Panic Disorder

  • Michelle G. Craske
  • Sachin V. Waikar


Panic attacks are discrete episodes of intense fear or dread, accompanied by a cluster of physical and cognitive symptoms; these include heart palpitations, dizziness, chest discomfort, paresthesias, depersonalization, and fears of loss of control and death (DSM-III-R, American Psychiatric Association, 1987). Rather than gradually mounting anxious arousal, panic attacks are characterized by suddenness or abruptness of onset. Sometimes the episodes occur unexpectedly, and although the concept of “unexpectedness” is somewhat elusive in the diagnostic criteria, it refers to occurrences of panic in situations or at times that were not expected. Panic attacks evolve into panic disorder when they occur at least four times within 4 weeks, or the individual is pervasively apprehensive about their recurrence, or both.


Anxiety Disorder Personality Disorder Panic Disorder Anxiety Sensitivity Panic Attack 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Agras, W. S., Telch, M. J., Taylor, C. B., Roth, W. T., & Brouillard, M. (in press). Imipramine and exposure therapy in agoraphobia: The type of exposure may matter. Behavior Therapy.Google Scholar
  2. Alneas, R., & Torgersen, S. (1990). DSM-III personality disorders among patients with major depression, anxiety disorders, and mixed conditions. Journal of Nervous and Mental Disease, 178, 693–698.CrossRefGoogle Scholar
  3. American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
  4. American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.Google Scholar
  5. Azrin, N., Naster, B., & Jones, R. (1973). Reciprocity counselling: A rapid learning-based procedure for marital counselling. Behaviour Research and Therapy, 11, 365–382.PubMedCrossRefGoogle Scholar
  6. Barlow, D. H. (1988). Anxiety and its disorders: The nature and treatment of anxiety and panic. New York: Guilford.Google Scholar
  7. Barlow, D. H. & Craske, M. G. (1988). Mastery of your anxiety and panic. Albany, NY: Graywind.Google Scholar
  8. Barlow, D. H., Craske, M. G., Cerny, J. A., & Klosko, J. S. (1989). Behavioral treatment of panic disorder. Behavior Therapy, 20, 261–282.CrossRefGoogle Scholar
  9. Barlow, D. H., O’Brien, G. T., & Last, C. G. (1984). Couples treatment of agoraphobia. Behavior Therapy, 15, 41–58.CrossRefGoogle Scholar
  10. Barlow, D. H., Vermilyea, J., Blanchard, E., Vermilyea, B., DiNardo, P., & Cerny, J. (1985). Phenomenon of panic. Journal of Abnormal Psychology, 94, 320–328.PubMedCrossRefGoogle Scholar
  11. Beck, A. T. (1988). Cognitive approaches to panic disorder: Theory and therapy. In S. J. Rachman & J. D. Maser (Eds.), Panic: Psychological perspectives (pp. 91–110). Hillsdale, NJ: Erlbaum.Google Scholar
  12. Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1991). An inventory for measuring clinical anxiety; the Beck Anxiety Inventory. Journal of Consulting and Clinical Psychology, 56, 893–897.CrossRefGoogle Scholar
  13. Bourdon, K. H., Boyd, J. H., Rae, D. S., Burns, B. J., Thompson, J. W., & Locke, B. Z. (1988). Gender differences in phobias: Results of the ECA community survey. Journal of Anxiety Disorders, 2, 227–241.CrossRefGoogle Scholar
  14. Bouton, M., & Swartzentruber, D. (1991). Sources of relapse after extinction in Pavlovian conditioning and instrumental conditioning. Behavioral Neuroscience, 104, 44–55.CrossRefGoogle Scholar
  15. Breier, A., Charney, D. S., & Heninger, G. R. (1986). Agoraphobia with panic attacks. Archives of General Psychiatry, 43, 1029–1036.PubMedCrossRefGoogle Scholar
  16. Bruce, T. J., Spiegel, D. A., Falkin, S. M., & Nuzzarello, A. (1992, March). Does cognitive behavioral therapy assist slow-taper alprazolam discontinuation in panic disorder? Poster presented at the conference of the National Anxiety Disorders Association of America, Houston.Google Scholar
