Panic and bodily alarm

لَا يَحۡزُنُهُمُ ٱلۡفَزَعُ ٱلۡأَكۡبَرُ وَتَتَلَقَّىٰهُمُ ٱلۡمَلَٰٓئِكَةُ هَٰذَا يَوۡمُكُمُ ٱلَّذِي كُنتُمۡ تُوعَدُونَ

They will have no fear of the great Terror: the angels will receive them with the words, ‘This is the Day you were promised!’

إِذۡ يُوحِي رَبُّكَ إِلَى ٱلۡمَلَٰٓئِكَةِ أَنِّي مَعَكُمۡ فَثَبِّتُواْ ٱلَّذِينَ ءَامَنُواْۚ سَأُلۡقِي فِي قُلُوبِ ٱلَّذِينَ كَفَرُواْ ٱلرُّعۡبَ فَٱضۡرِبُواْ فَوۡقَ ٱلۡأَعۡنَاقِ وَٱضۡرِبُواْ مِنۡهُمۡ كُلَّ بَنَانࣲ‏

Your Lord revealed to the angels: ‘I am with you: give the believers firmness; I shall put terror into the hearts of the disbelievers- strike above their necks and strike all their fingertips.’

سَنُلۡقِي فِي قُلُوبِ ٱلَّذِينَ كَفَرُواْ ٱلرُّعۡبَ بِمَآ أَشۡرَكُواْ بِٱللَّهِ مَا لَمۡ يُنَزِّلۡ بِهِۦ سُلۡطَٰنࣰ اۖ وَمَأۡوَىٰهُمُ ٱلنَّارُۖ وَبِئۡسَ مَثۡوَى ٱلظَّٰلِمِينَ

We will strike panic into the disbelievers’ hearts because they attribute partners to God although He has sent no authority for this: their shelter will be the Fire- how miserable is the home of the evildoers

وَأَنزَلَ ٱلَّذِينَ ظَٰهَرُوهُم مِّنۡ أَهۡلِ ٱلۡكِتَٰبِ مِن صَيَاصِيهِمۡ وَقَذَفَ فِي قُلُوبِهِمُ ٱلرُّعۡبَ فَرِيقࣰ ا تَقۡتُلُونَ وَتَأۡسِرُونَ فَرِيقࣰ ا

He brought those People of the Book who supported them down from their strongholds and put panic into their hearts. Some of them you [believers] killed and some you took captive

هُوَ ٱلَّذِيٓ أَخۡرَجَ ٱلَّذِينَ كَفَرُواْ مِنۡ أَهۡلِ ٱلۡكِتَٰبِ مِن دِيَٰرِهِمۡ لِأَوَّلِ ٱلۡحَشۡرِۚ مَا ظَنَنتُمۡ أَن يَخۡرُجُواْۖ وَظَنُّوٓاْ أَنَّهُم مَّانِعَتُهُمۡ حُصُونُهُم مِّنَ ٱللَّهِ فَأَتَىٰهُمُ ٱللَّهُ مِنۡ حَيۡثُ لَمۡ يَحۡتَسِبُواْۖ وَقَذَفَ فِي قُلُوبِهِمُ ٱلرُّعۡبَۚ يُخۡرِبُونَ بُيُوتَهُم بِأَيۡدِيهِمۡ وَأَيۡدِي ٱلۡمُؤۡمِنِينَ فَٱعۡتَبِرُواْ يَٰٓأُوْلِي ٱلۡأَبۡصَٰرِ

It was He who drove those of the People of the Book who broke faith out from their homes at the first gathering of forces––you [believers] never thought they would go, and they themselves thought their fortifications would protect them against God. God came up on them from where they least expected and put panic into their hearts: their homes were destroyed by their own hands, and the hands of the believers. Learn from this, all of you with insight

مَن جَآءَ بِٱلۡحَسَنَةِ فَلَهُۥ خَيۡرࣱ مِّنۡهَا وَهُم مِّن فَزَعࣲ يَوۡمَئِذٍ ءَامِنُونَ

whoever comes with a good deed will be rewarded with something better, and be secure from the terrors of that Day

The greatest terror shall not make them sorrow, and the angels will receive them: “This is the day that you were promised.” On the Day of Resurrection in the greatest gathering place and most tremendous courtyard, they will not hear from the angels the call “no good news” [25:22], nor the address, “Stand apart today, O offenders!” [36:59], nor the harsh call, “Slink into it, and do not talk to Me!” [23:108]. They will not hear the call of separation's pain, nor will they despair of mercy. Rather the angels will keep on coming, company after company, and they will give the good news: “This is the day that you were promised,” that is, “This is the day in which you have the promised reward.” Among them are those who will be received by the angels, and among them are those who will be addressed and made known by the King. God will say, “My servants, have you been yearning for Me?” He will sa

The Supreme Terror — which is that a servant be ordered off to the Fire shall not grieve them and the angels shall receive them upon their exiting from their graves saying to them ‘This is your day the one which you were promised’ during the life of the world.

