Interventions for Panic Disorder: A Critical Review of the Literature

Initial etiological theories of panic were largely grounded in a biological framework due to the seemingly spontaneous nature of most attacks. More recently, however, cognitive, hyperventilatory, and conditioning theories of panic have been proposed. Cognitive theorists emphasize the causal role of catastrophic misattributions of benign somatic cues in panic; therefore, treatment involves providing the client with corrective information. Proponents of the hyperventilatory theory of panic implicate inappropriately increased ventilation; consequently, interventions emphasize breathing retraining. Finally, conditioning theorists hold that initial attacks are caused by hyperventilation or some other discrete event and that contiguous interoceptive stimuli become conditioned elicitors of future panics; as a result, treatment consists of exposure to the interoceptive cues which trigger panic. Combinations of treatments address possible multiple causal pathways and have been found to be relatively more effective than interventions based on only one etiological perspective.