Panic anxieties and panic disorders have become very common in this world today. There are almost 30 to 40 percent of the world populations who face panic disorder with or without agoraphobia PD/PDA. This paper tries to analyze the various factors and symptoms of PDA along with the possible treatments to such problems. The main purpose of this paper is to reconcile the differences between the varied treatments available for PDA and conclude that combination of psychotherapy along with pharmacological treatment is the best solution to this problem.

1. Panic Disorder With Agoraphobia
Abstract: Panic anxieties and panic disorders have become very common in this world today.
There are almost 30 to 40 percent of the world populations who face panic disorder with or
without agoraphobia PD/PDA. This paper tries to analyze the various factors and symptoms
of PDA along with the possible treatments to such problems. The main purpose of this paper
is to reconcile the differences between the varied treatments available for PDA and conclude
that combination of psychotherapy along with pharmacological treatment is the best solution
to this problem.
Introduction
Almost everyone has felt anxious at some point in their life. However, panic attack is a much
more serious problem that almost grips the person like a heart attack. Panic disorder is a
recurrent form of panic attacks that leads the patient to a debilitating state. Sometimes when
panic attacks recur continuously then it might lead to agoraphobia. Agoraphobia means the
phobia (fear) of agora (Greek marketplace), because generally people who visit malls and
suffer from panic attacks find it very difficult to find an exit (Rachman, 1984). Panic
Disorder can either occur with agoraphobia (PDA) or without agoraphobia (PD). While panic
disorder and agoraphobia generally occur together, they can also exist in isolation without the
influence of the other problem. This paper tries to analyze the main causes behind panic
disorder with agoraphobia (PDA) and find possible solutions that range from psychotherapy,
cognitive-behavioral treatment to normal medication treatment.
What Is Panic Disorder With Agoraphobia?

2. According to the Diagnostic and Statistical Manual of Mental Disorders, (4th ed., Text
Revision; DSM-IV-TR; American Psychiatric Association, 2000), a panic attack is a
combination of fear and discomfort that is generally characterized by more than four
conditions that affect the person’s well-being. Panic attacks make the heart pound, make the
person feel dizzy and disrupt normal breathing (Smith & Segal, 2012). Recurrent panic
attacks make the person weak and leads to a disorder which is often accompanied with
agoraphobia. Agoraphobia is often believed as a condtion where people are scared of open
places. It has been reported that almost one third to one half of patients who suffer from panic
disorder also suffers from agoraphobia (Antony & Swinson, 2000). Panic disorders can be
very difficult to cope with so patients are always advised to seek medical or professional help
at the earliest. Panic disorder is chronic and it may adversely affect normal functioning of any
person (Antony & Swinson, 2000). Panic disorders lead to agoraphobia which has been
defined by DSM-IV-TR as a condition where people seek escape from a certain situation or
place. In most cases, agoraphobia leads to extreme anxiety and fear which are faced by
people who are away from home, in a crowd or while traveling in a bus or train. Now, let us
look at the pain factors that lead to panic disorder with agoraphobia (PDA).
Factors That Cause Panic Disorder With Agoraphobia (PDA)
It has been reported that symptoms and factors leading to panic disorder with agoraphobia
(PDA) are almost similar in various parts of the world (Klerman et al., 1991). Today, most
researchers believe that agoraphobia can be triggered by recurrent panic disorders (Antony &
Swinson, 2000). It has been reported that some of the common factors that lead to panic
disorders have been inherited by us since in earlier days, human beings used to live in fear of
wild animals. However, from the point of etiology, though there might be some genetic links
but PDA is not entirely the reason of genes. It has been reported that in any given year,