When your Lord inspired the angels with whom He reinforced the Muslims saying ‘I am with you with assistance and victorious help so make the believers stand firm by helping them and giving them good tidings. I shall cast terror fear into the hearts of the disbelievers; so smite above the necks that is the heads and smite of them every finger!’ that is smite the extremities of their hands and feet thus when one of them went to strike an disbeliever’s head it would roll off before his sword reached it. The Prophet s threw a handful of pebbles against them and every single idolater was struck in his eye and thus they were defeated.

(Remember) when He covered you with a slumber as a security from Him, and He caused water (rain) to descend on you from the sky, to clean you thereby and to remove from you the Rijz (whispering or dirt) of Shaytan, and to strengthen your hearts, and make your feet firm thereby (11)(Remember) when your Lord revealed to the angels, "Verily, I am with you, so keep firm those who have believed. I will cast terror into the hearts of those who have disbelieved, so strike them over the necks, and smite over all their fingers and toes. (12)This is because they defied and disobeyed Allah and His Messenger. And whoever defies and disobeys Allah and His Messenger, then verily, Allah is severe in punishment (13)This is (the torment), so taste it; and surely, for the disbelievers is the torment of the Fire (14) Slumber overcomes Muslims Allah reminds the believers of the slumber that He sent down o

(We shall cast terror into the hearts of those who disbelieve) [3:151]. Said al-Suddi: �After Uhud, Abu Sufyan and the idolaters headed toward Mecca. But after they traversed a certain distance, they felt regret, saying: �Evil is that which we have done! We massacred them such that none of them remained except those who fled from the battlefield and then we left them alone. Go back and exterminate them�. But when they decided to do so, Allah, exalted is He, cast terror in their hearts which made them decide against what they had resolved to do. Allah, exalted is He, then revealed this verse�.

(All that is in the heavens and all that is in the earth glorifieth Allah� Allah is Able to do all things) [59:1-6]. The commentators of the Qur'an said: �This verse was revealed about Banu'l-Nadir. When the Prophet, Allah bless him and give him peace, moved to Medina, they signed a treaty with him in which they agreed not fight against him or with him and the Messenger of Allah, Allah bless him and give him peace, consented. Then when the Messenger of Allah, Allah bless him and give him peace, defeated the idolaters at Badr, Banu'l-Nadir said: 'By Allah, he is the Prophet whose description we find in the Torah; he will not be defeated'. However, when the Muslims were defeated at Uhud, they broke their pledge and showed enmity toward the Messenger of Allah, Allah bless him and give him peace, and Muslims. The Messenger of Allah, Allah bless him and give him peace, surrounded them and the

أَخْبَرَنَا أَبُو عَبْدِ الرَّحْمَنِ، أَحْمَدُ بْنُ شُعَيْبٍ قَالَ أَنْبَأَنَا عَمْرُو بْنُ عَلِيٍّ، قَالَ حَدَّثَنَا أَبُو عَاصِمٍ، قَالَ حَدَّثَنَا ابْنُ أَبِي ذِئْبٍ، قَالَ حَدَّثَنِي أَسِيدُ بْنُ أَبِي أَسِيدٍ، عَنْ مُعَاذِ بْنِ عَبْدِ اللَّهِ، عَنْ أَبِيهِ، قَالَ أَصَابَنَا طَشٌّ وَظُلْمَةٌ فَانْتَظَرْنَا رَسُولَ اللَّهِ صلى الله عليه وسلم لِيُصَلِّيَ بِنَا ثُمَّ ذَكَرَ كَلاَمًا مَعْنَاهُ فَخَرَجَ رَسُولُ اللَّهِ صلى الله عليه وسلم لِيُصَلِّيَ بِنَا فَقَالَ ‏"‏ قُلْ ‏"‏ ‏.‏ فَقُلْتُ مَا أَقُولُ قَالَ ‏"‏ ‏{‏ قُلْ هُوَ اللَّهُ أَحَدٌ ‏}‏ وَالْمُعَوِّذَتَيْنِ حِينَ تُمْسِي وَحِينَ تُصْبِحُ ثَلاَثًا يَكْفِيكَ كُلَّ شَىْءٍ ‏"‏ ‏.‏

It was narrated from Mu'adh bin 'Abdullah that his father said:"It was raining and dark, and we were waiting for the Messenger of Allah [SAW] to lead us in prayer. Then the Messenger of Allah [SAW] came out to lead us in prayer and he said: 'Say.' I said: 'What should I say?' He said: 'Say: He is Allah, (the) One and Al-Mu'awwadhatain in the evening and in the morning, three times, and that will suffice you against everything

