A 30-year-old woman has recurrent panic attacks and now avoids public transport fearing she cannot escape if she panics. She restricts travel to only accompanied journeys. The MOST effective long-term treatment combining pharmacotherapy and psychotherapy is:
- A Alprazolam PRN + supportive counselling
- B SSRI (e.g., paroxetine) + Cognitive Behaviour Therapy with interoceptive exposure and agoraphobia hierarchy ✓
- C Propranolol daily + relaxation training alone
- D Buspirone + exposure therapy only
Explanation
Panic disorder with agoraphobia is best treated with a combination of SSRIs (paroxetine, sertraline, escitalopram have strongest evidence) and CBT incorporating interoceptive exposure (confronting feared bodily sensations), panic psychoeducation, and graduated exposure to agoraphobic situations. This combination produces superior long-term outcomes compared to either alone. Benzodiazepines (alprazolam) provide short-term relief but worsen long-term outcomes by preventing extinction learning. Buspirone is not effective for panic disorder. Propranolol addresses peripheral symptoms only.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.