Based on a large body of evidence, the RANZCP guidelines recommend 8-12 sessions of face-to-face or guided digital CBT as the first-line treatment for panic disorder [1158]. Outcomes for individual or group therapy appear to be comparable, and the effects have been shown to be long-lasting. Although other psychological therapies have been tested (e.g., mindfulness, ACT, and psychodynamic therapies) there is insufficient evidence to recommend their use in the treatment of panic disorder at this time. For those experiencing moderate or severe panic disorder, or those who do not demonstrate sufficient improvement in response to CBT, the use of pharmacotherapies may be considered as an alternate or adjunctive treatment [1158].
The small amount of literature relating to the treatment of both panic disorder and AOD use has concentrated on CBT and should be regarded as preliminary. In an RCT of people with panic disorder receiving inpatient treatment for alcohol dependence, Bowen and colleagues [1181] examined CBT for panic disorder in addition to a regular alcohol treatment program. They found that, although there were improvements in anxiety symptoms and alcohol use, there was no additional benefit of the CBT treatment component. Kushner and colleagues [1169] similarly evaluated an integrated group CBT program for co-occurring anxiety and alcohol use disorders in a RCT of individuals in a residential treatment program for alcohol use disorders with co-occurring GAD, panic disorder, or SAD. Those randomised to receive the CBT program experienced considerably better alcohol outcomes relative to the control group who received progressive muscle relaxation training, and both groups demonstrated a reduction in anxiety symptoms. However, as only 17% of the sample had a principal diagnosis of panic disorder, the degree to which the findings reflect this client population is uncertain. In a third RCT, Buckner and colleagues [1171] similarly evaluated an individual integrated CBT program for people with co-occurring anxiety and cannabis use disorders which was delivered as an outpatient treatment. People who received the integrated intervention were more likely to be abstinent and report greater reductions in the severity of anxiety symptoms following treatment compared to the control group (who received motivation enhancement therapy), and both groups used less cannabis, and reported fewer cannabis-related problems. However, only 18% of the sample had a principal diagnosis of panic disorder.