3. almost 30 to 40 percent of the general population face panic attacks or PDA that makes them
feel nervous and suffer immense mental problems. According to survey results conducted in
U.S., almost 5 to 8 percent of adult population face PD or PDA at some point in their life
which implies that 15 to 25 million people undergo this problem, or simply stated one out of
every 12 person in U.S. are under the threat of PD or PDA (Meca et al., 2010). In Australia,
PD affects 1-2 percent of the population each year and the same can be seen in other places
too (Sanderson & Rego 2000). Through all social cultures, people and races, PDA is a very
common problem that needs immediate solution.
Panic disorder symptoms are generally: shortness of breath or smothering sensations, pain
and discomfort, heart palpitations, choking and sweating, feeling nervous, feeling dizzy and
trembling, fear of going insane, nausea, numbness, derealization or depersonalization,
paresthesias, and fear of dying. Following the first panic attack most people go through a
month of repeated attacks (Sanderson & Rego 2000). Most people who have experienced
panic attacks do not understand why the problem occurred in their life. Panic disorder with
agoraphobia (PDA) is experienced in claustrophobic places such as in theaters, restaurants,
malls, busses and trains, basements, auditoriums, elevators and escalators (Sanderson & Rego
2000). Sometimes, panic attacks are also caused due to some medical problems. These
problems range from hyperthyroidism to pheochromocytoma, extreme use of amphetamines,
hypoglycemia, asthma, mitral valve prolapse and gastrointestinal problems. However, most
of these conditions that lead to PDA cannot be controlled with only medication.
Though PDA may last for only five to ten minutes but the effects can leave the patients
shocked for hours. It has been also reported that patients who suffer from PD or PDA coupled
with depression are at a higher risk of committing suicides. PD/PDA occurs in conjunction
with other problems 50 percent of the times and patients need special treatment to get out of

4. this problem (Meca et al., 2010). The following sections discuss the various treatments that
are available to treat patients suffering from PDA.
Conventional Treatment
Treatment for panic disorders with agoraphobia (PDA) can be of different types but most
often they include medication along with psychotherapy. There are two schools of thoughts
behind treatment of PDA. One school thinks that PDA can be controlled only by
neurophysiological or psychopharmacological treatment while the other school thinks that
cognitive-behavioural treatment is the only possible solution for PDA (Busch, 1995). Let us
now discuss the psychopharmacological treatment that is most often used to treat patients
suffering from PDA.
According to Saeed and Bruce (1998), most medications that have been found beneficial in
treating PD/PDA are tricyclic antidepressants, benzodiazepines, serotonin reuptake inhibitors
and monoamine oxidase inhibitors. Benzodiazepines have been recommended to be the most
effective out of all these medicines to combat PD/PDA (Watanabe et al., 2007).
According to Klein (1993), panic attacks can be controlled with only medication. Treating
patients with imipramine have revealed good results. According to Klein’s studies, panic
disorder with agoraphobia (PDA) is different from normal panic disorder and both these
conditions require different form of treatment (Busch, 1995). Antidepressants, such as
fluoxitene and sertraline can be used to stop panic attacks but to treat PDA one has to educate
the patient as well as the family. He further states that pharmacological intervention may not
be necessary when it comes to treating patients with only panic disorders but for treating
patients with PDA, structured programs along with medicines is mandatory (Busch, 1995).
However, modern research shows that when benzodiazepines are used in combination with

5. psychotherapy then best results can be achieved (Watanabe et al., 2007). The following
section discusses the importance of behavioral treatment in dealing with PD/PDA.
Role of Mental Health In Treating Panic Disorder With Agoraphobia
Panic disorder with or without agoraphobia (PD/PDA) can be a very strenuous condition that
makes the patient weak and tired. It is believed that the first panic attacks must have been
caused by misfiring of a natural fear system (Busch, 1995). This leads to a vicious cycle
which finally leads to agoraphobia. Though conventional treatment of PDA is medication but
modern research reveals that Cognitive Behavioral Treatment (CBT) is one of the most
effective types of treatment for such problems (Galassi, 2007). It has been reported that
pharmacological treatment is effective for PDA but results show that most patients refuse to
take medicines or face troublesome side effects so they discontinue medication. Due to these
reasons, psychotherapy and CBT have been recommended by researchers to treat patients
(Telch et al., 1993). CBT treatment entails four basic components, of which, cognitive
restructuring is the first basic step. This step helps the patients to understand the problems
and conditions that trigger panic attacks. Self-awareness and sensing the problem is very
important to understand PDA (Busch, 1995). The next component of CBT is to understand
specific cognitions that showcase why the person is thinking about panic attacks and to
negate those distortions of thinking. Thirdly, the patients are put through “interoceptive
exposure” whereby patients are put under panic situations and told to cope with the problems.
Lastly, the patients are put under situational exposure to panic situations and they are
repeated continuously until the patient understands that there is no fear of such situations
(Busch, 1995). All these situations have been found to be very effective in treating patients
suffering from PDA. CBT techniques can be further classified as either (a) Cognitive
restricting treatment or (b) in vivo exposure treatment methods (Galassi, 2007). Some

