Breaking the fear loop: A CBT case study of panic disorder with agoraphobia

Abstract

This case report presents the cognitive-behavioral treatment of a 38-year-old woman diagnosed with panic disorder with Agoraphobia and comorbid Major Depressive Disorder. The client experienced intense panic attacks, avoidance of open and enclosed spaces, and heavy reliance on her spouse. The case formulation was based on the Clark and Salkovskis (1991) model, emphasizing catastrophic misinterpretations of bodily sensations and safety behaviors. Treatment involved psychoeducation, cognitive restructuring using the ABC model, and targeted behavioral experiments. Graded exposure to avoided situations (e.g., leaving safety cues, traveling alone) was introduced progressively. By session 11, significant reductions were observed in anxiety and depression scores (e.g., BAI from 49 to 22; BDI from 38 to 13), along with improved functioning and autonomy. The client began reengaging with daily activities and reported enhanced emotional connection with her family. The case illustrates how a structured CBT model can effectively address panic-agoraphobic symptom cycles by challenging maladaptive beliefs and safety strategies. Therapy was conducted under expert psychiatric supervision, with full informed consent and anonymization of personal data.