Cognitive Behavioral Group Therapy for Panic Disorder

Treatment

DIAGNOSIS: Panic Disorder

TREATMENT: Cognitive Behavioral Group Therapy for Panic Disorder

BRIEF SUMMARY

Basic premise: Panic disorder (PD) as an anxiety condition is characterized by recurrent, unexpected panic attacks accompanied by symptoms such as concern about future attacks, worrying about consequences, behavior changes, and more. Panic disorder and agoraphobia are separate conditions with distinct criteria, resulting in two separate diagnoses if they coexist. Cognitive-behavioral therapy (CBT) is one of the well-established alternative treatment options to pharmacotherapy for PD with or without agoraphobia.
Essence of therapy: Group therapy has proven to be an established and cost-effective psychological treatment for both PD with or without agoraphobia. Cognitive-behavioral group therapy (CBGT) has gained recognition as a prominent approach in the treatment of PD. It takes place in a group setting where participants learn and apply cognitive and behavioral techniques to effectively manage and reduce symptoms of their panic attacks and associated anxiety. CBGT for panic disorder with or without agoraphobia encourages support among participants, offers psychoeducation to enhance understanding, and assists individuals in cultivating effective coping mechanisms within a supportive group setting.

American Psychological Association. (n.d.). Panic disorder (PD). APA dictionary of psychology. https://dictionary.apa.org/panic-disorder

Dannon, P. N., Gon-Usishkin, M., Gelbert, A., Lowengrub, K., & Grunhaus, L. (2004). Cognitive Behavioral Group Therapy in Panic Disorder Patients: The Efficacy of CBGT versus Drug Treatment. Annals of Clinical Psychiatry, 16(1), 41–46. https://doi.org/10.1080/10401230490281609

Schwartze, D., Barkowski, S., Strauss, B., Burlingame, G. M., Barth, J., & Rosendahl, J. (2017). Efficacy of group psychotherapy for panic disorder: Meta-analysis of randomized, controlled trials. Group Dynamics: Theory, Research, and Practice, 21(2), 77–93. https://doi.org/10.1037/gdn0000064

TREATMENT RESOURCES

TREATMENT MANUALS

Anxiety and Panic Disorder. Patient Treatment Manual. (Clinical Research Unit for Anxiety Disorders St. Vincent’s Hospital Sidney)

Coping with panic: A drug-free approach to dealing with anxiety attack (Clum, 1989)

Panic disorder and agoraphobia (Craske & Barlow, 2001)

Mastery of your anxiety and panic: Therapist guide (Craske & Barlow, 2006)

Group cognitive-behavioral therapy of anxiety: A transdiagnostic treatment manual (Norton, 2012)

Don’t panic: Taking control of anxiety attacks (Wilson, 2009)

CBT for anxiety disorders: A practitioner book (Simos & Hofmann, 2013)

WORKBOOKS and WORKSHEETS

Mastery of your anxiety and panic: Workbook (Barlow & Craske, 2022)

The Anxiety and Phobia Workbook (Bourne, 2020)

Worksheets for cognitive behavioral therapy for panic disorder: CBT workbook to deal with stress, anxiety, anger, control mood, learn new behaviors & regulate emotions (Cruise, 2019)

How to Beat Panic Disorder One Step at a Time: Using evidence-based low-intensity CBT (Farrand & Chellingsworth, 2016)

The panic attack workbook: A workbook of therapy assignments (Lawrence, 2017)

Dealing With Panic The CBT Way (Linde)

The cognitive behavioral therapy workbook for panic attacks the cognitive behavioral therapy workbook for panic attacks (Welsh, 2019)

ADDITIONAL RESOURCES

Coping with panic (Young, 2010)

Panic disorder self-help resources - information sheets & workbooks (Centre for Clinical Interventions, 2023)

Panic Attack Worksheets (Inner Health Studio)

Multicenter collaborative Panic Disorder Severity Scale (Shear et al., 1997)

Treating panic & Panic Disorder: A CBT approach (Nader, 2021)

Panic disorder self-help resources - information sheets & workbooks (Centre for Clinical Interventions, 2023)

Group Therapy: Definition, Types, Techniques, and Efficacy (Cherry, 2022)

Cognitive Behavioral Therapy for Panic Disorder: How It Works & What to Expect (Deupree, 2023)

CBT for panic disorder: Everything you need to know (Greene, 2022)

