Empirically Supported Treatments for Panic Disorder
Abstract
This article provides an empirical review of the elements and efficacy of both pharmacologic and psychosocial treatments for panic disorder. Both monotherapies and combination treatment strategies are considered. The available evidence suggests that both cognitive behavioral therapy (CBT) and pharmacotherapy (prominently, selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors) are effective first-line agents and that CBT offers particular cost efficacy relative to both pharmacotherapy alone and combined pharmacotherapy and CBT. Predictors of non-response and mechanisms of action are considered, as are novel treatment strategies, including the use of memory enhancers to improve CBT outcome.
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The treatment of choice for panic disorder and agoraphobia (PD/A) is cognitive behavioral therapy (CBT), considered a first-line treatment.
“The treatment of choice is cognitive behavioral therapy (CBT).”
From Enhancing In Vivo Exposure in the Treatment of Panic Disorder and Agoraphobia Using Location-Based Technologies: A Case Study (2020) · cites this paper as McHugh et al., 2009
Cites
Clark, D. M. (1986) · Behaviour Research and Therapy · doi:10.1016/0005-7967(86)90011-2 · Cited by 2,422 · see citing works
Hoffman, S. G., & Smits, J. A. J. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0415 · Cited by 1,420 · see citing works
Self-citationRethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V.
Watson, D. (2005) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.114.4.522 · Cited by 1,332 · see citing works
Ressler, K. J., Rothbaum, B. O., Tannenbaum, L., Anderson, P., Graap, K., Zimand, E., Hodges, L., & Davis, M. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.11.1136 · Cited by 1,063 · see citing works
Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2000) · JAMA · doi:10.1001/jama.283.19.2529 · Cited by 953 · see citing works
Conway, K. P., Compton, W., Stinson, F. S., & Grant, B. F. (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n0211 · Cited by 934 · see citing works
Clark, D. M., Salkovskis, P. M., Hackmann, A., Middleton, H., Anastasiades, P., & Gelder, M. (1994) · British Journal of Psychiatry · doi:10.1192/bjp.164.6.759 · Cited by 673 · see citing works
Ballenger, J. C. (1988) · Archives of General Psychiatry · doi:10.1001/archpsyc.1988.01800290027004 · Cited by 564 · see citing works
Augmentation of Exposure Therapy With D-Cycloserine for Social Anxiety Disorder
Hofmann, S. G., Meuret, A. E., Smits, J. A. J., Simon, N. M., Pollack, M. H., Eisenmenger, K., Shiekh, M., & Otto, M. W. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.3.298 · Cited by 560 · see citing works
Self-citationSocial phobia: the role of in-situation safety behaviors in maintaining anxiety and negative beliefs
Wells, A., Clark, D. M., Salkovskis, P., Ludgate, J., Hackmann, A., & Gelder, M. (1995) · Behavior Therapy · doi:10.1016/s0005-7894(05)80088-7 · Cited by 548 · see citing works
A meta-analysis of treatment outcome for panic disorder
Gould, R. A., Ott, M. W., & Pollack, M. H. (1995) · Clinical Psychology Review · doi:10.1016/0272-7358(95)00048-8 · Cited by 520 · see citing works
A meta-analysis of D-cycloserine and the facilitation of fear extinction and exposure therapy
Norberg, M. M., Krystal, J. H., & Tolin, D. F. (2008) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.01.012 · Cited by 510 · see citing works
