The best panic attack treatment – general information.

interesting panic attack facts. Panic attack treatment.

Panic attack facts

Treatment for panic attacks or panic disorders is widely available, both in person and online. Unfortunately, not all panic disorder treatments are effective or produce long-term effects. In general, panic attack treatment focuses on the reduction of panic attacks, its symptoms, and coping mechanisms.
There are three ways panic attack treatment is offered: psychotherapy, medication, and a combination of both. Medication alone is not effective on the long term [4]; the moment someone stops taking medication, panic disorder symptoms will most likely return. However, medication can be very helpful to those who experience a lot of anxiety and panic: anti-anxiety medication can reduce the experienced panic and anxiety, which in turn improves the effects of psychotherapy. This page discusses each evidence based panic attack treatment offered in terms of effectiveness and describes how each therapy looks like.


At Barends Psychology Practice, we treat Panic attacks Online and in person. Contact us to schedule a first, free of charge, session. (Depending on your health insurance, treatment may be reimbursed).


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Panic attack treatment – psychotherapy

Panic Attack Circle explained. Panic attack treatment.

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Cognitive Behavioural Therapy (CBT):
CBT aims to reduce the fear of fear (FOF; the tendency to respond fearful to bodily sensations) by exposure, breathing techniques and relaxation training [11]. Reducing the FOF in people with panic disorder reduces their anxiety symptoms, phobic avoidance, panic frequency, and the amount of panic attacks [11]. Also other studies have demonstrated that CBT significantly reduces panic disorder symptoms [1],[2],[3],[4],[7] both in person and online [2],[8].
In a meta analysis of cognitive behavioural therapy in the treatment of panic disorder the strongest effect sizes were found when cognitive restructuring was combined with exposure in vivo: effect size of 0.88 [7]. In general, the effect size of CBT was 0.68, which was significantly higher than medications (0.47) [7]. Also, at the 1-year follow up the effect size as almost similar (-0.07) [7].
In another meta analysis, the best treatment for panic disorder was a combination of exposure, breathing techniques and relaxation training [3]. Also, homework exercises significantly improved treatment outcomes [3].

Online CBT treatment for panic disorder is effective and reduces treatment costs significantly [2],[8],[10] a meta analysis shows. The reduced cost can be explained by the reduced time with a therapist, or by a more affordable fee with an online therapist.

In short: CBT is very effective as a panic disorder treatment, both in person and online. The best treatment combination consists of exposure in vivo, breathing techniques, relaxation training, and to have home work exercises.

Panic attack treatment – other psychotherapies

Emotion focused therapy is less effective in treating panic disorder as CBT or imipramine is [12]. Its effectivity as a panic attack treatment is comparable to placebo [12].
There is evidence supporting Panic-Focused Psycho-dynamic Psychotherapy (PFPP) to be effective in the treatment of panic disorder [13],[14]. NOTE: both published articles about its effectiveness came from the same authors.
Panic attack treatment – medication
Medication in combination with CBT is more effective than just medication alone [5],[6]. Imipramine is effective in treating panic disorder, especially in combination with CBT [5]. Unfortunately, long term effects are not as good as with CBT alone or CBT in combination with imipramine [4].
SSRI’s and TCA’s are equally effective in treating panic disorder; they are both more effective than placebo [9].
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  • [1] Smits, J. A., Powers, M. B., Cho, Y., & Telch, M. J. (2004). Mechanism of change in cognitive-behavioral treatment of panic disorder: evidence for the fear of fear mediational hypothesis. Journal of consulting and clinical psychology, 72, 646.
  • [2] Kiropoulos, L. A., Klein, B., Austin, D. W., Gilson, K., Pier, C., Mitchell, J., & Ciechomski, L. (2008). Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT?. Journal of anxiety disorders, 22, 1273-1284.
  • [3] Sánchez-Meca, J., Rosa-Alcázar, A. I., Marín-Martínez, F., & Gómez-Conesa, A. (2010). Psychological treatment of panic disorder with or without agoraphobia: a meta-analysis. Clinical psychology review, 30, 37-50.
  • [4] Botella, C., García‐Palacios, A., Villa, H., Baños, R. M., Quero, S., Alcañiz, M., & Riva, G. (2007). Virtual reality exposure in the treatment of panic disorder and agoraphobia: A controlled study. Clinical Psychology & Psychotherapy, 14, 164-175.
  • [5] Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. Jama, 283, 2529-2536.
  • [6] Van Apeldoorn, F. J., Van Hout, W. J. P. J., Mersch, P. P. A., Huisman, M., Slaap, B. R., Hale, W. W., … & Den Boer, J. A. (2008). Is a combined therapy more effective than either CBT or SSRI alone? Results of a multicenter trial on panic disorder with or without agoraphobia. Acta Psychiatrica Scandinavica, 117, 260-270.
  • [7] Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical psychology review, 26, 17-31.
  • [8] Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P., & Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PloS one, 5, e13196.
  • [9] Bakker, A., Van Balkom, A. J. L. M., & Spinhoven, P. (2002). SSRIs vs. TCAs in the treatment of panic disorder: a meta‐analysis. Acta Psychiatrica Scandinavica, 106, 163-167.
  • [10] Carlbring, P., Nilsson-Ihrfelt, E., Waara, J., Kollenstam, C., Buhrman, M., Kaldo, V., … & Andersson, G. (2005). Treatment of panic disorder: live therapy vs. self-help via the Internet. Behaviour research and therapy, 43, 1321-1333.
  • [11] Smits, J. A., Powers, M. B., Cho, Y., & Telch, M. J. (2004). Mechanism of change in cognitive-behavioral treatment of panic disorder: evidence for the fear of fear mediational hypothesis. Journal of consulting and clinical psychology, 72, 646.
  • [12] Shear, M. K., Houck, P., Greeno, C., & Masters, S. (2001). Emotion-focused psychotherapy for patients with panic disorder. American Journal of Psychiatry, 158, 1993-1998.
  • [13] Busch, F. N., Milrod, B. L., & Sandberg, L. S. (2009). A study demonstrating efficacy of a psychoanalytic psychotherapy for panic disorder: implications for psychoanalytic research, theory, and practice. Journal of the American Psychoanalytic Association, 57, 131-148.
  • [14] Milrod, B., Leon, A. C., Busch, F., Rudden, M., Schwalberg, M., Clarkin, J., … & Graf, E. (2007). A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. American Journal of Psychiatry, 164, 265-272.