Psychological Treatments for Panic Disorders, Phobias, and Generalized Anxiety Disorder

Abstract

A substantial number of excellent studies, largely Type 1, have established the clinical efficacy of situational in vivo exposure for patients with panic disorder with moderate to severe agoraphobia. A substantial number of Type 1 studies have established the efficacy of cognitive-behavioral treatments for persons with panic disorder with no more than mild agoraphobia; these treatments focus on cognitive therapy, exposure to interoceptive sensations similar to physiological panic sensations, and breathing retraining. One large clinical trial (Type 1) has been reported that explores the efficacy of separate and combined psychological and pharmacological treatment of panic disorder. Recently, two large effectiveness trials (Type 1) have established successful dissemination of the cognitive-behavioral treatment. The treatment of choice for specific phobias is exposure-based procedures, particularly in vivo exposure; this consensus reflects a very large number of Type 1 studies of these procedures with patients with specific phobias. The most common treatment approaches to social phobia include social skills training (SST), relaxation techniques, exposure-based methods, and multicomponent cognitive-behavioral treatments, with the latter, as well as exposure-based procedures, attaining the highest level of treatment efficacy in Type 1 studies. In early studies, different treatment conditions for patients with generalized anxiety disorder (GAD) did not lead to differential improvement rates, although most studies showed that active treatments were superior to nondirective approaches and uniformly superior to no treatment. Recently, however, a few studies have suggested that the most successful psychological treatments for GAD combine relaxation exercises and cognitive therapy with the goal of bringing the worry process itself under the patient’s control.