Marks, I. M., Swinson, R. P., Başoǧlu, M., Kuch, K., Noshirvani, H., O'Sullivan, G., Lelliott, P. T., Kirby, M., McNamee, G., Sengun, S., et al. (1993) · British Journal of Psychiatry · doi:10.1192/bjp.162.6.776 · Cited by 478 · see citing works
Fluoxetine, Comprehensive Cognitive Behavioral Therapy, and Placeboin Generalized Social Phobia
Davidson, J. R. T., Foa, E. B., Huppert, J. D., Keefe, F. J., Franklin, M. E., Compton, J. S., Zhao, N., Connor, K. M., Lynch, T. R., & Gadde, K. M. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.10.1005 · Cited by 415 · see citing works
Oxford Handbook of Anxiety and Related Disorders
(2008) · doi:10.1093/oxfordhb/9780195307030.001.0001 · Cited by 402 · see citing works
Psychological treatment of panic: Work in progress on outcome, active ingredients, and follow-up
Margraf, J., Barlow, D. H., Clark, D. M., & Telch, M. J. (1993) · Behaviour Research and Therapy · doi:10.1016/0005-7967(93)90036-t · Cited by 377 · see citing works
Guastella, A. J., Richardson, R., Lovibond, P. F., Rapee, R. M., Gaston, J. E., Mitchell, P., & Dadds, M. R. (2008) · Biological Psychiatry · doi:10.1016/j.biopsych.2007.11.011 · Cited by 326 · see citing works
A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder
Milrod, B., Leon, A. C., Busch, F., Rudden, M., Schwalberg, M., Clarkin, J., Aronson, A., Singer, M., Turchin, W., Klass, E. T., et al. (2007) · American Journal of Psychiatry · doi:10.1176/ajp.2007.164.2.265 · Cited by 323 · see citing works
Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A., & Gelder, M. G. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00153-3 · Cited by 310 · see citing works
Group cognitive-behavioral treatment of panic disorder
Telch, M. J., Lucas, J. A., Schmidt, N. B., Hanna, H. H., Jaimez, T. L., & Lucas, R. A. (1993) · Behaviour Research and Therapy · doi:10.1016/0005-7967(93)90026-q · Cited by 265 · see citing works
Introduction to the Special Section: Toward a Dimensionally Based Taxonomy of Psychopathology.
Krueger, R. F., Watson, D., & Barlow, D. H. (2005) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.114.4.491 · Cited by 263 · see citing works
(1993) · American Journal of Psychiatry · doi:10.1176/ajp.150.10.1485 · Cited by 263 · see citing works
Self-citationBrown, T. A., & Barlow, D. H. (1995) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.63.5.754 · Cited by 262 · see citing works
The cost of treating anxiety: the medical and demographic correlates that impact total medical costs
Marciniak, M. D., Lage, M. J., Dunayevich, E., Russell, J. M., Bowman, L., Landbloom, R. P., & Levine, L. R. (2005) · Depression and Anxiety · doi:10.1002/da.20074 · Cited by 204 · see citing works
Schmidt, N. B., Woolaway-Bickel, K., Trakowski, J., Santiago, H., Storey, J., Koselka, M., & Cook, J. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.3.417 · Cited by 189 · see citing works
Goisman, R. M., Warshaw, M. G., & Keller, M. B. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.11.1819 · Cited by 171 · see citing works
Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder
Meuret, A. E., Wilhelm, F. H., Ritz, T., & Roth, W. T. (2008) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2007.06.005 · Cited by 159 · see citing works
Does Cognitive Behavior Therapy Assist Slow-Taper Alprazolam Discontinuation in Panic Disorder?
