A 40-year-old man with panic disorder on paroxetine reports that his panic attacks are well controlled but he remains housebound due to fear of having an attack in public. He avoids malls, buses, and open spaces. The most appropriate adjunct psychotherapy is:

• A Supportive psychotherapy focusing on validation
• B Cognitive Behavioural Therapy with interoceptive exposure and in-vivo exposure ✓
• C Psychodynamic therapy exploring unconscious conflicts
• D EMDR for trauma-based component of avoidance

Explanation

This patient has developed Agoraphobia secondary to Panic Disorder. CBT is the gold-standard psychotherapy, incorporating interoceptive exposure (deliberately inducing physical sensations like hyperventilation to reduce fear of bodily sensations) and in-vivo exposure to feared situations (graduated exposure to malls, buses). Situational avoidance maintains agoraphobia. Pharmacotherapy controls panic attacks but does not address avoidance behaviors; hence both modalities are needed. Psychodynamic therapy lacks evidence for panic disorder. EMDR is indicated for PTSD.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.