How to treat panic attacks: 6 exercises and techniques (Smith, 2021)

SUPPORTING STUDIES

Bergström, J., Andersson, G., Ljótsson, B., Rück, C., Andréewitch, S., Karlsson, A., Carlbring, P., Andersson, E., & Lindefors, N. (2010). Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: A randomised trial. BMC Psychiatry, 10(1), 54.

https://doi.org/10.1186/1471-244X-10-54

Bohni, M. K., Spindler, H., Arendt, M., Hougaard, E., & Rosenberg, N. K. (2009). A randomized study of massed three-week cognitive behavioural therapy schedule for panic disorder: Three-week group CBT for panic disorder. Acta Psychiatrica Scandinavica, 120(3), 187–195.

https://doi.org/10.1111/j.1600-0447.2009.01358.x

Bouchard, S., Gauthier, J., Laberge, B., French, D., Pelletier, M.-H., & Godbout, C. (1996). Exposure versus cognitive restructuring in the treatment of panic disorder with agoraphobia. Behaviour Research and Therapy, 34(3), 213–224.

https://doi.org/10.1016/0005-7967(95)00077-1

Carter, M. M., Sbrocco, T., Gore, K. L., Marin, N. W., & Lewis, E. L. (2003). Cognitive–Behavioral Group Therapy Versus a Wait-List Control in the Treatment of African American Women with Panic Disorder. Cognitive Therapy and Research, 27(5), 505–518.

https://doi.org/10.1023/A:1026350903639

Craske, M. G., DeCola, J. P., Sachs, A. D., & Pontillo, D. C. (2003). Panic control treatment for agoraphobia. Journal of Anxiety Disorders, 17(3), 321–333.

https://doi.org/10.1016/S0887-6185(02)00203-7

https://doi.org/10.1080/10401230490281609

Erickson, D. H., Janeck, A. S., & Tallman, K. (2007). A cognitive-behavioral group for patients with various anxiety disorders. Psychiatric Services, 58(9), 1205–1211.

https://doi.org/10.1176/ps.2007.58.9.1205

Hazen, A. L., Walker, J. R., & Eldridge, G. D. (1996). Anxiety sensitivity and treatment outcome in panic disorder. Anxiety, 2(1), 34–39.

https://doi.org/10.1002/(SICI)1522-7154(1996)2:1<34::AID-ANXI5>3.0.CO;2-D

Hovland, A., Nordhus, I. H., Sjøbø, T., Gjestad, B. A., Birknes, B., Martinsen, E. W., Torsheim, T., & Pallesen, S. (2013). Comparing Physical Exercise in Groups to Group Cognitive Behaviour Therapy for the Treatment of Panic Disorder in a Randomized Controlled Trial. Behavioural and Cognitive Psychotherapy, 41(4), 408–432.

https://doi.org/10.1017/S1352465812000446

Korrelboom, K., Peeters, S., Blom, S., & Huijbrechts, I. (2014). Competitive Memory Training (COMET) for Panic and Applied Relaxation (AR) Are Equally Effective in the Treatment of Panic in Panic-Disordered Patients. Journal of Contemporary Psychotherapy, 44(3), 183–190.

https://doi.org/10.1007/s10879-013-9259-3

Lidren, D. M., Watkins, P. L., Gould, R. A., Clum, G. A., Asterino, M., & Tulloch, H. L. (1994). A comparison of bibliotherapy and group therapy in the treatment of panic disorder. Journal of Consulting and Clinical Psychology, 62(4), 865–869.

https://doi.org/10.1037//0022-006x.62.4.865

Marchand, A., Roberge, P., Primiano, S., & Germain, V. (2009). A randomized, controlled clinical trial of standard, group and brief cognitive-behavioral therapy for panic disorder with agoraphobia: A two-year follow-up. Journal of Anxiety Disorders, 23(8), 1139–1147.

https://doi.org/10.1016/j.janxdis.2009.07.019

Marchione, K. E., Michelson, L., Greenwald, M., & Dancu, C. (1987). Cognitive behavioral treatment of agoraphobia. Behaviour Research and Therapy, 25(5), 319–328.

https://doi.org/10.1016/0005-7967(87)90010-6

Meulenbeek, P., Willemse, G., Smit, F., van Balkom, A., Spinhoven, P., & Cuijpers, P. (2008). Early intervention in panic: Randomized controlled trial and cost-effectiveness analysis. Trials, 9(1), 67.

