Diversity of effective treatments of panic attacks: what do they have in common?


  • Walton T. Roth M.D.

    Corresponding author
    1. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
    2. Department of Veterans Affairs Health Care System, Palo Alto, California
    • VA Health Care System (116F-PAD), 3801 Miranda Ave., Palo Alto, CA 94304
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  • This article is a US Government copyright and, as such, is in the public domain in the United States of America.


By comparing efficacious psychological therapies of different kinds, inferences about common effective treatment mechanisms can be made. We selected six therapies for review on the basis of the diversity of their theoretical rationales and evidence for superior efficacy: psychoanalytic psychotherapy, hypercapnic breathing training, hypocapnic breathing training, reprocessing with and without eye-movement desensitization, muscle relaxation, and cognitive behavior therapy. The likely common element of all these therapies is that they reduce the immediate expectancy of a panic attack, disrupting the vicious circle of fearing fear. Modifying expectation is usually regarded as a placebo mechanism in psychotherapy, but may be a specific treatment mechanism for panic. The fact that this is seldom the rationale communicated to the patient creates a moral dilemma: Is it ethical for therapists to mislead patients to help them? Pragmatic justification of a successful practice is a way out of this dilemma. Therapies should be evaluated that deal with expectations directly by promoting positive thinking or by fostering non-expectancy. Depression and Anxiety, 2010. Published 2009 Wiley-Liss, Inc.