أَخْبَرَنَا مُحَمَّدُ بْنُ عَلِيٍّ، قَالَ حَدَّثَنِي الْقَعْنَبِيُّ، عَنْ عَبْدِ الْعَزِيزِ، عَنْ عَبْدِ اللَّهِ بْنِ سُلَيْمَانَ، عَنْ مُعَاذِ بْنِ عَبْدِ اللَّهِ بْنِ خُبَيْبٍ، عَنْ أَبِيهِ، عَنْ عُقْبَةَ بْنِ عَامِرٍ الْجُهَنِيِّ، قَالَ بَيْنَا أَنَا أَقُودُ، بِرَسُولِ اللَّهِ صلى الله عليه وسلم رَاحِلَتَهُ فِي غَزْوَةٍ إِذْ قَالَ ‏"‏ يَا عُقْبَةُ قُلْ ‏"‏ ‏.‏ فَاسْتَمَعْتُ ثُمَّ قَالَ ‏"‏ يَا عُقْبَةُ قُلْ ‏"‏ ‏.‏ فَاسْتَمَعْتُ فَقَالَهَا الثَّالِثَةَ فَقُلْتُ مَا أَقُولُ فَقَالَ ‏"‏ ‏{‏ قُلْ هُوَ اللَّهُ أَحَدٌ ‏}‏ ‏"‏ ‏.‏ فَقَرَأَ السُّورَةَ حَتَّى خَتَمَهَا ثُمَّ قَرَأَ ‏{‏ قُلْ أَعُوذُ بِرَبِّ الْفَلَقِ ‏}‏ وَقَرَأْتُ مَعَهُ حَتَّى خَتَمَهَا ثُمَّ قَرَأَ ‏{‏ قُلْ أَعُوذُ بِرَبِّ النَّاسِ ‏}‏ فَقَرَأْتُ مَعَهُ حَتَّى خَتَمَهَا ثُمَّ قَالَ ‏"‏ مَا تَعَوَّذَ بِمِثْلِهِنَّ أَحَدٌ ‏"‏ ‏.‏

It was narrated that 'Uqbah bin 'Amir Al-Juhani said:"While I was leading the Messenger of Allah [SAW] on his mount on a military campaign, he said: 'O 'Uqbah, say!' I listened, then he said: 'O 'Uqbah, say!' I listened, then he said it a third time. I said: 'What should I say?' He said: 'Say: He is Allah, (the) One...' and he recited the Surah to the end. Then he recited: 'Say: I seek refuge with (Allah) the Lord of the daybreak...' and I recited it with him until the end. Then he recited: 'Say: I seek refuge with (Allah) the Lord of mankind...' and I recited it with him until the end. Then he said: 'No one ever sought refuge (with Allah) by means of anything like them

فتوهم نفسك وقد وثبت متغيرا وجهك مغبرا بدنك من فرقك إلى قدمك من تراب قبرك مبهوتا من شدة الصعقة شاخص العين نحو النداء وقد ثار الخلق ثورة واحدة من القبور التى طال فيها بلاؤهم وقد أزعجهم الفزع والرعب مضافا إلى ما كان عندهم من الهموم والغموم وشدة الانتظار لعاقبة الأمر كما قال تعالى ونفخ فى الصور فصعق من فى السموات ومن فى الأرض إلا من شاء الله ثم نفخ فيه أخرى فإذا هم قيام ينظرون وقال تعالى @QB@ فإذا نقر في الناقور فذلك يومئذ يوم عسير على الكافرين غير يسير @QE@ وقال تعالى @QB@ ويقولون متى هذا الوعد إن كنتم صادقين ما ينظرون إلا صيحة واحدة تأخذهم وهم يخصمون فلا يستطيعون توصية ولا إلى أهلهم يرجعون ونفخ في الصور فإذا هم من الأجداث إلى ربهم ينسلون قالوا يا ويلنا من بعثنا من مرقدنا هذا ما وعد الرحمن وصدق المرسلون @QE@ فلو لم يكن بين يدي الموتى إلا هول تلك النفخة لكان ذلك جديرا بأن يتقى فإنها نفخة وصيحة يصعق بها من فى السموات والأرض يعنى يموتون بها إلا من شاء الله وهو بعض الملائكة

واما المنافق فانه عمي قلبه لم يجاوز بصره الظلمة ولم ير الا برقا يكاد يخطف البصر و رعدا عظيما وظلمة فاستوحش من ذلك وخاف منه فوضع اصابعه في اذنيه لئلا يسمع صوت الرعد وهاله ذلك البرق وشدة لمعانه وعظم نوره فهو خائف ان يختطف معه بصره لان بصره اضعف من ان يثبت معه فهو في ظلمة يسمع اصوات الرعد القاصف ويرى ذلك البرق الخاطف فان اضاء له ما بين يديه مشى في ضوئه وان فقد الضوء قام متحير ا لا يدري اين يذهب ولجهله لا يعلم ان ذلك من لوازم الصيب الذي به حياة الأرض والنبات وحياته هو نفسه بل لا يدرك الا رعدا وبرقا وظلمة ولا شعور له بما وراء ذلك فالوحشة لازمة له والرعب والفزع لا يفارقه واما من انس بالصيب وعلم انه لا بد فيه من رعد وبرق وظلمة بسبب الغيم استانس بذلك ولم يستوحش منه ولم يقطعه ذلك عن اخذه بنصيبه من الصيب فهذا مثل مطابق للصيب الذي نزل به جبريل صلى الله عليه وسلم من عند رب العالمين تبارك وتعالى على قلب رسول الله صلى الله عليه وسلم ليحيي به القلوب والوجود اجمع اقتضت حكمته ان يقارنه من الغيم والرعد وا

وجملة أدب المريض حسن الصبر وقلة الشكوى والضجر والفزع إلى الدعاء والتوكل بعد الدواء على خالق الدواء

