Behavioural Psychotherapy of Agoraphobia/Panic Disorder

Abstract

The behavioural treatment of agoraphobia and panic has evolved from graded imaginal exposure techniques, of limited power, to exposure based treatments that produce improvement in 65–75% of patients. Treatment based on self-directed exposure principles is rapidly effective and the improvements are maintained over years. Therapy may occur singly or in groups and may involve spouses or significant others. There is little evidence that medication adds to the effects of self-directed in vivo exposure. Panics decrease during behavioural psychotherapy without concomitant medication. Variants of exposure therapy include the addition of congitive and marital therapy. These additions may add to the efficacy. Despite the success of exposure based therapy 20% of patients do not improve and a large proportion are left with residual symptoms.