6. researchers have also used group CBT treatment to find that it is indeed very effective in
treating PDA. Panic attacks and agoraphobic behavior can be reduced with such form of
treatment (Galassi, 2007). However, the duration of treatment is a very serious factor while
treating PDA patients (Sanderson & Rego, 2000). CBT is similar to psychoanalysis though
the approach is different. Overall, it can be stated that CBT under group therapy conditions is
a very effective means of controlling and treating PDA patients. This form of treatment is low
cost and can be effective under both short-term and long-term conditions (Galassi, 2007).
This form of treatment teaches the patient to control the anxiety triggering factors and helps
them to cope with discomfort by controlling feelings. Breathing techniques, meditation,
cognitive therapy and psychoanalysis are other forms of treatment that have been found to be
effective in treating patients with PDA.
Reconciling Different Approaches of Treatment
Though the above sections clearly show that pharmacological treatment as well as Cognitive
Behavior Treatment (CBT) can be effective in treating panic disorders with agoraphobia
(PDA) but modern research shows that when both these forms of treatment are used in
combination then the best results can be obtained for patients. According to Silverman, PD
and PDA are heterogeneous forms of disorders that require different forms of treatment
(Busch, 1995). Psychoanalysis has been reported to decrease the panic fears of patients but
when combined with pharmacological treatment it can substantially yield the results within a
much shorter time period. Some research has reported that combined therapy can be more
effective than exposure therapy where benzodiazepines are used (Sanderson & Rego 2000).
For patients who have access to behavior therapy, benzodiazepine is not recommended.
Exposure therapy is recommended to PDA patients but only if they have access to proper
resources (Watanabe et al., 2007). Patients suffering from PD with or without agoraphobia

7. can be best treated by combination of interoceptive and non-interoceptive exposure combined
with breathing training, stress–relieving techniques and CBT (Meca et al., 2010). All in all, it
can be stated that patients suffering from PD/PDA should look for combined treatment rather
than relying on only one form of treatment.
Understanding and Conclusion
References
Antony, A.A. and Swinson, R.P. (2000). Panic Disorder and Agoraphobia.
Busch, F.N. (1995). Agoraphobia and Panic States.
Galassi, Ferdinando. (2007). Cognitive-Behavioural Group Treatment For Panic Disorder
With Agoraphobia.
Klerman, G., Weissman, M. M., Oullette, R., Johnson, J., & Greenwald, S. (1991). Panic
attacks in the community: Social morbidity and health care utilization. Journal of the
American Medical Association, 265, 742–746.
Meca, Julio Sacnhez., Alcazar, Ana., Martinez, Fulgenico and Conesa, Antonia. (2010).
“Psychological Treatment of Panic Disorder with or without Agoraphobia: A Meta Analysis.”
Clinical Psychology Review 30: 37–5.

8. Rachman, S. (1984). Agoraphobia—A safety-signal perspective. Behaviour Research and
Therapy, 22, 59–70.
Saeed, S.A. and Bruce, T.J. (1998). Panic disorder: effective treatment options. American
Family Physician. Volume 57, No. 10:2405-2412.
Sanderson,W. C.,&Rego, S. A. (2000). Empirically supported treatment for panic disorder:
Research, theory and application of cognitive behavioral therapy. Journal of Cognitive
Psychotherapy, 14, 219–244.
Smith, M.A. and Segal, Jeanne. (2012). Panic Attacks and Panic Disorder. Helpguide.
Retrieved 29 Feb. 2012, from
http://www.helpguide.org/mental/panic_disorder_anxiety_attack_symptom_treatment.htm
Telch, M. J., Lucas, J. A., Schmidt, N. B., Hanna, H. H., LaNae Jaimez, T., & Lucas, R. A.
(1993). Group cognitive behavioral treatment of panic disorder. Behavior Research and
Therapy, 31,279–287.
Watanabe, N., Churchill, Rachel, and Furukawa, Toshi. A. (2007). “Combination of
Psychotherapy and Benzodiazepines Versus Either Therapy Alone For Panic Disorder.”
BMC Psychiatry 2007, 7:18.