وجملة آداب المريض: حسن الصبر، وقلة الشكوى والتضجر، والفزع إلى #

أي لذلك الماء الذي غمر الأرض ومن عليها فصل وأما الوهل فهو بتحريك الهاء وأصله الفزع والروع يقال وهل يوهل وهو وهل ومستوهل قال القطامي يصف إبلا

وأما اللوعة فقال في الصحاح لوعة الحب حرقته وقد لاعه الحب يلوعه والتاع فؤاده أي احترق من الشوق ومنه قولهم أتان لاعة الفؤاد إلى جحشها قال الأصمعي أي لائعة الفؤاد وهي التي كأنها ولهى من الفزع فصل

A Lifetime Prevalence of Comorbidity Between Bipolar Affective Disorder and Anxiety Disorders: A Meta-analysis of 52 Interview-based Studies of Psychiatric Population.: Background: Bipolar affective disorder has a high rate of comorbidity with a multitude of psychiatric disorders and medical conditions. Among all the potential comorbidities, co-existing anxiety disorders stand out due to their high prevalence. Aims: To determine the lifetime prevalence of comorbid anxiety disorders in bipolar affective disorder under the care of psychiatric services through systematic review and meta-analysis. Method: Random effects meta-analyses were used to calculate the life

How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association.: Objective: The presence of anxiety disorders (AD) in schizophrenia (SZ) is attracting increasing interest. However, published studies have yielded very broad variations in prevalence rates across studies. The current meta-analysis sought to (1) investigate the prevalence of co-occurring AD in SZ by reporting pooled prevalence rates and (2) identify potential sources of variations in reported rates that could guide our efforts to identify and treat these co-occurring disorders in patients with SZ

Experience sampling and ecological momentary assessment for studying the daily lives of patients with anxiety disorders: a systematic review.: Anxiety disorders are highly prevalent. Symptoms may occur unpredictably (e.g., panic attacks) or predictably in specific situations (e.g., social phobia). Consequently, it may be difficult to assess anxiety and related constructs realistically in the laboratory or by traditional retrospective questionnaires. Experience sampling methods (ESM) and ecological momentary assessment (EMA) can deepen the understanding of the course of anxiety disorders by frequently assessing symptoms and other variab

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared With Diagnosis-Specific Protocols for Anxiety Disorders: A Randomized Clinical Trial.: Importance: Transdiagnostic interventions have been developed to address barriers to the dissemination of evidence-based psychological treatments, but only a few preliminary studies have compared these approaches with existing evidence-based psychological treatments. Objective: To determine whether the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is at least as efficacious as single-disorder protocols (SDPs) in the treatment of anxiety disorders. Design, setting, an

Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials.: Trials of virtual reality exposure therapy (VRET) for anxiety-related disorders have proliferated in number and diversity since our previous meta-analysis that examined 13 total trials, most of which were for specific phobias (Powers & Emmelkamp, 2008). Since then, new trials have compared VRET to more diverse anxiety and related disorders including social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), and panic disorder (PD) with and without agoraphobia. With the availability of

Comorbidity of personality disorders in anxiety disorders: a meta-analysis of 30 years of research.: Background: A comprehensive meta-analysis to identify the proportions of comorbid personality disorders (PD) across the major subtypes of anxiety disorders (AD) has not previously been published. Methods: A literature search identified 125 empirical papers from the period 1980-2010 on patients with panic disorders, social phobia, generalised anxiety, obsessive-compulsive (OCD) and post-traumatic stress disorder (PTSD). Several moderators were coded. Results: The rate of any comorbid PD was high

Efficacy of internet therapy for panic disorder.

Fifty-five people with panic disorder (PD) were randomised to internet-based cognitive behavioural panic treatment (CBT) (with email contact), therapist-assisted CBT manual or information-only control (both with telephone contact). Both CBT treatments were more effective in reducing PD symptomatology, panic-related cognition, negative affect, and number of GP visits and improving physical health ratings. Internet treatment was more effective than CBT manual in reducing clinician-rated agoraphobia and number of GP visits at post-assessment. At follow-up, these effects were maintained for both CBT groups, with internet CBT better at improving physical health ratings and reducing GP visits. This study provides support for the efficacy of internet-based CBT.

matched on Panic Disorder (mesh), Agoraphobia (mesh), panic disorder (text)

A randomized, controlled trial of the effectiveness of cognitive-behavioral therapy and sertraline versus a waitlist control group for anxiety disorders in older adults.

Objective: This study is the first to investigate the relative effectiveness of cognitive-behavioral therapy (CBT) compared with a selective serotonin reuptake inhibitor (SSRI; sertraline) in a randomized, controlled trial on the treatment of anxiety disorders in older adults. Method: Eighty-four patients 60 years of age and over with a principal diagnosis of generalized anxiety disorder, panic disorder, agoraphobia, or social phobia were randomly assigned to one of three conditions: 15 sessions of CBT, pharmacologic treatment with an SSRI (sertraline; maximum dosage 150 mg), or a waitlist control group. Participants completed measures of primary outcome (anxiety) and coexistent worry and depressive symptoms at baseline, posttreatment, and at three-month follow up. Results: Attrition rates were high in both treatment groups. Consequently, findings are based on a relatively small sample o…

matched on Panic Disorder (mesh), Agoraphobia (mesh), panic disorder (text)

Disorder-specific versus transdiagnostic and clinician-guided versus self-guided treatment for major depressive disorder and comorbid anxiety disorders: A randomized controlled trial.