https://doi.org/10.1186/1745-6215-9-67

Michelson, L. K., Marchione, K. E., Greenwald, M., Testa, S., & Marchione, N. J. (1996). A comparative outcome and follow-up investigation of panic disorder with agoraphobia: The relative and combined efficacy of cognitive therapy, relaxation training, and therapist-assisted exposure. Journal of Anxiety Disorders, 10(5), 297–330.

https://doi.org/10.1016/0887-6185(96)00001-1

Norton, P. J., & Hope, D. A. (2005). Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 36(2), 79–97.

https://doi.org/10.1016/j.jbtep.2004.07.002

Norton, P. J. (2012). A Randomized Clinical Trial of Transdiagnostic Cognitive-Behavioral Treatments for Anxiety Disorder by Comparison to Relaxation Training. Behavior Therapy, 43(3), 506–517.

https://doi.org/10.1016/j.beth.2010.08.011

Norton, P. J., & Barrera, T. L. (2012). Transdiagnostic versus Diagnosis-specific CBT for Anxiety Disorders: A Preliminary Randomized Controlled Noninferiority Trial. Depression and Anxiety, 29(10), 874–882.

https://doi.org/10.1002/da.21974

Prasko, J., Horácek, J., Záleský, R., Kopecek, M., Novák, T., Pasková, B., Skrdlantová, L., Belohlávek, O., & Höschl, C. (2004). The change of regional brain metabolism (18FDG PET) in panic disorder during the treatment with cognitive behavioral therapy or antidepressants. Neuroendocrinology Letters, 25(5), 340-348.

https://pubmed.ncbi.nlm.nih.gov/15580167/

Roberge, P., Marchand, A., Reinharz, D., & Savard, P. (2008). Cognitive-Behavioral Treatment for Panic Disorder With Agoraphobia: A Randomized, Controlled Trial and Cost-Effectiveness Analysis. Behavior Modification, 32(3), 333–351.

https://doi.org/10.1177/0145445507309025

Schmidt, N. B., Buckner, J. D., Pusser, A., Woolaway-Bickel, K., Preston, J. L., & Norr, A. (2012). Randomized Controlled Trial of False Safety Behavior Elimination Therapy: A Unified Cognitive Behavioral Treatment for Anxiety Psychopathology. Behavior Therapy, 43(3), 518–532.

https://doi.org/10.1016/j.beth.2012.02.004

Schmidt, N. B., McCreary, B. T., Trakowski, J. J., Santiago, H. T., Woolaway-Bickel, K., & Ialongo, N. (2003). Effects of cognitive behavioral treatment on physical health status in patients with panic disorder. Behavior Therapy, 34(1), 49–63.

https://doi.org/10.1016/S0005-7894(03)80021-7

Schmidt, N. B., Staab, J. P., Trakowski, J. H., & Sammons, M. (1997). Efficacy of a Brief Psychosocial Treatment for Panic Disorder in an Active Duty Sample: Implications for Military Readiness. Military Medicine, 162(2), 123–129.

https://doi.org/10.1093/milmed/162.2.123

Schmidt, N. B., Woolaway-Bickel, K., Trakowski, J., Santiago, H., Storey, J., Koselka, M., & Cook, J. (2000). Dismantling cognitive–behavioral treatment for panic disorder: Questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology, 68(3), 417–424.

https://doi.org/10.1037/0022-006X.68.3.417

Sharp, D. M., Power, K. G., & Swanson, V. (2004). A comparison of the efficacy and acceptability of group versus individual cognitive behaviour therapy in the treatment of panic disorder and agoraphobia in primary care. Clinical Psychology & Psychotherapy, 11(2), 73–82.

https://doi.org/10.1002/cpp.393

Telch, M. J., Lucas, J. A., Schmidt, N. B., Hanna, H. H., Jaimez, T. L., & Lucas, R. A. (1993). Group cognitive-behavioral treatment of panic disorder. Behaviour Research and Therapy, 31(3), 279–287.

https://doi.org/10.1016/0005-7967(93)90026-Q

Westra, H. A., & Dozois, D. J. (2006). Preparing clients for cognitive behavioral therapy: A randomized pilot study of motivational interviewing for anxiety. Cognitive Therapy and Research, 30, 481–498.

https://doi.org/10.1007/s10608-006-9016-y