Unpacking Cognitive Therapy for Panic Disorder

November 28, 2023

Unpacking Cognitive Therapy for Panic Disorder

Research Summary in Three Key Points
1. Cognitive behavioral therapy (CBT) is proven to be effective for panic disorder treatment.
2. No significant differences were found in treatment effectiveness between individual (face-to-face) treatment, group (face-to-face) treatment, and expert-guided self-treatment (remote). Compliance with the treatment also showed no significant difference.
3. Self-conducted CBT without expert's guidance showed no significant effect compared to the control group.

Cognitive Behavioral Therapy (CBT) for panic disorder is effective, and there is abundant evidence to back this up. Respected institutions such as APA and NICE describe CBT as 'the most realistic and recommended' psychological approach for managing panic disorder. Another pillar is medication. However, many studies support the fact that CBT plays a significant role in reducing the recurrence of panic disorder on a different level than medication.

As CBT has been accepted as a universal approach, many studies have been conducted on the format of conducting CBT. CBT can be carried out in various formats, which are broadly divided into four categories:

  • Face-to-face group therapy
  • Face-to-face individual therapy
  • Digital program therapy conducted on one's own
  • Expert-assisted digital program therapy

The strengths and weaknesses of each format would be clearly identifiable. So, which format will truly prove effective? Which format could provide greater accessibility without losing its effectiveness?

A good study was published in the Psychological Medicine in 2022 on this topic. It is a meta-analysis that integrates random assortment clinical trials (RCT) on the formats of CBT for panic disorder, thus making it a relatively high-level evidence-based study. The content of the study is straightforward – it aims to find out how effective the treatments carried out in the four aforementioned formats were and to what extent the users followed along. The results were as follows (as the graph is not easy to interpret, it is for reference only).

Figure 1. The red circles represent face-to-face treatments, and the blue circles represent non-face-to-face treatments. In the control group, TAU (Treatment as usual), only evaluations were carried out, or simple information was conveyed by the therapist or counselor with minimal intervention, or regular drug treatments were conducted.

In terms of effectiveness, face-to-face group therapy, face-to-face individual therapy, and digital programs assisted by professionals were more effective compared to the control group. There was no significant difference of effectiveness between these three forms of therapy. On the other hand, digital program therapy conducted alone was not more effective compared to the control group. Conversely, in terms of therapy adherence, meaning to what degree users followed the therapy, none of the treatments showed a significant difference with the control group.

Interestingly, for digital program therapy assisted by professionals, the involvement of a professional, although minimal, was regularly provided. Meaning, while it doesn't matter much if the degree of encountering a professional is lower than in face-to-face therapy, regular support and advice are still necessary. Thus, the therapy effect is the same.

This implies important implications. Digital program treatment assisted by professionals is more cost-effective and has better accessibility since it can be utilized anytime, anywhere, compared to face-to-face group or individual treatment. Therefore, the research concludes with the following opinions:

  • First, considering societal and individual costs and accessibility, digital program therapy assisted by professionals should be considered as the first-line option for treating panic disorder.
  • Second, especially, it should be made easier for individuals who have cost issues, problems visiting a center due to disorder (e.g. social anxiety), or difficulty in receiving regular therapy due to limited time, to utilize digital program therapy assisted by professionals.
  • Third, when the initially provided digital program therapy assisted by professionals does not work well, more concentrated care should be provided.

In fact, our experience at Distancing also aligns with this. Programs administered completely by users did not generate significant therapeutic effects, while Distancing programs, where professionally trained cognitive therapists provide a little assistance, have shown good effects such as clinical indicators for assessing depression and anxiety decreasing by around 40–50% after 7 weeks into the program. The cost is much cheaper than conventional methods.

The essence of mental healthcare is health. The key issue is how to solve health problems more effectively and efficiently. In that regard, the research published last year might be seen as a good starting point, raising an important issue about how to deal with the problem, which is encountered by 30% of the population.


Papola D, Ostuzzi G, Tedeschi F, Gastaldon C, Purgato M, Del Giovane C, Pompoli A, Pauley D, Karyotaki E, Sijbrandij M, Furukawa TA, Cuijpers P, Barbui C. CBT treatment delivery formats for panic disorder: a systematic review and network meta-analysis of randomised controlled trials. Psychol Med. 2023 Feb;53(3):614-624. doi: 10.1017/S0033291722003683. Epub 2022 Dec 9. PMID: 37132646; PMCID: PMC9975966.

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