The debate between CBT and psychodynamic therapy for panic disorder tends to be presented as a choice between two incompatible approaches, but Dr. Steinbok's clinical work at his Boca Raton practice treats them as complementary tools applied at different levels of the same problem. CBT is effective at addressing the cognitive and behavioral mechanics of panic: the catastrophic appraisals, the avoidance behaviors, and the anticipatory anxiety that sustains the disorder. Exposure-based techniques within the CBT framework are particularly useful for reducing agoraphobic avoidance and building tolerance for the physical sensations associated with panic.
Psychodynamic therapy reaches a different level of the panic disorder presentation. For patients whose panic is organized around deeper concerns, around fears of losing control, of being overwhelmed, of separation, or of something catastrophic that is understood symbolically rather than literally, the psychodynamic approach provides a framework for examining and eventually modifying those underlying organizing beliefs. Patients who have completed CBT for panic and achieved significant symptom reduction but find that the underlying anxiety remains, that a residual dread persists even when the behavioral avoidance has been addressed, often find that psychodynamic work with Dr. Steinbok in Boca Raton reaches what the behavioral component left untouched.
