Behaviour therapy, involving relaxation and gradual exposure to the precipitating situation, is of proven value in phobic disorders and in panic disorder when there is avoidance behaviour. A clinical psychologist should assess the patient and organise treatment if behaviour and cognitive therapy are considered appropriate. Phenelzine is a useful adjunct to psychological methods of treatment. Drug treatment is more important in spontaneous panic attacks; phenelzine, imipramine, and paroxetine have been shown to be effective.
There has been considerable interest in the psychological treatment of victims of accidents or disasters who are at risk of developing post-traumatic stress and other psychiatric disorders. Early intervention has been advocated but its efficacy has not been convincingly demonstrated. Cognitive therapy and exposure, preventing the development of avoidance therapy, are now established components of treatment.38 If symptoms have become established, either tricyclic antidepressants or monoamine oxidase inhibitors can provide symptomatic relief.39
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