Integrating mindfulness and cognitive-behavioral therapy for panic disorder: A theoretically-based treatment manual

摘要

Panic disorder is a prevalent mental health disorder that entails significant costs, both to the individual and to society. Currently, the gold standard treatments for panic disorder have their basis in cognitive-behavioral theory. Outcome research has demonstrated panic-free rates in the range of 50-70% after treatment with CBT (e.g., Barlow, Craske, Cerny, u26 Klosko, 1989; Clark et al., 1994). Therefore, while these treatments are successful for many individuals diagnosed with panic disorder, a large number (30-50%) do not respond to these treatments. The purpose of this dissertation is to explore how the integration of mindfulness-based interventions into current cognitive-behavioral treatments may assist those who do not respond to cognitive-behavioral interventions alone. In this dissertation, I explore the diagnosis of panic disorder itself including definition, course and prevalence, comorbidity and risk factors, and costs to the individual and society. In addition, I examine relevant etiological models of the cause and maintenance of panic disorder. The process of reviewing the literature revealed that there is currently no established mindfulness-based etiological model of panic disorder. Therefore, after careful review of established mindfulness-based practices and the mechanisms of mindfulness, I propose such a model. I review current evidence-based cognitive-behavioral treatments for panic disorder including the therapeutic mechanisms at work. Although there is not an established mindfulness-based treatment specifically for panic disorder, I examine other mindfulness-based treatments, including therapeutic mechanisms. This research culminates in the proposal of a treatment manual. The treatment manual utilizes well-established cognitive-behavioral interventions and therapeutic mechanisms; however, the proposed protocol implements them through a mindfulness-based perspective. The treatment manual is structured into eight modules. Each module is divided into five sections: Materials Needed, Outline, Goals and Rationale, Therapist Tasks, and At Home Practice. The necessary worksheets for both the client and therapist are provided at the end of the treatment manual. Limitations of the research as well as future directions are explored.