What non-pharmacological interventions are effective for managing panic disorder in a primary care setting?

Effective non-pharmacological interventions for managing panic disorder in a primary care setting include:

• Cognitive Behavioural Therapy (CBT): CBT is the recommended psychological treatment and should be delivered by suitably trained and supervised practitioners following empirically grounded protocols. Optimal CBT duration is 7 to 14 hours, typically delivered as weekly 1 to 2-hour sessions over a maximum of 4 months. Briefer CBT integrated with structured self-help materials is also effective for some patients ¹.
• Low-intensity psychological interventions: For mild to moderate panic disorder, offer or refer for individual non-facilitated self-help or individual facilitated self-help based on CBT principles. These interventions involve written or electronic materials and minimal therapist contact, such as occasional short telephone calls or brief face-to-face sessions ¹.
• Provision of written information and support: Patients should be given appropriate written information about panic attacks and sources of support, including local and national voluntary and self-help groups, which may provide face-to-face or telephone support based on CBT principles ¹.
• Exercise: Discuss the benefits of exercise as part of good general health with all patients, as exercise has been shown to improve anxiety symptoms ¹.

These interventions should be offered promptly in primary care, with shared decision-making guiding the choice of treatment. Referral to specialist mental health services is recommended if two interventions (psychological, medication, or bibliotherapy) have been tried without sufficient improvement ¹.