Disorder-specific cognitive behavior therapy (DS-CBT) is effective at treating major depressive disorder (MDD) while transdiagnostic CBT (TD-CBT) addresses both principal and comorbid disorders by targeting underlying and common symptoms. The relative benefits of these two models of therapy have not been determined. Participants with MDD (n=290) were randomly allocated to receive an internet delivered TD-CBT or DS-CBT intervention delivered in either clinician-guided (CG-CBT) or self-guided (SG-CBT) formats. Large reductions in symptoms of MDD (Cohen's d≥1.44; avg. reduction≥45%) and moderate-to-large reductions in symptoms of comorbid generalised anxiety disorder (Cohen's d≥1.08; avg. reduction≥43%), social anxiety disorder (Cohen's d≥0.65; avg. reduction≥29%) and panic disorder (Cohen's d≥0.45; avg. reduction≥31%) were found. No marked or consistent differences were observed across the…

matched on Panic Disorder (mesh), Phobic Disorders (mesh), panic disorder (text)

Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: A randomized controlled trial.

Generalized anxiety disorder (GAD) can be treated effectively with either disorder-specific cognitive behavior therapy (DS-CBT) or transdiagnostic CBT (TD-CBT). The relative benefits of DS-CBT and TD-CBT for GAD and the relative benefits of delivering treatment in clinician guided (CG-CBT) and self-guided (SG-CBT) formats have not been examined. Participants with GAD (n=338) were randomly allocated to receive an internet-delivered TD-CBT or DS-CBT intervention delivered in either CG-CBT or SG-CBT formats. Large reductions in symptoms of GAD (Cohen's d ≥ 1.48; avg. reduction ≥ 50%) and comorbid major depressive disorder (Cohen's d ≥ 1.64; avg. reduction ≥ 45%), social anxiety disorder (Cohen's d ≥ 0.80; avg. reduction ≥ 29%) and panic disorder (Cohen's d ≥ 0.55; avg. reduction ≥ 33%) were found across the conditions. No substantive differences were observed between DS-CBT and TD-CBT or CG…

matched on Panic Disorder (mesh), Phobic Disorders (mesh), panic disorder (text)

Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial.

Clinician-guided Internet-based cognitive behavioural therapy (iCBT) programs are clinically effective at treating specific anxiety disorders. The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment (iCBT) program to treat more than one anxiety disorder within the same program (the Anxiety Program). Eighty six individuals meeting diagnostic criteria for generalized anxiety disorder (GAD), panic disorder, and/or social phobia were randomly assigned to a treatment group, or to a waitlist control group. Treatment consisted of CBT based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. An intention-to-treat model using the baseline-observation-carried-forward principle was employed for data analyses. Sevent…

matched on Panic Disorder (mesh), Phobic Disorders (mesh), panic disorder (text)

Internet-guided self-help with or without exposure therapy for phobic and panic disorders.

Background: As many sufferers from phobic and panic (phobia/panic) disorders cannot get to suitable therapists, routine aspects of therapy were delegated to internet-accessed computer-aided self-help with or without exposure instructions. Methods: Phobia/panic referrals were randomised to computer-aided self-help via the internet at home in a 2:1 ratio either by self-exposure cognitive behaviour therapy (CBT) [FearFighter (FF), n = 45] or by minimal CBT without exposure [Managing Anxiety (MA), n = 23]. All had brief backup phone advice from a clinician concerning their computer guidance. Results: On self-ratings and blinded assessor ratings, patients improved equally with each form of self-help over 10 treatment weeks but significantly more on 5 out of 10 measures by week 14 (1-month follow-up) when the self-help included self-exposure instructions than when it did not. In accord with th…

matched on Panic Disorder (mesh), Phobic Disorders (mesh), panic disorder (text)

A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder.

Background: Panic disorder is a prevalent, often disabling condition among patients in the primary care setting. Although numerous studies have assessed the effectiveness of treatments for depression in primary care, few such studies have been conducted for panic disorder. Objective: To implement and test the effectiveness of a combined pharmacotherapy and cognitive-behavioral intervention for panic disorder tailored to the primary care setting. Design: Randomized, controlled study comparing intervention to treatment as usual. Setting: Six primary care clinics associated with 3 university medical schools, serving an ethnically and socioeconomically diverse patient population. Participants: Two hundred thirty-two primary care patients meeting DSM-IV criteria for panic disorder. Comorbid mental and physical disorders were permitted, provided these did not contraindicate the treatment to be…

matched on Panic Disorder (mesh), panic attack (text), panic disorder (text)

Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness.

Background: Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls. Methods: A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence. Results: A large, pooled effect size of g = 0.80 [95% Conf…

matched on Panic Disorder (mesh), panic disorder (text)

Specificity of treatment effects: cognitive therapy and relaxation for generalized anxiety and panic disorders.

