psychotherapy outcome studies. American Psychologist 32:752–760, 1977.Google Scholar
  38. 38.
    Cohen J: Statistical Power Analysis for the Behavioral Sciences. Hillsdale NJ, Erlbaum, 1988.Google Scholar
  39. 39.
    Welkowitz LA, Papp LA, Cloitre M, et al.: Cognitive-behavior therapy for panic disorder delivered by psychopharmacologically oriented clinicians. Journal of Nervous and Mental Disease 179:473–477, 1991.Google Scholar
  40. 40.
    Fyer A, Liebowitz M, Gorman J, et al.: Discontinuation of alprazolam treatment in panic patients. American Journal of Psychiatry 144:303–308, 1987.Google Scholar
  41. 41.
    Margraf J, Barlow DH, Clark DM, et al.: Psychological treatment of panic: Work in progress on outcome, active ingredients, and follow-up. Behavior Research and Therapy 31:1–8, 1993.Google Scholar
  42. 42.
    Salkovskis PM, Clark DM, Hackmann A: Treatment of panic attacks using cognitive therapy without exposure or breathing retraining. Behavior Research and Therapy 29:161–166, 1991.Google Scholar
  43. 43.
    Ascher LM: Employing paradoxical intention in the treatment of agoraphobia. Behavior Research and Therapy 19:533–542, 1981.Google Scholar
  44. 44.
    Beck AT: Cognitive approaches to panic disorder: Theory and therapy, in Panic: Psychological Perspectives. Edited by Rachman S, Maser J. Hillsdale NJ, Erlbaum, 1988.Google Scholar
  45. 45.
    Hibbert GA, Chan M: Respiratory control: Its contribution to the treatment of panic attacks: A controlled study. British Journal of Psychiatry 154:232–236, 1989.Google Scholar
  46. 46.
    Epstein S: Cognitive-experiential self-theory: An integrative theory of personality, in The Relational Self: Theoretical Convergences in Psychoanalysis and Social Psychology. Edited by Curtis R. New York, Guilford Press, 1991.Google Scholar
  47. 47.
    Epstein S: Integration of the cognitive and the psychodynamic unconscious. American Psychologist 49:709–724, 1994.Google Scholar
  48. 48.
    Beck AT, Emery G, Greenberg RL: Anxiety Disorders and Phobias: A Cognitive Perspective. New York, Basic Books, 1985.Google Scholar
  49. 49.
    Clark DM, Beck AT: Cognitive approaches, in Handbook of Anxiety Disorders. Edited by Last C, Hersen M. New York, Pergamon Press, 1988.Google Scholar
  50. 50.
    Freud S: Inhibitions, symptoms and anxiety. Standard Edition 20:87–174. London, Hogarth Press, 1959.Google Scholar
  51. 51.
    Stampfl TG, Levis DJ: Essentials of implosive therapy: A learning-theory-based psychodynamic behavioral therapy. Journal of Abnormal Psychology 72:496–503, 1967.Google Scholar

Copyright information

© Human Sciences Press, Inc. 1998

Authors and Affiliations

  • Carlos Goldberg
    • 1
  1. 1.Indiana University-Purdue University atIndianapolis

Personalised recommendations