Albany Panic Control Treatment (PCT) for Panic Disorder and Agoraphobia

Julia Turovsky and David H. Barlow

Center for Stress and Anxiety Disorders
State University of New York at Albany

Reprinted from:
Turovsky, J. & Barlow, D.H. (1995). Albany panic control treatment (PCT) for panic disorder and agoraphobia. The Clinical Psychologist, 48(3), 5-6.

I. Description of Treatment

The Albany Panic Control Treatment (PCT) for panic disorder with or without agoraphobia was originally developed at the Center for Stress and Anxiety Disorders by David H. Barlow, Ph.D. and Michelle G. Craske, Ph.D., and has recently been revised and refined to incorporate new advances in the conceptualization of the disorder (Barlow & Craske, 1994). The efficacy of this treatment approach has been documented in a consensus conference sponsored by the National Institute of Mental Health on treatments of panic disorder, where this treatment, along with certain drugs, was recommended as the treatment of choice for panic disorder.

While the PCT protocol is in either individual or small group format for panic disorder without agoraphobia, patients with moderate to severe levels of agoraphobia are successfully treated with PCT and self paced in-vivo exposure in a couples format, an approach that has been found to be superior to treating the patient without their partner. Couples treatment is based on the notion that the interpersonal context may play a role in the development, maintenance, and treatment of agoraphobia. The PCT treatment protocol with or without the agoraphobia supplement consists of 12-15 sessions, and can be used in conjunction with antidepressant medication. A modified version of the protocol is currently used to assist patients with benzodiazepine discontinuation.

The PCT protocol is rooted in a cognitive-behavioral treatment perspective and is intended to influence directly the patients cognitive misappraisals of panic attacks, the hyperventilatory response, conditioned reactions to physical cues, and fear and avoidance of situations if agoraphobia is present. This is accomplished by providing patients with in-depth information regarding the physiology of panic attacks. Cognitive restructuring techniques are used to teach patients to identify and modify cognitive misappraisals. Breathing retaining is provided to decrease the overbreathing that occurs during panic. Repeated exposure to feared internal cues (interoceptive exposure) is conducted to decondition fear reactions to panic-like sensations. If agoraphobia is present, in vivo exposure to feared and avoided situations is practiced to weaken associations between certain situations and the experience of panic and avoidance. Monitoring of anxiety and home practices are continuously assigned throughout the protocol to consolidate treatment gains, and safety signals such as safe objects, behavior, or people are gradually discontinued.

II. Summary of Studies Supporting Treatment Efficacy

In the first controlled behavioral treatments for panic disorder, PCT alone or in combination with progressive muscle relaxation (PMR) was found to be superior to PMR alone and a wait-list control. Fully 87% of patients in the PCT groups were free of panic at posttreatment (Barlow et al., Behavior Therapy 20: 261-282, 1989). These results were maintained up to 24 months following treatment completion for the PCT alone group, while the combined group tended to deteriorate over the follow up (Craske et al., Behavior Therapy 22: 289-304. 1991). In a subsequent study, Klosko et al. (Journal of Consulting and Clinical Psychology 58: 77-84, 1990) demonstrated that PCT was as good or better on all measures of outcome immediately after treatment than alprazolam (Xanax). Currently, a large collaborative study funded by NIMH is ongoing to investigate the effectiveness of combining PCT with the leading antidepressant (imipramine) used in the treatment of panic disorder.

III. Clinical References Describing the Approach

Barlow, D. H., & Craske, M. G. (1994). Mastery of your anxiety and panic II. Albany, NY: Graywind Publications Incorporated.

Craske, M. G., Meadows, E. A., & Barlow, D. H. (1994). Therapist guide for the mastery of your anxiety and panic II and agoraphobia supplement. Albany, NY: Graywind Publications Incorporated.

Craske, M. G. & Barlow, D.H. (1993). Panic disorder and agoraphobia. In D.H. Barlow (Ed.), Clinical handbook of psychological disorders (pp. 1-47). New York: Guilford Press.

IV. Resources for Training

A PCT home based training and certification program is currently available. This involves individual training and supervision in the administration of PCT in the clinician's home setting, while actually treating cases of panic disorder. This program also serves as a more generic training program for cognitive behavioral approaches to emotional disorders. Interested therapists can contact:

Graywind Publications
Executive Park Drive
Albany, NY 12203
(518) 438-3231

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