  17. Burns, L. E., Thorpe, G. L., & Cavallaro, L. A. (1986). Agoraphobia eight years after behavioral treatment: A follow-up study with interview, self-report, and behavioral data. Behavior Therapy, 17, 580–591.CrossRefGoogle Scholar
  18. Carr, D. B., & Sheehan, D. V. (1984). Panic anxiety: A new biological model. Journal of Clinical Psychiatry, 45, 323–330.PubMedGoogle Scholar
  19. Cerny, J. A., Barlow, D. H., Craske, M. G., & Himadi, W. G. (1987). Couples treatment of agoraphobia: A two-year follow-up. Behavior Therapy, 18, 401–415.CrossRefGoogle Scholar
  20. Chambless, D. L. (1989, November). Spacing of exposure sessions in the treatment of phobia. Poster presented at the convention of the Annual Association for the Advancement of Behavior Therapy, New York.Google Scholar
  21. Chambless, D. L., Caputo, G., Bright, P., & Gallagher, R. (1984). Assessment of fear in agoraphobics: The Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090–1097.PubMedCrossRefGoogle Scholar
  22. Chambless, D. L., Caputo, G., Gracely, S., Jasin, E., & Williams, C. (1985). The Mobility Inventory for agoraphobia. Behaviour Research and Therapy, 23, 35–44.PubMedCrossRefGoogle Scholar
  23. Chambless, D., & Renneberg, B. (1988, September). Personality disorders of agoraphobics. Paper presented at World Congress of Behavior Therapy, Edinburgh, Scotland.Google Scholar
  24. Chaplin, E. W., & Levine, B. A. (1981). The effects of total exposure duration and interrupted versus continued exposure in flooding therapy. Behavior Therapy, 12, 360–368.CrossRefGoogle Scholar
  25. Clark, D. M. (1988). A cognitive model of panic attacks. In S. Rachman & J. D. Maser (Eds.), Panic: Psychological perspectives (pp. 71–89). Hillsdale, NJ: Erlbaum.Google Scholar
  26. Clark, D., Salkovskis, P., & Chalkley, A. (1985). Respiratory control as a treatment for panic attacks. Journal of Behavior Therapy and Experimental Psychiatry, 16, 23–30.PubMedCrossRefGoogle Scholar
  27. Clark, D. M., Salkovskis, P., Gelder, M., Koehler, C., Martin, M., Anastasiades, P., Hackmann, A., Middleton, H., & Jeavons, A. (1988). Tests of a cognitive theory of panic. In I. Hand & H. Wittchen (Eds.), Panic and phobias II (pp. 71–90). Berlin: Springer-Verlag.Google Scholar
  28. Cohen, S. D., Monteiro, W, & Marks, I. M. (1984). Two-year follow-up of agoraphobics after exposure and imipramine. British Journal of Psychiatry, 144, 276–281.PubMedCrossRefGoogle Scholar
  29. Craske, M. G., Brown, T. A., & Barlow, D. H. (1991). Behavioral treatment of panic disorder: A two-year follow-up. Behavior Therapy, 22, 289–304.CrossRefGoogle Scholar
  30. Craske, M. G., Curtis, G. C., McNally, R. J., Ost, L. G., & Salkovskis, P. (1992). An integrative review of issues related to the diagnosis of Simple Phobia. DSM-IV Source Book. Washington, DC: American Psychiatric Press.Google Scholar
  31. Craske, M. G., Miller, P. P., Rotunda, R., & Barlow, D. H. (1990). A descriptive report of features of initial unexpected panic attacks in minimal and extensive avoiders. Behaviour Research and Therapy, 28, 395–400.PubMedCrossRefGoogle Scholar
  32. Craske, M. G., Street, L, & Barlow, D. H. (1989). Instructions to focus upon or distract from internal cues during exposure treatment for agoraphobic avoidance. Behaviour Research and Therapy, 27, 663–672.PubMedCrossRefGoogle Scholar
  33. Crowe, R. R. (1985). The genetics of panic disorder and agoraphobia. Psychiatric Developments, 2, 171–186.Google Scholar
  34. DiNardo, P., & Barlow, D. H. (1988). Anxiety Disorders Interview Schedule—Revised (ADISR). Albany, NY: Phobia and Anxiety Disorders Clinic, The University of Albany, State University of New York.Google Scholar
