Managing the Approach-Avoidance Dialectic in Treating a Complex Veteran With Panic and Posttraumatic Stress Disorder

Abstract

Cognitive-behavioral therapy (CBT) is the treatment of choice for panic disorder (PD); however, the effectiveness of the treatment is often thought to be diminished in the presence of comorbid conditions. PD and posttraumatic stress disorder (PTSD) commonly co-occur in veteran populations, potentially complicating the effective treatment of each disorder. The individual presented in this case is a female veteran in her mid-50s who received treatment for PD and presented with significant comorbidities (PTSD, histrionic personality traits, major depressive disorder, and chronic suicidality). She participated in an intensive weekend treatment for PD that involved psychoeducation, cognitive restructuring, and interoceptive exposure. This case illustrates the challenges in implementing a manualized treatment for panic with a diagnostically complex veteran and the improvement in panic symptoms despite comorbid presentation.

Keywords

panic disorder PTSD cognitive-behavioral therapy comorbidity veterans

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