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As defined by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition,1 and the International Classification of Diseases, tenth revision,2 panic disorder is characterized by recurrent, unexpected panic attacks. Panic attacks are followed by at least 1 month of anxiety about future attacks or the implications of the attacks, or significant behavior change because of them.1,3 Panic disorder is accompanied by both cognitive and behavioral symptoms, such as negative thoughts about potential catastrophic outcomes of panic attacks (eg, “I might have a heart attack”) and avoidance of activities that induce feared physical sensations (eg, refusing to exercise to avoid increases in heart rate).
Panic disorder has been shown to be responsive to cognitive-behavioral strategies and techniques.4 Cognitive-behavioral therapy (CBT) for panic disorder can be used as a stand-alone treatment or can be added to selective serotonin reuptake inhibitor treatment.
Cognitive-Behavioral Model of Panic Disorder
One of the most prominent aspects of the cognitive-behavioral model is the role cognitions play in maintaining anxiety. The model states that panic arises when benign bodily sensations (eg, increased heart rate) are thought of as being indicative of danger or doom (eg, going crazy, impending death).5 These symptoms, triggered either by an external stimulus (such as an enclosed space) or internal stimulus (such as a rapid heartbeat after exercising), can lead to the misinterpretation of the sensations as being dangerous (termed “anxiety sensitivity”6) and trigger a panic attack. In subsequent instances of panic, the misinterpretations may be activated by the environment that prompted the original panic attack or benign bodily sensations to which the person has an increased awareness and sensitivity. Once activated, the misinterpretations lead to fear and avoidance of the benign symptoms, which exacerbate the symptoms themselves, reinforcing the misinterpretations. Thus, the beliefs about the panic sensations generate a self-perpetuating cycle that is difficult from which to escape.
To treat these cognitive symptoms of panic disorder, the therapy targets these misinterpretations of bodily symptoms. Through techniques such as cognitive restructuring, clinicians work with a person with panic disorder to intervene in the self-perpetuating cycle of panic and to loosen the associations between the bodily sensations and thinking about them.
The cognitive-behavioral model also includes a focus on the behavioral...