  35. Ehlers, A., & Breuer, P. (1992). Increased cardiac awareness in panic disorder. Journal of Abnormal Psychology, 101, 371–382.PubMedCrossRefGoogle Scholar
  36. Emmelkamp, P. M. G., & Ultee, K. A. (1974). A comparison of “successive approximation” and “self-observation” in the treatment of agoraphobia. Behavior Therapy, 5, 606–613.Google Scholar
  37. Feigenbaum, W. (1988). Long-term efficacy of ungraded versus graded massed exposure in agoraphobics. In I. Hand & H. Wittchen (Eds.), Panic and phobias: Treatments and variables affecting course and outcome (pp. 149–158). Berlin: Springer-Verlag.Google Scholar
  38. Foa, E. B., Jameson, J. S., Turner, R. M., & Payne, L. L. (1980). Massed vs. spaced exposure sessions in the treatment of agoraphobia. Behaviour Research and Therapy, 18, 333–338.PubMedCrossRefGoogle Scholar
  39. Foa, E. B., & Kozak, M. S. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.PubMedCrossRefGoogle Scholar
  40. Fyer, A. J., Sandberg, D., & Klein, D. F. (1991). The pharmacological treatment of panic disorder and agoraphobia. In J. R. Walker, G. R. Norton, and C. A. Ross (Eds)., Panic disorder and agoraphobia: A comprehensive guide for the practitioner (pp. 211–251). Belmont, CA: Brooks/Cole.Google Scholar
  41. Garssen, B., de Ruiter, C., & van Dyck, R. (1992). Breathing retraining. A rational placebo? Clinical Psychology Review, 12, 141–153.CrossRefGoogle Scholar
  42. Gray, J.A. (1987). The psychology of fear and stress. Cambridge, UK: Cambridge University Press.Google Scholar
  43. Hackmann, A., Clark, D., Salkovskis, P., Wells, A., & Gelder, M. (1992, June). Making cognitive therapy for panic more efficient: Preliminary results with a four session version of treatment. Paper presented at the World Congress of Cognitive Therapy, Toronto, Canada.Google Scholar
  44. Hafher, R. J. (1976). Fresh symptom emergence after intensive behavior therapy. British Journal of Psychiatry, 129, 378–383.CrossRefGoogle Scholar
  45. Hamilton, M. (1959). A rating scale for depression. British Journal of Medical Psychology, 32, 50–55.PubMedCrossRefGoogle Scholar
  46. Hamilton, M. (1960). The assessment of anxiety states by rating. Journal of Neurology, Neurosurgery, & Psychiatry, 23, 56–62.CrossRefGoogle Scholar
  47. Jacobson, N. S., Wilson, L, & Tupper, C. (1988). The clinical significance of treatment gains resulting from exposure-based interventions for agoraphobia: A re-analysis of outcome data. Behavior Therapy, 19, 539–554.CrossRefGoogle Scholar
  48. Jansson, L., Jerremalm, A., & Ost, L.-G. (1986). Follow-up of agoraphobic patients treated with exposure in-vivo or applied relaxation. British Journal of Psychiatry, 149, 486–490.PubMedCrossRefGoogle Scholar
  49. Jansson, L., & Ost, L.-G. (1982). Behavioral treatments for agoraphobia: An evaluative review. Clinical Psychology Review, 2, 311–336.CrossRefGoogle Scholar
  50. Klein, D. F. (1964). Dissection of two drug-responsive anxiety syndromes. Psychopbarmacologia, 5, 397–408.CrossRefGoogle Scholar
  51. Lydiard, B. (1985, October) Desipramine in panic disorder. An open fixed-dose study. Paper presented at the meeting of the American Academy of Clinical Psychiatry, San Francisco.Google Scholar
  52. Margraf, J. (1989, June). Comparative efficacy of cognitive, exposure, and combined treatments for panic disorder. Paper presented at the annual meeting of the European Association for Behavior Therapy, Vienna.Google Scholar
  53. Margraf, J., Taylor, C. B., Ehlers, A., Roth, W. T., & Agras, W. S. (1987). Panic attacks in the natural environment. Journal of Nervous and Mental Disease, 175, 558–565.PubMedCrossRefGoogle Scholar
  54. Marks, I. M. (1971). Phobic disorders four years after treatment: A prospective follow-up. British Journal of Psychiatry, 118, 683–686.PubMedCrossRefGoogle Scholar
