Academic journal article Journal of Mental Health Counseling

Treatment of Panic Disorder: Practical Guidelines. (Practice)

Academic journal article Journal of Mental Health Counseling

Treatment of Panic Disorder: Practical Guidelines. (Practice)

Article excerpt

This article presents current research information on the treatment of panic disorder. Specific guidelines are presented to guide the mental health counselor in the delivery of effective psychopharmacological and cognitive-behavioral treatment.


Panic disorder is a major health problem (Barlow, 1997) and one of the most common psychiatric disorders in the United States. Prevalence rates have been estimated from 3 million to 6 million in the general U.S. population (Foote & Seibert, 1999). Prevalence rates in clinical populations have been reported at approximately 10% (Raj, Corvea, & Dagon, 1993).

The essential feature of panic disorder is the reoccurrence of panic attacks. Panic attacks are sudden episodes of intense fear and apprehension. They can occur independent of specific psychiatric or medical diagnoses. Unlike attacks associated with other anxiety disorders, they are not cued by external stimuli. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), at least four of the common symptoms of an attack (e.g., shortness of breath, dizziness, heart palpitations, a fear of dying) must be experienced for a diagnosis of panic disorder. One of the panic attacks must be followed by at least 1 month of persistent concern about having additional attacks (American Psychiatric Association, 1994).

This disorder can wax and wane in severity of symptoms and, if left untreated, become chronic and severely reduce an individual's quality of life with disabling health consequences, including increased risk for severe depression and substance abuse (Agras, 1993). There is an increased likelihood of a suicide attempt for individuals with panic disorder. Up to 20% of individuals with panic disorder attempt suicide during their lifetime (Agras, 1993). Individuals diagnosed with substance abuse, depression, or personality disorders are also at risk for developing chronic panic disorder (Bowden, 1992).

Effective and prompt diagnosis and treatment of panic disorder can contribute to a reduction in the chronicity of this disorder. Effective treatment of panic disorder may also result in the reduction in the development of agoraphobia (Michelson, Marchione, Greenwald, Testa, & Marchione, 1996).

Individuals suffering from symptoms associated with panic disorder may seek relief either from a medical or mental health practitioner. These symptoms may either be treated from a medical, psychiatric, or mental health perspective, including psychiatric medication, medical treatment, or any number of therapies. Outcome research supports the treatment of panic disorder from a combination of psychopharmacological and cognitive-behavioral treatments (Beamish et al., 1996; Margraf, Barlow, Clark, & Telch, 1993). Although these accounts report research findings, clear cut clinical guidelines are often missing. The purpose of this article is to delineate the specific strategies identified in the research literature for use by mental health counselors in the treatment of panic disorder.


Panic attacks differ with regard to frequency, form, and severity from individual to individual and, at times, within the same individual. Full resolution of panic attacks by one form of treatment may not always be possible (Bowden, 1992).

Pharmacological Interventions

Although the prescription of pharmacological treatment is outside the scope of practice of the mental health counselor, knowledge and understanding of effective drug therapy can facilitate the treatment of panic disorder. Clients often present for counseling when they are already taking medications. Information regarding the commonly prescribed drugs, side effects, and recommended dosages is helpful in treating clients with panic disorder. Mental health counselors can better determine when to refer for medication, communicate more effectively with prescribing physicians, and evaluate changes in treatment with this basic knowledge. …

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