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Long-Term Effects of Behavioural Treatment for Panic Disorder with Agoraphobia

Published online by Cambridge University Press:  02 January 2018

Giovanni A. Fava*
Department of Psychology, University of Bologna, Italy
Maria Zielezny
Department of Social and Preventive Medicine, State University of New York at Buffalo, USA
Silvana Grandi
University of Bologna, Italy
Professor Fava, Department of Psychology, University of Bologna, Viale Berti Pichat 5, 1–40127 Bologna, Italy



There are few long-term follow-up studies of panic disorder treatments, particularly when patients have been treated by behavioural methods only and have recovered.


110 consecutive patients satisfying the DSM–III–R criteria for panic disorder with agoraphobia were treated in an out-patient clinic with behavioural methods based on exposure. After 12 sessions of psychotherapy, 81 patients became panic-free. A 2–9 year follow-up was available. Survival analysis was employed to characterise the clinical course of patients. Regular assessments by a clinical psychologist were based on the Clinical Interview for Depression.


The estimated cumulative percentage of patients remaining in remission was 96.1% for at least two years, 77.6% for at least five years, and 67.4% for at least seven years. These outcomes greatly improved in the absence of a personality disorder or residual agoraphobia after treatment.


The findings suggest that, even though one patient in four is unable to complete treatment or does not benefit sufficiently from it, exposure treatment can provide lasting relief for the majority of patients. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.

Copyright © 1995 The Royal College of Psychiatrists 

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