Reference Work Entry

Handbook of Clinical Psychology Competencies

pp 723-758


  • Paul M. G. EmmelkampAffiliated withUniversity of Amsterdam
  • , Mark B. PowersAffiliated withUniversity of Amsterdam


This chapter summarizes the literature on assessment, maintenance, treatment, and mechanisms of change in treatment of patients with panic disorder with or without agoraphobia. Relevant theoretical contributions which are discussed may help to understand the genesis and maintenance factors of panic disorder and agoraphobia. Further, we provide an overview of empirically supported treatment approaches for these disorders and discuss the mechanisms of change involved in these treatments Knowledge of the burgeoning literature in this area is relevant for the development of basic and expert clinical competencies in panic disorder/agoraphobia. It is argued that the clinician should first be familiar with the diagnostic criteria for panic disorder and for agoraphobia. Knowledge of structured clinical interviews is needed to be able to formalize the diagnosis. In addition, knowledge of self-report measures, behavioral assessment, and self-monitoring is needed to assess the quality and severity of panic disorder and agoraphobia and to evaluate progress of treatment. Further, basic competencies also require knowledge on which factors are involved in the maintenance of these disorders. In addition, basic clinical competencies should entail knowledge about psycho-education, and evidence-based protocols for conducting interoceptive exposure and exposure in vivo outside the therapist office. Expert clinical competencies may entail advanced understanding and skills of applying psychological and pharmacological procedures to augment exposure therapy, skills in enactment of cognitive therapy and couple therapy, knowledge and skills to deal with panic disorder and agoraphobia in cases with comorbid disorders (e.g. substance abuse/dependence, and depression) as well sensitivity to anxiety related cultural factors.