(1994) · American Journal of Psychiatry · doi:10.1176/ajp.151.6.876 · Cited by 153 · see citing works
Anxiety disorders: a comprehensive review of pharmacotherapies
Hoffman, E. J., & Mathew, S. J. (2008) · Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine · doi:10.1002/msj.20041 · Cited by 149 · see citing works
Tsao, J. C. I., Mystkowski, J. L., Zucker, B. G., & Craske, M. G. (2002) · Behavior Therapy · doi:10.1016/s0005-7894(02)80013-2 · Cited by 128 · see citing works
The Effects of Cognitive-Behavior Therapy for Panic Disorder on Comorbid Conditions
Tsao, J. C. I., Lewin, M. R., & Craske, M. G. (1998) · Journal of Anxiety Disorders · doi:10.1016/s0887-6185(98)00020-6 · Cited by 121 · see citing works
Internet-Guided Self-Help with or without Exposure Therapy for Phobic and Panic Disorders
Schneider, A. J., Mataix-Cols, D., Marks, I. M., & Bachofen, M. (2005) · Psychotherapy and Psychosomatics · doi:10.1159/000084000 · Cited by 118 · see citing works
Kenwright, M., Liness, S., & Marks, I. (2001) · British Journal of Psychiatry · doi:10.1192/bjp.179.5.456 · Cited by 112 · see citing works
Exposure versus cognitive restructuring in the treatment of panic disorder with agoraphobia
Bouchard, S., Gauthier, J., Laberge, B., French, D., Pelletier, M.-H., & Godbout, C. (1996) · Behaviour Research and Therapy · doi:10.1016/0005-7967(95)00077-1 · Cited by 102 · see citing works
Hasler, G., Nugent, A. C., Carlson, P. J., Carson, R. E., Geraci, M., & Drevets, W. C. (2008) · Archives of General Psychiatry · doi:10.1001/archpsyc.65.10.1166 · Cited by 101 · see citing works
Exposure reduced agoraphobia but not panic, and cognitive therapy reduced panic but not agoraphobia
van den Hout, M., Arntz, A., & Hoekstra, R. (1994) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)90008-6 · Cited by 92 · see citing works
Hirschmann, S., Dannon, P. N., Iancu, I., Dolberg, O. T., Zohar, J., & Grunhaus, L. (2000) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-200010000-00011 · Cited by 89 · see citing works
Computer-aided self-help for phobia/panic via internet at home: A pilot study
Kenwright, M., Marks, I. M., Gega, L., & Mataix-Cols, D. (2004) · British Journal of Psychiatry · doi:10.1192/bjp.184.5.448 · Cited by 76 · see citing works
Cognitive-behavior therapy for discontinuation of SSRI treatment of panic disorder: a case series
Whittal, M. L., Otto, M. W., & Hong, J. J. (2001) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(00)00067-x · Cited by 44 · see citing works
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Reenvisioning Clinical Science: Unifying the Discipline to Improve the Public Health
Onken, L. S., Carroll, K. M., Shoham, V., Cuthbert, B. N., & Riddle, M. (2014) · Clinical Psychological Science · doi:10.1177/2167702613497932 · Cited by 872 · see citing works
Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., Christmas, D. M., Davies, S., Fineberg, N., Lidbetter, N., et al. (2014) · Journal of Psychopharmacology · doi:10.1177/0269881114525674 · Cited by 676 · see citing works
Gloster, A. T., Wittchen, H.-U., Einsle, F., Lang, T., Helbig-Lang, S., Fydrich, T., Fehm, L., Hamm, A. O., Richter, J., Alpers, G. W., et al. (2011) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0023584 · Cited by 203 · see citing works
Deacon, B., Kemp, J. J., Dixon, L. J., Sy, J. T., Farrell, N. R., & Zhang, A. R. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.06.006 · Cited by 176 · see citing works
Effect of a Stepped-Care Intervention Approach on Weight Loss in Adults: A Randomized Clinical Trial
Jakicic, J. M., Tate, D. F., Lang, W., Davis, K. K., Polzien, K., Rickman, A. D., Erickson, K., Neiberg, R. H., & Finkelstein, E. A. (2012) · JAMA · doi:10.1001/jama.2012.6866 · Cited by 158 · see citing works
Agoraphobia: a review of the diagnostic classificatory position and criteria