The aim of this study was to address claims that among bona fide treatments no one is more efficacious than another by comparing the relative efficacy of cognitive therapy (CT) and relaxation therapy (RT) in the treatment of generalized anxiety disorder (GAD) and panic disorder without agoraphobia (PD). Two fixed-effects meta-analyses were conducted, for GAD and PD separately, to review the treatment outcome literature directly comparing CT with RT in the treatment of those disorders. For GAD, CT and RT were equivalent. For PD, CT, which included interoceptive exposure, outperformed RT on all panic-related measures, as well as on indices of clinically significant change. There is ample evidence that both CT and RT qualify as bona fide treatments for GAD and PD, for which they are efficacious and intended to be so. Therefore, the finding that CT and RT do not differ in the treatment of GA…

matched on Panic Disorder (mesh), panic disorder (text)

Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: a meta-regression of factors that may predict outcome.

Objective: To determine which factors impact on the efficacy of cognitive behavioural therapy (CBT) for depression and anxiety. Factors considered include those related to clinical practice: disorder, treatment type, duration and intensity of treatment, mode of therapy, type and training of therapist and severity of patients. Factors related to the conduct of the trial were also considered, including: year of study, country of study, type of control group, language, number of patients and percentage of dropouts from the trial. Method: We used the technique of meta-analysis to determine an overall effect size (standardized mean difference calculated using Hedges' g) and meta-regression to determine the factors that impact on this effect size. We included randomized controlled trials with a wait list, pill placebo or attention/psychological placebo control group. Study participants had to …

matched on Panic Disorder (mesh), panic disorder (text)

The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication.

Context: Only limited information exists about the epidemiology of DSM-IV panic attacks (PAs) and panic disorder (PD). Objective: To present nationally representative data about the epidemiology of PAs and PD with or without agoraphobia (AG) on the basis of the US National Comorbidity Survey Replication findings. Design and setting: Nationally representative face-to-face household survey conducted using the fully structured World Health Organization Composite International Diagnostic Interview. Participants: English-speaking respondents (N=9282) 18 years or older. Main outcome measures: Respondents who met DSM-IV lifetime criteria for PAs and PD with and without AG. Results: Lifetime prevalence estimates are 22.7% for isolated panic without AG (PA only), 0.8% for PA with AG without PD (PA-AG), 3.7% for PD without AG (PD only), and 1.1% for PD with AG (PD-AG). Persistence, lifetime number…

matched on Panic Disorder (mesh), Agoraphobia (mesh), panic attack (text), panic disorder (text)

Panic attack symptom dimensions and their relationship to illness characteristics in panic disorder.

Subtyping panic disorder by predominant symptom constellations, such as cognitive or respiratory, has been done for some time, but criteria have varied considerably between studies. We sought to identify statistically symptom dimensions from intensity ratings of 13 DSM-IV panic symptoms in 343 panic patients interviewed with the Anxiety Disorders Interview Schedule for DSM-IV Lifetime Version. We then explored the relation of symptom dimensions to selected illness characteristics. Ratings were submitted to exploratory maximum likelihood factor analysis with a Promax rotation. A three-factor solution was found to account best for the variance. Symptoms loading highest on the first factor were palpitations, shortness of breath, choking, chest pain, and numbness, which define a cardio-respiratory type (with fear of dying). Symptoms loading highest on the second factor were sweating, trembli…

matched on Panic Disorder (mesh), Agoraphobia (mesh), panic attack (text), panic disorder (text)

Predicting treatment response to cognitive behavioral therapy in panic disorder with agoraphobia by integrating local neural information.

Importance: Although neuroimaging research has made substantial progress in identifying the large-scale neural substrate of anxiety disorders, its value for clinical application lags behind expectations. Machine-learning approaches have predictive potential for individual-patient prognostic purposes and might thus aid translational efforts in psychiatric research. Objective: To predict treatment response to cognitive behavioral therapy (CBT) on an individual-patient level based on functional magnetic resonance imaging data in patients with panic disorder with agoraphobia (PD/AG). Design, setting, and participants: We included 49 patients free of medication for at least 4 weeks and with a primary diagnosis of PD/AG in a longitudinal study performed at 8 clinical research institutes and outpatient centers across Germany. The functional magnetic resonance imaging study was conducted between…

matched on Panic Disorder (mesh), Agoraphobia (mesh), panic disorder (text)

Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis.

Cognitive-behaviour therapy (CBT) for panic disorder may consist of different combinations of several therapeutic components such as relaxation, breathing retraining, cognitive restructuring, interoceptive exposure and/or in vivo exposure. It is therefore important both theoretically and clinically to examine whether specific components of CBT or their combinations are superior to others in the treatment of panic disorder. Component network meta-analysis (NMA) is an extension of standard NMA that can be used to disentangle the treatment effects of different components included in composite interventions. We searched MEDLINE, EMBASE, PsycINFO and Cochrane Central, with supplementary searches of reference lists and clinical trial registries, for all randomized controlled trials comparing different CBT-based psychological therapies for panic disorder with each other or with control interven…

matched on Panic Disorder (mesh), panic disorder (text)

The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease.

Objective: To (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy of anxiety disorder treatments in CHD. Methods: A comprehensive electronic database search was performed in November 2013 for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From 4041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible). Results: Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n=2851). There was a non-significant association between GAD and MACE (risk ratio=1.20, 95% CI .86-1.68, P=.28) however t…

matched on Panic Disorder (mesh), panic disorder (text)

Risk factors for the onset of panic and generalised anxiety disorders in the general adult population: a systematic review of cohort studies.

Background: We aimed to assess available evidence on risk factors associated with the onset of panic disorder (PD) and/or generalised anxiety disorder (GAD) in cohort studies in the general adult population. Methods: Systematic review using MEDLINE, PsycINFO and Embase. Search terms included panic disorder, generalised anxiety disorder, cohort studies and risk factors. Results: We finally selected 21 studies, involving 163,366 persons with a median follow-up of 5 years. 1) Sociodemographic factors: PD was associated with age, female gender, and few economic resources. GAD was associated with age, non-Hispanics and Blacks, being divorced or widowed, and few economic resources. 2) Psychosocial factors: PD was associated with smoking and alcohol problems. GAD was associated with stressful life events in childhood and adulthood, and personality. 3) Physical and mental health factors: PD was …

matched on Panic Disorder (mesh), panic disorder (text)

Examination of the utility of the Beck Anxiety Inventory and its factors as a screener for anxiety disorders.

The Beck Anxiety Inventory (BAI) and the Anxiety Disorders Interview Schedule (ADIS-IV) were administered to 193 adults at a major Midwestern university recruited from an anxiety research and treatment center. The BAI and its four factor scores were compared from individuals with a primary diagnosis of generalized anxiety disorder (GAD), specific or social phobia, panic disorder with or without agoraphobia, obsessive-compulsive disorder (OCD), and no psychiatric diagnosis. The cut scores on the BAI and its factors, their sensitivity, specificity, as well as positive and negative predictive values were calculated for each group. The results of this study support previous findings that the strongest quality of the BAI is its ability to assess panic symptomatology. The present study also expands on this notion by establishing that the BAI can be used as an efficient screening tool for disti…

matched on Panic Disorder (mesh), Obsessive-Compulsive Disorder (mesh), Phobic Disorders (mesh), panic disorder (text)

Psychometric properties of the social phobia inventory: further evaluation.

This study investigated the psychometric properties of the Social Phobia Inventory [SPIN; Connor, K. M., Davidson, J. R. T., Churchill, L. E., Sherwood, A., Foa, E., Wesler, R.H., 2000. Psychometric properties of the Social Phobia Inventory (SPIN). British Journal of Psychiatry, 176, 379-386], a measure of severity in social phobia (social anxiety disorder). Participants included 132 participants with social phobia, 57 participants with panic disorder and agoraphobia (PDA), and 62 participants with obsessive-compulsive disorder (OCD). Confirming findings from an initial validation study, the SPIN was found to have excellent internal consistency and good test-retest reliability. It also distinguished well between those with social phobia and those with either PDA or OCD. Good convergent and discriminant validity were established by examining correlations with other conceptually related an…

matched on Panic Disorder (mesh), Obsessive-Compulsive Disorder (mesh), Phobic Disorders (mesh), panic disorder (text)

Heart rate and heart rate variability in panic, social anxiety, obsessive-compulsive, and generalized anxiety disorders at baseline and in response to relaxation and hyperventilation.

It remains unclear if diminished high frequency heart rate variability (HF-HRV) can be found across anxiety disorders. HF-HRV and heart rate (HR) were examined in panic (PD), generalized anxiety (GAD), social anxiety (SAD), and obsessive-compulsive disorder (OCD) relative to healthy controls at baseline and during anxiety stressors. All disorders evidenced diminished baseline HF-HRV relative to controls. Baseline HRV differences were maintained throughout relaxation. For hyperventilation, PD and GAD demonstrated greater HR than controls. Psychotropic medication did not account for HF-HRV differences except in OCD. Age and sex evidenced multiple main effects. Findings suggest that low baseline HF-HRV represents a common index for inhibitory deficits across PD, GAD, and SAD, which is consistent with the notion of autonomic inflexibility in anxiety disorders. Elevated HR responses to hyperv…

matched on Panic (mesh), Obsessive-Compulsive Disorder (mesh), Phobic Disorders (mesh)

Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults.

Background: Cognitive behavioural therapy (CBT) is an evidence-based treatment for anxiety disorders. Many people have difficulty accessing treatment, due to a variety of obstacles. Researchers have therefore explored the possibility of using the Internet to deliver CBT; it is important to ensure the decision to promote such treatment is grounded in high quality evidence. Objectives: To assess the effects of therapist-supported Internet CBT (ICBT) on remission of anxiety disorder diagnosis and reduction of anxiety symptoms in adults as compared to waiting list control, unguided CBT, or face-to-face CBT. Effects of treatment on quality of life and patient satisfaction with the intervention were also assessed. Search methods: We searched the Cochrane Depression, Anxiety and Neurosis Review Group Specialised Register (CCDANCTR) to 16 March 2015. The CCDANCTR includes relevant randomised con…

matched on Agoraphobia (mesh), Phobic Disorders (mesh), panic disorder (text)

Effect of a Biofeedback Intervention on Heart Rate Variability in Individuals With Panic Disorder: A Randomized Controlled Trial.

Objective: Some individuals with panic disorder (PD) display reduced heart rate variability (HRV), which may result in an increased risk of cardiovascular mortality. Heart rate variability-biofeedback (HRV-BF) training has been shown to improve the modulation of the autonomic activity. Therefore, this randomized controlled trial was conducted to investigate the effect of a 4-week HRV-BF intervention in individuals with PD. HRV-BF training improved the modulation of the autonomic activity. Therefore, with this randomized controlled trial, we aimed to investigate the effect of a 4-week HRV-BF intervention in people with PD. Methods: Thirty-six women and 16 men with PD (mean age = 35.85 [15.60] years) were randomly allocated either to HRV-BF with 0.1-Hz breathing as intervention group or to HRV-Sham-BF as active control group. HRV-BF was performed for 4 weeks, whereas HRV was measured both …

matched on Panic Disorder (mesh), panic disorder (text)

Neurocognitive processes in d-cycloserine augmented single-session exposure therapy for anxiety: A randomized placebo-controlled trial.

Drugs targeting N-methyl-d-aspartate (NMDA) receptors and the ability to learn new associations have been proposed as adjunct treatments to boost the success of exposure therapy for anxiety disorders. However, the effects of the NMDA partial agonist d-cycloserine on psychological treatment have been mixed. We investigated potential neurocognitive mechanisms underlying the clinical effects of d-cycloserine-augmented exposure, to inform the optimal combination of this and similar agents with psychological treatment. Panic disorder patients were randomised to single-dose d-cycloserine (250 mg; N = 17) or matching placebo (N = 16) 2hrs before one session of exposure therapy. Neurocognitive markers were assessed one day after treatment, including reaction-time based threat bias for fearful faces (primary outcome) and amygdala response to threat (secondary outcome). Clinical symptom severity w…

matched on Panic Disorder (mesh), panic disorder (text)

Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: A randomized controlled trial.

Acceptance and Commitment Therapy (ACT) can be effective in treating anxiety disorders, yet there has been no study on Internet-delivered ACT for social anxiety disorder (SAD) and panic disorder (PD), nor any study investigating whether therapist guidance is superior to unguided self-help when supplemented with a smartphone application. In the current trial, n=152 participants diagnosed with SAD and/or PD were randomized to therapist-guided or unguided treatment, or a waiting-list control group. Both treatment groups used an Internet-delivered ACT-based treatment program and a smartphone application. Outcome measures were self-rated general and social anxiety and panic symptoms. Treatment groups saw reduced general (d=0.39) and social anxiety (d=0.70), but not panic symptoms (d=0.05) compared to the waiting-list group, yet no differences in outcomes were observed between guided and ungui…

matched on Panic Disorder (mesh), panic disorder (text)

Internet-delivered cognitive behavioural therapy for children with anxiety disorders: A randomised controlled trial.

Background: Cognitive behaviour therapy (CBT) has been shown to be an effective treatment for anxiety disorders in children, but few affected seek or receive treatment. Internet-delivered CBT (ICBT) could be a way to increase the availability of empirically supported treatments. Aims: A randomised controlled trial was conducted to evaluate ICBT for children with anxiety disorders. Method: Families (N = 93) with a child aged 8-12 years with a principal diagnosis of generalised anxiety disorder, panic disorder, separation anxiety, social phobia or specific phobia were recruited through media advertisement. Participants were randomised to 10 weeks of ICBT with therapist support, or to a waitlist control condition. The primary outcome measure was the Clinician Severity Rating (CSR) and secondary measures included child- and parent-reported anxiety. Assessments were made at pre-treatment, pos…

matched on Panic Disorder (mesh), panic disorder (text)

Disorder-specific versus transdiagnostic and clinician-guided versus self-guided internet-delivered treatment for panic disorder and comorbid disorders: A randomized controlled trial.

Transdiagnostic cognitive behaviour therapy (TD-CBT) aims to target the symptoms of multiple disorders whereas disorder-specific CBT (DS-CBT) targets the symptoms of principal disorders. This study compared the relative benefits of internet-delivered TD-CBT and DS-CBT when provided in clinician-guided (CG-CBT) and self-guided (SG-CBT) formats for people with a principal diagnosis of Panic Disorder (PD). Participants (n=145) were randomly allocated to receive TD-CBT or DS-CBT and CG-CBT or SG-CBT. Large reductions in symptoms of PD (Cohen's d ≥ 0.71; avg. reduction ≥ 36%) and moderate-to-large reductions in symptoms of comorbid depression (Cohen's d ≥ 0.71; avg. reduction ≥ 33%), generalised anxiety disorder (Cohen's d ≥ 0.91; avg. reduction ≥ 34%) and social anxiety disorder (Cohen's d ≥ 0.50; avg. reduction ≥ 15%) were found over the 24-month follow-up period. Highlighting their efficac…

matched on Panic Disorder (mesh), panic disorder (text)