[The role of psychotherapy in managing panic disorder]

This general presentation reviews briefly the various psychotherapies proposed for panic attacks and agoraphobia treatment. Cognitive-behaviour therapy (CBT) is the only validated therapy. Behavioural model of agoraphobia and cognitive model of panic attacks are detailed. The main techniques are described. The results of controlled studies and meta-analyses demonstrate that CBT represents an alternative to anxiolytics and antidepressants. CBT is a brief form of therapy (10-20 sessions) which has been compared with waiting list, placebo, relaxation, antidepressants, anxiolytics or supportive therapy. Four meta-analyses agree on that in vivo exposure is a core element of the treatment of panic attacks and agoraphobia. They demonstrate also that agoraphobia is more difficult to treat than panic attacks in which placebo effect is quite powerful. Cognitive therapy centered on panic attacks demonstrated a significant effectiveness in controlled studies. CBT facilitates benzodiazepines withdrawal. Combination of in vivo exposure with high doses of benzodiazepines is counter-productive in the long term. Controlled studies are favorable to the combination of CBT with imipramine, SSRI (paroxetine, fluvoxamine) or buspirone. But the positive effects of these combinations are only found in the short term. CBT possesses the advantage of stable long term effects.