  55. Marks, I., Grey, S., Cohen, S. D., Hill, R., Mawson, D., Ramm, E., & Stern, R. (1983). Imipramine and brief therapist-aided exposure in agoraphobics having self-exposure homework: A controlled trial. Archives of General Psychiatry, 40, 153–162.PubMedCrossRefGoogle Scholar
  56. Marshall, W. L. (1985). The effects of variable exposure in flooding therapy. Behavior Therapy, 16, 117–135.CrossRefGoogle Scholar
  57. Mavissakalian, M., & Hamman, M. (1986). DSM-III personality disorder in agoraphobia. Comprehensive Psychiatry, 27, 471–479.PubMedCrossRefGoogle Scholar
  58. Mavissakalian, M., & Hamman, M. (1987). DSM-III personality disorder in agoraphobia: II. Changes with treatment. Comprehensive Psychiatry, 28, 356–361.PubMedCrossRefGoogle Scholar
  59. Mavissakalian, M., & Michelson, L. (1986). Two-year follow-up of exposure and imipramine treatment of agoraphobia. American Journal of Psychiatry, 143, 1106–1112.PubMedGoogle Scholar
  60. Michels, R., Frances, A. J., & Shear, M. K. (1985). Psychodynamic models of anxiety. In A. H. Tuma & J. D. Maser (Eds.), Anxiety and the anxiety disorders (pp. 595–618). Hillsdale, NJ: Erlbaum.Google Scholar
  61. Michelson, L., Mavissakalian, M., Marchione, K., Ulrich, R., Marchione, N., & Testa, S. (1990). Psycho-physiological outcome of cognitive, behavioral, and psychophysiologically-based treatments of agoraphobia. Behaviour Research and Therapy, 28, 127–139.PubMedCrossRefGoogle Scholar
  62. Munby, J., & Johnston, D. W. (1980). Agoraphobia: The long-term follow-up of behavioural treatment. British Journal of Psychiatry, 137, 418–427.PubMedCrossRefGoogle Scholar
  63. Myers, J., Weissman, M., Tischler, C., Holzer, C., Orvaschel, H., Anthony, J., Boyd, J., Burke, J., Kramer, M., & Stoltzam, R. (1984). Six-month prevalence of psychiatric disorders in three communities. Archives of General Psychiatry, 41, 959–967.PubMedCrossRefGoogle Scholar
  64. National Institute of Health. (1991, September 25-27). NIH Consensus Development Conference on Panic, 9, No. 2.Google Scholar
  65. Norton, G., Dorward, J., & Cox, B. (1986). Factors associated with panic attacks in nonclinical subjects. Behavior Therapy, 17, 239–252.CrossRefGoogle Scholar
  66. Noyes, R., Crowe, R. R., Harris, E. L., Hamra, B. J., McChesney, C. M., & Chaudhry, D. R. (1986). Relationship between panic disorder and agoraphobia: A family study. Archives of General Psychiatry, 43, 227–232.PubMedCrossRefGoogle Scholar
  67. Noyes, R., Reich, J., Suelzer, M., & Christiansen, J. (1991). Personality traits associated with panic disorder: Change associated with treatment. Comprehensive Psychiatry, 32, 282–294.Google Scholar
  68. Ost, L.-G. (1988). Applied relaxation vs. progressive relaxation in the treatment of panic disorder. Behaviour Research and Therapy, 26, 13–22.PubMedCrossRefGoogle Scholar
  69. Pollard, C. A., Pollard, H. J., & Corn, K.J. (1989). Panic onset and major events in the lives of agoraphobics: A test of contiguity. Journal of Abnormal Psychology, 98, 318–321.PubMedCrossRefGoogle Scholar
  70. Rachman, S. J., Craske, M. G., Tallman, K., & Solyom, C. (1986). Does escape behavior strengthen agoraphobic avoidance? A replication. Behavior Therapy, 17, 366–384.CrossRefGoogle Scholar
  71. Rapee, R. M. (1985). A case of panic disorder treated with breathing retraining. Behavior Therapy and Experimental Psychiatry, 16, 63–65.CrossRefGoogle Scholar
  72. Rapee, R. M., Craske, M. G., & Barlow, D. H. (1990). Subject described features of panic attacks using a new self-monitoring form. Journal of Anxiety Disorders, 4, 171–181.CrossRefGoogle Scholar
  73. Rapee, R. M., Litwin, E. M., & Barlow, D. H. (1990). Impact of life events on subjects with panic disorder and on comparison subjects. American Journal of Psychiatry, 147, 640–644.PubMedGoogle Scholar
