Abnormal Psychology

276 CHAPTER 7

FEEDBACK LOOPS IN TREATMENT: Panic Disorder

Invariably, medication—which changes neurological functioning—stops exerting its

benefi cial effect when the patient stops taking it. The positive changes in neural

communication and brain activity, and the associated changes in thoughts, feelings,

and behaviors do not endure. Eventually, the symptoms of panic disorder return.

For some patients, though, medication is a valuable fi rst step, providing enough

relief from symptoms that they are motivated to obtain CBT, which can change

their reactions (psychological factor) to perceived bodily sensations (neurological

factor). When a patient receives both medication and CBT, however, the medication

should be at a low enough dose that the patient can still feel the sensations that led

to panic in the past (Taylor, 2000). In fact, the dose should be gradually decreased

so that the patient can experience enough anxiety to be increasingly able to make

use of cognitive-behavioral methods. It is the CBT that leads to enduring changes:

Researchers have found that adding medication to CBT doesn’t provide an advan-

tage over CBT alone (de Beurs et al., 1999). This fi nding has led to CBT’s being

recommended even for those who prefer medication (Ellison & McCarter, 2002).

Whether it involves medication or CBT or both, successful treatment will probably

lead the patient, especially if he or she also has agoraphobia, to become more

independent—which in turn can change the person’s relationships, particularly

with their safe people (social factor). These factors and their feedback loops are

summarized in Figure 7.7.

Figure 7.7

7.7 • Feedback Loops in

Treating Panic Disorder

and Agoraphobia

Changes neural

activity

Treatments Targeting

Neurological Factors

Medication: SSRIs,

SNRIs, TCAs,

benzodiazepines

Treatments Targeting

Psychological Factors

CBT: Breathing

retraining, relaxation,

interoceptive

exposure, exposure to

agoraphobia-related

stimuli,

psychoeducation,

cognitive restructuring

Changes thoughts,

feelings, and

behaviors

Decreases shame and

isolation

Increases family

members’ support

Treatments Targeting

Social Factors

Group therapy

Couples or family

therapy

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