Agoraphobia and Panic States

The panel on agoraphobia and panic states, chaired by Allan Compton, was a unique program for the American Psychoanalytic Association, as experts from other areas of psychiatry were invited to present their approaches and studies, affording an opportunity for analysts to hear varying perspectives on the treatment and etiology of these conditions. Michelle Craske presented the cognitive-behavioral perspective; Donald Klein represented the neurophysiological approach; Jerrold Rosenbaum reviewed data on behavioral inhibition, a possible marker for panic disorder in children; and Martin Silverman advanced a multidimensional perspective. The panel grappled with a number of interesting issues: Do panic and agoraphobia represent a range of syndromes requiring a variety of treatment approaches, or does one size fit all? What is the role of psychoanalysis in the treatment of panic and agoraphobia when other treatment approaches have been found to be effective? Should analysts proceed with systematic research studies comparable to what has been done with other approaches?

Allan Compton opened with a review of the current state of treatments of agoraphobia/panic, which served to alert analysts that the psychoanalytic or psychodynamic approach is respected by only a limited segment of those concerned with mental health. Two approaches are widely respected as theories and treatments by the public, government agencies, and the insurance industry: the neurophysiological, or psychopharmacological, and the cognitive-behavioral. The former sees panic as stemming from a neurophysiological abnormality, probably of genetic origin, best treated by appropriate pharmacological