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Panic disorder — USMLE Step 3 MCQ

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HardPsychiatryPanic disorderUSMLE Step 3

A patient with panic disorder and agoraphobia has taken maximally tolerated sertraline for 12 weeks. Panic attacks are less frequent, but avoidance still prevents work, and she has never received structured psychotherapy. Which addition most directly targets the residual disability?

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Correct answer: A — Add panic-focused cognitive behavioral therapy with interoceptive and situational exposure

The best answer is “Add panic-focused cognitive behavioral therapy with interoceptive and situational exposure”. NIMH identifies CBT as the best-studied psychotherapy for panic disorder and describes interoceptive and situational exposure as methods that directly reverse fear of bodily sensations and avoided settings. In a partial SSRI response dominated by agoraphobic avoidance, adding this targeted treatment addresses the residual mechanism more directly than medication substitution or symptom-only pharmacologic augmentation.

Reference: NIMH: Panic Disorder—What You Need to Know: https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms