Rosh Psychiatry Board Practice Exam

What is the best initial non-pharmacologic treatment for a patient with panic disorder who prefers to avoid medication?

1. Cognitive-behavioral therapy

2. Electroconvulsive therapy

3. Hypnotherapy

4. Repetitive transcranial magnetic stimulation

The correct answer is: Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) is considered the best initial non-pharmacologic treatment for patients with panic disorder who prefer to avoid medication. CBT specifically addresses the cognitive and behavioral aspects of panic disorder, providing patients with tools to understand and manage their anxiety. This therapeutic approach often incorporates techniques such as exposure therapy, helping individuals gradually face situations that trigger their panic attacks, while also challenging distorted thinking patterns that contribute to their fear. Unlike the other options, CBT has a strong evidence base demonstrating its effectiveness in treating panic disorder. Electroconvulsive therapy (ECT) is generally reserved for severe cases of depression and is not indicated for panic disorder. Hypnotherapy lacks robust evidence supporting its efficacy for panic disorder and may not provide the structured approach needed for effective treatment. Repetitive transcranial magnetic stimulation (rTMS) is primarily used for depression and is not a first-line treatment for panic disorder. Therefore, CBT stands out as the appropriate choice for individuals seeking non-pharmacologic interventions for managing their panic symptoms.