84 J Gandhara Med Dent Sci
October - December 2025
:
:
ORIGINAL ARTICLE
EFFECTIVENESS OF BRIEF CBT FOR PANIC ANXIETY DISORDER: A FOLLOW -UP STUDY
Sherayub Dawar1, Safia Bibi2
ABSTRACT
OBJECTIVES
To examine the effectiveness of a brief CBT protocol in reducing panic
symptoms and anxiety, and to assess whether therapeutic gains are sustained
at follow-up.
METHODOLOGY
A quasi-experimental study was conducted at the Department of Psychiatry,
Khalifa Gulnawaz Teaching Hospital, Bannu, with 60 patients meeting the
DSM-5 criteria for PAD, recruited from outpatient psychiatry clinics in
Peshawar, Pakistan. Participants underwent a structured six-session CBT
program over a period of six weeks. Outcomes were measured using the
Panic Disorder Severity Scale (PDSS) and the Beck Anxiety Inventory (BAI)
at baseline, post-treatment, and at the three-month follow-up. Data were
analyzed using repeated measures ANOVA, effect size estimation, and
correlation analysis of demographic predictors.
RESULTS
A significant reduction in panic and anxiety symptoms was observed post-
treatment (PDSS: baseline M=15.6, SD=3.2; post-treatment M=7.4, SD=2.9;
p<0.001). Improvements were largely maintained at follow-up (M = 8.1, SD
= 3.0). Large effect sizes were recorded (Cohen’s d=1.3–1.6). Subgroup
analysis indicated that younger participants (18–30 years) and females
reported greater symptom reduction compared to older adults and males.
Correlation analysis revealed that higher baseline severity was associated
with greater improvement (r = 0.41, p = 0.003).
CONCLUSION
Brief CBT is highly effective in managing panic anxiety disorder and
demonstrates sustained benefits at follow-up. Its time-efficient nature makes it
particularly useful in low-resource clinical settings.
KEYWORDS: Panic Disorder, Brief CBT, Anxiety, Psychotherapy, Follow-
up
How to cite this article
Dawar S, Bibi S. Effectiveness of
Brief CBT for Panic Anxiety Disorder:
A Follow-Up Study. J Gandhara Med
Dent Sci. 2025;12(4):84-87.https://doi.
org/10.37760/jgmds.12-4.664
Date of Submission: 08-01-2025
Date Revised: 05-09-2025
Date Acceptance: 24-09-2025
1Assistant Professor, Bannu Medical
College
Correspondence
1Sherayub Dawar, Assistant Professor,
Department of Psychiatry, Bannu
Medical College
+92-333-9368720
drsherayub@gmail.com
INTRODUCTION
Panic Anxiety Disorder (PAD), commonly referred to
as panic disorder, is a chronic psychiatric condition
characterized by sudden, recurrent panic attacks,
accompanied by persistent concern about additional
attacks and maladaptive behavioral changes.1
Epidemiological research suggests that panic disorder
affects approximately 1.5-3.5% of the global
population, with higher prevalence rates in women and
young adults.2 The disorder is often comorbid with
agoraphobia, depression, and substance abuse, leading
to impaired functioning, increased healthcare costs, and
diminished quality of life.3,4 Despite its prevalence and
disabling consequences, PAD remains underdiagnosed
and undertreated in many low- and middle-income
countries (LMICs).5 This treatment gap is primarily due
to the scarcity of trained mental health professionals
and limited access to evidence-based psychotherapies.
Cognitive Behavioral Therapy (CBT) is regarded as the
gold-standard treatment for panic disorder, supported
by robust evidence from randomized controlled trials.6,7
Standard CBT protocols typically include 12–15
sessions incorporating psych education, cognitive
restructuring, interceptive and situational exposure, and
relapse prevention.8 However, in resource-constrained
contexts, lengthy interventions can be impractical due
to time, cost, and dropout concerns.9 Recent studies
have proposed brief CBT protocols, typically delivered
in 4–8 sessions, as effective alternatives without
significant compromise in treatment efficacy.10,11,12
Meta-analyses indicate that condensed CBT can
produce outcomes comparable to standard-length
therapy, particularly when focused on core CBT
principles.13 Brief interventions have the added
advantage of being cost-effective, improving treatment
adherence, and increasing scalability in community-
based or primary care settings.14 In Pakistan, where
mental health resources are limited and stigma often
deters individuals from seeking long-term therapy, brief
CBT may offer a pragmatic solution. However,
empirical data regarding its effectiveness in South
Asian populations is scarce. This study aimed to
85J Gandhara Med Dent Sci
October - December 2025
evaluate the effectiveness of a six-session CBT
program for panic anxiety disorder in Peshawar,
Pakistan, and to examine whether symptom reduction is
maintained at follow-up.
