Behavioural and Cognitive Psychotherapy

Accelerated Publication

Dissemination of Cognitive Therapy for Panic Disorder in Primary Care

Nick Greya1 c1, Paul Salkovskisa1, Alexandra Quigleya1, David M. Clarka1 and Anke Ehlersa1

a1 South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, UK


This study investigated whether brief training in cognitive therapy for panic disorder (Clark et al., 1994) can improve the outcomes that primary care therapists obtain with their patients. Seven primary care therapists treated 36 patients meeting DSM-IV (APA, 1994) criteria for panic disorder with or without agoraphobia in general practice surgeries. Outcomes for the cohort of patients whom the therapists treated with their usual methods (treatment-as-usual) before the training (N = 12) were compared with those obtained with similar patients treated by the same therapists after brief training and ongoing supervision in cognitive therapy (CT) for panic disorder (N = 24). Treatment-as-usual led to significant improvements in panic severity, general anxiety, and depression. However, only a small proportion (17% of the intent-to-treat sample) became panic free and there was no improvement in agoraphobic avoidance. Patients treated with CT achieved significantly better outcomes on all measures of panic attacks, including panic-free rate (54%, intent-to-treat), and showed significantly greater improvements in agoraphobic avoidance and patient-rated general anxiety. In conclusion, cognitive therapy for panic disorder can be successfully disseminated in primary care with a brief therapist training and supervision programme that leads to significant improvements in patient outcomes.


c1 Reprint requests to Nick Grey, Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Trust, 99 Denmark Hill, London SE5 8AZ, UK. E-mail: