Treatment for Panic Disorder and Agoraphobia

Our treatments for Panic Disorder include cognitive behavior therapy (CBT), relaxation training, and mindfulness and acceptance practices. You can learn more about these here and more about Panic Disorder in general in our education handout.

Cognitive Behavior Therapy (CBT)

One of the most effective treatments for panic disorder and agoraphobia is cognitive behavior therapy (CBT), which can be used alone or in conjunction with medications. CBT can often be utilized effectively on its own for milder cases, whereas a combination is often preferred for more severe cases. CBT is a structured treatment that can be provided in an individual or group format, usually on a weekly basis. The goal of CBT is to significantly reduce or eliminate panic attacks, as well as significantly decrease the fear and behavior changes associated with them. Much of the work of CBT is done between sessions in the form of “homework,” so that the person can monitor their panic symptoms and apply the techniques learned in therapy sessions.

CBT for panic disorder is based on the assumptions that: 1) individuals with panic disorder misinterpret their panic attacks as dangerous or scary, 2) they are overly attuned to their bodily sensations, making them more vulnerable to experiencing attacks, and 3) they often make changes in their behaviors, such as avoidance of situations that they associate with the attacks.  One of the goals of treatment is to help the person have a more realistic view of their panic attacks, in order to help make them less scary. This is done through providing education about panic disorder, teaching people to be aware of their scary thoughts about the attacks, and instructing them on how to change these thoughts to make them more realistic and less frightening.

A technique called interoceptive exposure is used to help people overcome their fear of the bodily sensations associated with panic attacks. Interoceptive exposure involves engaging in specific exercises to bring on the symptoms of anxiety and panic in a controlled way. Although often uncomfortable at first, these exposure exercises are very effective for alleviating the distress of experiencing symptoms of panic and eventually the symptoms themselves. Finally, CBT utilizes in vivo exposures, in which a person systematically starts to face the people, places, and activities that they might be avoiding as a result of the panic attacks. For example, if someone is avoiding exercising or drinking caffeine for fear of having an attack, the therapist will work with them to strategically plan on introducing and continuing these avoided activities.

With CBT for agoraphobia, the emphasis would likely be on the in vivo exposure element of treatment. By engaging in in vivo exposure therapy, individuals with agoraphobia will systematically and frequently approach feared situations and learn that they are not scary or dangerous.

Relaxation Training

Some therapists use relaxation training as a method of reducing anxiety and panic attacks. It can be used in conjunction with CBT and/or medication, but most professionals agree that relaxation training alone is probably not sufficient to fully alleviate panic symptoms for most people. One type of relaxation strategy often used for panic disorder is diaphragmatic breathing, or belly breathing. This type of breathing, which leads to deeper breaths and more oxygen in the lungs, might be particularly helpful for those who experience shortness of breath, chest pain, or dizziness during their panic attacks. Diaphragmatic breathing is also a relaxation strategy for treating more generalized anxiety, which might then reduce one’s susceptibility to having a panic attack. Likewise, progressive muscle relaxation, a type of relaxation which involves tensing and relaxing different muscles in the body, can also lead to reducing generalized anxiety.

Mindfulness and Acceptance Practices

Mindfulness is another technique often used in conjunction with CBT and/or medication. Contrary to what some people think, mindfulness and relaxation are not the same thing, although many people find practicing mindfulness to be relaxing. There are many ways to practice mindfulness. One common way is to sit quietly and focus attention on one’s breath, without actually trying to change the breath. People who regularly practice mindfulness can learn to be less reactive to their emotions and changes in their bodies. They can learn to be more accepting of negative emotional states, such as anxiety. For those with panic disorder and agoraphobia, mindfulness can teach people to observe their anxiety, rather than feeding into it with negative thoughts and avoidance behaviors. Thus, acceptance of one’s anxiety can cause the anxiety to lessen and feel less scary.