Well-Being Therapy in a Patient with Panic Disorder Who Failed to Respond to Paroxetine and Cognitive Behavior Therapy

Introduction: Cognitive Behavioural Therapy (CBT) is first line choice to treat panic disorder. Treatment response is 65%. Non-responders are usually those who did not complete the intervention. Next-step strategies in the treatment of patients who failed to complete CBT should be found. Case description: L. is a 64-year-old woman who had two lifetime episodes of panic disorder with agoraphobia comorbid with major depression. The first episode was treated with paroxetine and the second with levosulpiride, in both episodes depressive symptoms and panic attacks disappeared but mild agoraphobia remained. L. asked for the visit because of panic attacks, after the assessment the following diagnoses were formulated: panic disorder with agoraphobia (according to DSM), Health Anxiety and Thanatophobia (according to DCPR). Clonazepam and CBT were prescribed. During the first 3 CBT sessions, a behavioural therapy was administered to reduce avoidance. Thereafter, cognitive restructuring was proposed to reduce panic, Health Anxiety, and Thanatophobia. However, after 2 sessions of cognitive restructuring, L. worsened: she was so engaged in identifying negative automatic thoughts to be always thinking to anxiety and having it. Thus, Well-Being Therapy (WBT) was proposed to increase her general level of well-being. After 6 WBT sessions, L. was improved and became able to run 3 sessions of cognitive restructuring after which she was completely free of symptoms. She maintained this condition at one year follow-up. Comment: WBT should be considered as next-step strategy in the treatment of patients who failed to complete the CBT intervention.