Panic Disorder — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersPanic DisorderMRCPsych Paper B

A 19-year-old student has recurrent unexpected panic attacks followed by persistent concern about further attacks. They now avoid lecture theatres because escape might be difficult or embarrassing if an attack occurs. The symptoms are causing marked impairment, and the student prefers a high-intensity psychological intervention. According to NICE CG113, which treatment should be offered?

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Correct answer: C — Individual cognitive behavioural therapy

The correct answer is C. The recurrent unexpected attacks, continuing concern and avoidance associated with difficulty escaping indicate panic disorder with agoraphobic avoidance and marked functional impairment. NICE recommends CBT for moderate-to-severe panic disorder, with or without agoraphobia. It should be delivered by a suitably trained and supervised practitioner using an empirically grounded treatment protocol; NICE advises an optimal total duration of 7–14 hours, usually completed within 4 months. Psychodynamic psychotherapy, mindfulness-based cognitive therapy, interpersonal psychotherapy and supportive counselling are not the recommended high-intensity psychological treatments for panic disorder in CG113. Although panic-focused CBT commonly includes work on catastrophic interpretations, bodily sensations and avoidance, NICE does not mandate the Clark model specifically.

Reference: National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113), recommendations 1.3.12–1.3.16. Published 2011; updated 2020. https://www.nice.org.uk/guidance/cg113/chapter/Recommendations