Intensive Cognitive-Behavioral Treatment for Panic Disorder and Agoraphobia

Information for New Patients

The Intensive Program for Panic Disorder is a ten day to three week program designed for patients wishing to make rapid and effective progress overcoming severe and debilitating panic and agoraphobic symptoms. Based upon the cognitive-behavioral program of Barlow and Craske (1988), the program uses state-of-the-art methods of in vivo exposure and cognitive restructuring to assist patients to gain effective control over their panic and agoraphobic symptoms.

Structure of the Program

The program is done in three phases: Evaluation, Intensive Exposure, Maintenance and Follow-up. The patient meets with their cognitive-behavioral therapist between two and four hours per day for approximately three weeks. Some patients who require more time to complete treatment may do so with the permission of their therapist. Non-therapy hours are supplemented with extensive reading and home practice assignments.

I - Evaluation phase

During this phase, the patient undergoes an extensive evaluation of their panic problem, including history of the problem, previous treatment experiences, medication and medical history. In addition, a complete cognitive-behavioral assessment is done for the purpose of generating an intensive treatment strategy designed to effectively control panic and agoraphobic symptoms. This phase is completed within the first two to three days of the program.

II - Intensive Exposure Phase

During this phase, the patient engages in intensive exposure to both real-life feared and avoided external situations (in vivo exposure), e.g., shopping malls, theaters, elevators, crowded theater, while driving, etc., and to feared and avoided bodily sensations ("interoceptive" exposure) such as heart palpitations and shortness of breath. Through this process, the patient is armed with the tools to manage and master these avoided situations.

Cognitive restructuring techniques are also extensively employed to change dysfunctional beliefs and attitudes that perpetuate panic and avoidance. Approximately twelve to eighteen sessions lasting between two and four hours per day are usually needed to accomplish significant gains in overcoming panic and agoraphobic symptoms.

Patients should expect to come into contact with increasingly high levels of discomfort for the purpose of learning that anxiety and panic symptoms need not be feared. Patients learn that fear can be effectively controlled through natural means other than through escape or avoidance. At the end of this phase, having acquired the cognitive-behavioral skills to manage feared situations, patients engage in their own exposure work, independent of the therapist. This powerful learning process enables patients to rapidly overcome years of debilitating symptoms that have not responded to more traditional "talk" therapy methods.

III - Maintenance and Follow-up

During this phase the techniques of relapse prevention are taught, including methods of lifestyle and stress management, to better insure the long term management of panic and agoraphobia. To insure a smooth transition post-treatment, follow-up telephone or Internet video conferencing sessions (if patient owns this technology) are held once per week for two weeks, then one month later, and six months later. These follow-up sessions are designed to reinforce treatment gains and monitor patient progress incorporating new found skills into their lives.

Who is Appropriate for the Intensive Treatment Program?

While the Intensive Treatment Program for Panic Disorder and Agoraphobia can be very helpful to many patients, not all are appropriate for the program. To benefit from this program, patients must:

• Have primary difficulties avoiding many situations and activities because of the fear of panic attacks.
• Be willing to undergo rather intense periods of discomfort, including actual panic attacks within the treatment process itself in order to master their fear and anxiety.
• This form of treatment would be inadvisable for persons with certain medical or psychiatric disorders, such as severe depression, bipolar disorder or a history of psychosis. Patients who are actively abusing alcohol or drugs are not appropriate candidates.
• Those patients who take benzodiazepines (Xanax, Ativan, etc.) and antidepressants (Prozac, Paxil, Luvox, Zoloft, Celexa, Lexapro) must be on a stable regimen of these medications for a minimum of three months prior to the beginning of treatment.
• Patients who take benzodiazepines on a PRN (as needed) basis will not be permitted to take them PRN during the duration of the program. Scheduled dosages of these medications during the treatment are, however, permitted.
• All patients must have undergone a medical exam within the past year or since the onset of their panic symptoms within the past year.

Prior to your acceptance as a patient for the intensive program, we want to know if our program is the right one for you. Please provide us some brief information about your problem (the form is confidential) by filling out the following screening form and send to the center. It will be read by an associate within 24 hours and you'll be contacted by telephone to complete the initial screening process.

For questions about intensive treatment for panic disorder, contact us.