  74. Rapee, R. M., Mattick, R., & Murreil, E. (1986). Cognitive mediation in the affective component of spontaneous panic attacks. Journal of Behavior Therapy and Experimental Psychiatry, 17, 245–253.PubMedCrossRefGoogle Scholar
  75. Reich, J., Noyes, R., & Troughton, E. (1987). Dependent personality disorder associated with phobic avoidance in patients with panic disorder. American Journal of Psychiatry, 144, 323–326.PubMedGoogle Scholar
  76. Reiss, S., Peterson, R., Gursky, D., & McNally, R. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8.PubMedCrossRefGoogle Scholar
  77. Roy-Byrne, P. P., Geraci, ML, & Uhde, T. W. (1986). Life events and the onset of panic disorder. American Journal of Psychiatry, 143, 1424–1427.PubMedGoogle Scholar
  78. Salkovskis, P., Clark, D., & Hackmann, A. (1991). Treatment of panic attacks using cognitive therapy without exposure or breathing retraining. Behavior Research and Therapy, 29, 161–166.CrossRefGoogle Scholar
  79. Salkovskis, P., Warwick, H., Clark, D., & Wessels, D. (1986). A demonstration of acute hyperventilation during naturally occurring panic attacks. Behaviour Research and Therapy, 24, 91–94.PubMedCrossRefGoogle Scholar
  80. Sanderson, W. C., DiNardo, P. A., Rapee, R. M., & Barlow, D. H. (1990). Syndrome comorbidity in patients diagnosed with a DSM-III-R anxiety disorder. Journal of Abnormal Psychology, 99, 308–312.PubMedCrossRefGoogle Scholar
  81. Spanier, G. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 15–38.CrossRefGoogle Scholar
  82. Spielberger, C., Gorsuch, R., Lushene, R., Vagg, P., & Jacobs, G. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
  83. Spitzer, R. L., & Endicott, J. (1979). The Schedule for Affective Disorders and Schizophrenia—Lifetime Version (3rd ed.). New York: New York State Psychiatric Institute, Biometrics Research.Google Scholar
  84. Spitzer, R. L., Williams, J. B. W, & Gibbon, M. (1987). Structural Clinical Interview for DSM-III-R (SCID). New York: New York State Psychiatric Institute, Biometrics Research.Google Scholar
  85. Stern, R. S., & Marks, I. M. (1973). Brief and prolonged flooding: A comparison of agoraphobic patients. Archives of General Psychiatry, 28, 270–276.PubMedCrossRefGoogle Scholar
  86. Telch, M. J. (1988). Combined pharmacological and psychological treatments for panic sufferers. In S. Rachman & J. D. Maser (Eds.), Panic: Psychological perspectives (pp. 167–187). Hillsdale, NJ: Erlbaum.Google Scholar
  87. Telch, M. J., Agras, W. S., Taylor, C. B., Roth, W. T., & Gallen, C. (1985). Combined pharmacological and behavioral treatment for agoraphobia. Behaviour Research and Therapy, 21, 505–527.CrossRefGoogle Scholar
  88. Telch, M. J., Lucas, J. A., & Nelson, P. (1989). Nonclinical panic in college students: An investigation of prevalence and symptomatology. Journal of Abnormal Psychology, 98, 300–306.PubMedCrossRefGoogle Scholar
  89. Telch, M. J., Sherman, M., & Lucas, J. (1989). Anxiety sensitivity: Unitary personality trait or domain specific appraisals? Journal of Anxiety Disorders, 3, 25–32.CrossRefGoogle Scholar
  90. Weissman, M. M. (1986). The relationship between panic disorder and agoraphobia: An epidemiologic perspective. Psychopharmacology Bulletin, 22, 787–791.PubMedGoogle Scholar
  91. Williams, S. L., & Zane G. (1989). Guided mastery and stimulus exposure treatments for severe performance anxiety in agoraphobics. Behaviour Research and Therapy, 27, 237–245.PubMedCrossRefGoogle Scholar
  92. Wolpe, J., & Rowan, V. (1988). Panic disorder: A product of classical conditioning. Behaviour Research and Therapy, 26, 441–450.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • Michelle G. Craske
    • 1
  • Sachin V. Waikar
    • 1
  1. 1.Department of PsychologyUniversity of California, Los AngelesLos AngelesUSA

Personalised recommendations