Cognitive-behavioral therapy (CBT) is considered the most effective psychological treatment for panic disorder (Papola et al., 2022), and is based on Clark’s (1996) cognitive model of panic disorder. According to this model, panic attacks result from catastrophizing bodily sensations, such as interpreting an increased heart rate as a heart attack. This misinterpretation leads to increased anxiety levels, reinforcing the initial catastrophic belief and perpetuating the cycle of panic. CBT for panic disorder targets these beliefs and behaviors to break the cycle of catastrophic misinterpretation.
However, accessibility remains a significant issue in psychological therapies. Barriers to treatment delivery include geographical limitations for those in rural areas, full-time workers with daytime commitments, and patients with comorbid agoraphobia. Therapy delivered online and over the telephone has the potential to overcome these barriers with added flexibility, an issue that has become more pressing since the COVID-19 pandemic (Chevance et al., 2020).
Papola et al. (2023) conducted a study to compare the effectiveness of different delivery formats of CBT for panic disorder. The researchers utilized a network meta-analysis of randomized control trials (RCTs) to evaluate the efficacy and acceptability of various CBT delivery formats. The study included 74 studies with over 6,000 participants and found that face-to-face individual, face-to-face group, and guided self-help CBT were all superior to treatment as usual or waitlist controls in relieving symptoms of panic disorder.
The study also found that unguided self-help was not significantly better than waitlist controls, indicating that this format may not be as suitable for treating panic disorder as the other formats. However, there were no significant differences in treatment efficacy based on delivery format, suggesting that more accessible delivery formats are not necessarily detrimental to treatment quality.
One strength of the study is that it is the first to compare alternative delivery formats on a common metric for a specific anxiety disorder. However, the researchers did not consider the baseline severity of panic symptoms, and the heterogeneous features across the studies may have contributed to differences in program efficacy. They also did not comment on differences between online and in-person deliveries of CBT, raising questions for future research.
Overall, the study’s findings suggest that more accessible delivery formats of CBT, such as guided self-help, are as effective as traditional face-to-face formats for treating panic disorder. This supports the continued use and investment in these alternative delivery options and could have practical advantages in reducing therapist workload and shortening waiting lists. However, further research is needed to address the limitations of the current study and to inform stepped care approaches for the treatment of panic disorder.