Wittchen, H.-U., Gloster, A. T., Beesdo-Baum, K., Fava, G. A., & Craske, M. G. (2010) · Depression and Anxiety · doi:10.1002/da.20646 · Cited by 150 · see citing works
Kredlow, M. A., Unger, L. D., & Otto, M. W. (2016) · Psychological Bulletin · doi:10.1037/bul0000034 · Cited by 130 · see citing works
Self-citationBarkowski, S., Schwartze, D., Strauss, B., Burlingame, G. M., Barth, J., & Rosendahl, J. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.02.005 · Cited by 134 · see citing works
Therapist perceptions and delivery of interoceptive exposure for panic disorder
Deacon, B. J., Lickel, J. J., Farrell, N. R., Kemp, J. J., & Hipol, L. J. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.02.004 · Cited by 101 · see citing works
Apolinário-Hagen, J., Drüge, M., & Fritsche, L. (2020) · Advances in Experimental Medicine and Biology · doi:10.1007/978-981-32-9705-0_17 · Cited by 100 · see citing works
Oromendia, P., Orrego, J., Bonillo, A., & Molinuevo, B. (2016) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2016.1163615 · Cited by 52 · see citing works
Sundermann, B., Bode, J., Lueken, U., Westphal, D., Gerlach, A. L., Straube, B., Wittchen, H.-U., Ströhle, A., Wittmann, A., Konrad, C., et al. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00099 · Cited by 46 · see citing works
Quero, S., Pérez-Ara, M. Á., Bretón-López, J., García-Palacios, A., Baños, R. M., & Botella, C. (2014) · British Journal of Guidance & Counselling · doi:10.1080/03069885.2013.852159 · Cited by 42 · see citing works
White, K. S., Payne, L. A., Gorman, J. M., Shear, M. K., Woods, S. W., Saksa, J. R., & Barlow, D. H. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0030666 · Cited by 42 · see citing works
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Perna, G., Guerriero, G., & Caldirola, D. (2011) · Expert Opinion on Emerging Drugs · doi:10.1517/14728214.2011.628313 · Cited by 23 · see citing works
Miralles, I., Granell, C., García-Palacios, A., Castilla, D., González-Pérez, A., Casteleyn, S., & Bretón-López, J. (2020) · Clinical Case Studies · doi:10.1177/1534650119892900 · Cited by 11 · see citing works
“The treatment of choice for PD and agoraphobia (PD/A) is cognitive behavioral therapy (CBT), which is considered a first-line treatment (McHugh et al., 2009).”
BackgroundQuality of life in panic disorder: the influence of clinical features and personality traits
Fidry, M., Zugliani, M. M., do Valle, C. R., Martins, R. M., Cabo, M. C. D., Nardi, A. E., & Freire, R. C. (2019) · Trends in Psychiatry and Psychotherapy · doi:10.1590/2237-6089-2019-0008 · Cited by 10 · see citing works
- Authors
- McHugh, R. K., Smits, J. A. J., & Otto, M. W.
- Affiliations
- Boston University (US)
- Southern Methodist University (US)
- Corresponding author
- McHugh, R. Kathryn
- Venue
- Psychiatric Clinics of North America
- Publisher
- Elsevier BV
- Published
- 2009-09
- Volume
- 32
- Issue
- 3
- Pages
- 593-610
- ISSN
- 0193-953X (ISSN-L)
- OpenAlex
- W2049533907
- Cited by
- 106
- References
- 39
- Citations by year
- 2026: 3 · 2024: 1 · 2023: 2 · 2022: 7 · 2021: 23 · 2020: 2 · 2019: 4 · 2018: 3 · 2017: 6 · 2016: 7 · 2015: 3 · 2014: 13 · 2013: 9 · 2012: 9
- FWCI
- 1.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Clinics of North America (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- panic disorder, cognitive behavioral therapy, pharmacotherapy, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, combination therapy, treatment efficacy, cost-effectiveness, mechanism of action
- MeSH terms
- Combined Modality Therapy, Drug Therapy, Humans, Models, Psychological, Synaptic Transmission, Psychotherapy, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome, Evidence-Based Medicine, Diagnostic and Statistical Manual of Mental Disorders
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