METHODOLOGY
This study employed a quasi-experimental pre-post
design with follow-up, conducted at the Department of
Psychiatry, Khalifa Gulnawaz Teaching Hospital,
Bannu, between March and August 2024. Ethical
approval was obtained from the institutional review
board, and informed consent was taken from all
participants. A total of 60 patients, aged 18-45 years,
diagnosed with panic disorder according to DSM-5
criteria, were included. Diagnosis was established by
consultant psychiatrists using structured clinical
interviews. Participants with comorbid psychotic
disorders, substance dependence, or severe cognitive
impairment were excluded. The intervention consisted
of a six-session structured CBT protocol, delivered
weekly in 60-minute individual sessions by trained
clinical psychologists. The therapy was based on
evidence-based manuals but condensed to target
essential mechanisms. Session one introduced
psychoeducation about panic disorder, the cognitive-
behavioral model, and the rationale for therapy. Session
two focused on cognitive restructuring of catastrophic
misinterpretations. Session three introduced
interoceptive exposure exercises, such as
hyperventilation and rapid heartbeat induction, to
reduce the fear of bodily sensations. Session four
involved situational exposure, encouraging patients to
confront avoided places (e.g., markets, public
transport). Session five focused on coping skills and
relaxation training. Session six focused on relapse
prevention and consolidating learned strategies.
Assessment tools included the Panic Disorder Severity
Scale (PDSS) and the Beck Anxiety Inventory (BAI),
both validated measures widely used in clinical
research.15,16 Assessments were conducted at baseline,
immediately after treatment, and three months after
treatment. Data analysis was performed using SPSS
version 26.
RESULTS
Of the 60 participants, 35 (58.3%) were female and 25
(41.7%) male. The mean age was 29.4 years (SD = 6.7).
The mean illness duration was 2.3 years (SD = 0.9).
The dropout rate was low (6.6%; 4 participants).
Pearson’s correlation revealed that higher baseline
PDSS scores predicted greater improvement post-
treatment (r = 0.41, p = 0.003). Gender was a
significant predictor, with females showing slightly
greater symptom reduction. The duration of illness was
not significantly correlated with treatment response (r =
0.12, p = 0.28).
Meas
ure
Baseline
(M±SD)
Post-
treatment
(M±SD)
3-month
Follow-up
(M±SD)
F-
value
p-
value
PDSS 15.6 ±3.2 7.4 ± 2.9 8.1 ± 3.0 45.7 <0.001
BAI 28.3 ±6.1 14.2 ± 5.7 15.6 ± 5.9 51.3 <0.001
Table 2: Effect Sizes (Cohen’s d) for Symptom Reduction
Measure Baseline vs. Post Baseline vs. Follow-up
PDSS 1.60 1.43
BAI 1.47 1.34
Table 3: Symptom Change by Age and Gender
Group Mean Δ PDSS p-value
Age 18–30 -8.9 <0.001
31–45 -6.1 0.02
Gender Male -7.2 0.01
Female -9.3 <0.001
Table 4: Correlation Analysis of Predictors and Treatment
Response
Variable R-values P-value
Baseline PDSS severity 0.41 0.003
Age (18–30) -0.29 0.024
Gender (Female) 0.31 0.018
Duration of illness -0.12 0.28
Table 1: Mean PDSS and BAI Scores across Time Points
DISCUSSION
The findings of this study strongly support the
effectiveness of a brief six-session CBT protocol in
reducing symptoms of panic anxiety disorder.
Significant reductions were observed on both panic-
specific (PDSS) and general anxiety (BAI) measures,
with large effect sizes maintained at three-month
follow-up. These results align with the global literature,
which suggests that condensed CBT can be as effective
as standard-length therapy.10,11,12,13 The observed
improvements align with earlier studies that reported
CBT’s strong efficacy for panic disorder .6,7 Our
findings extend this evidence by demonstrating that
time-limited interventions are also beneficial,
particularly in LMICs. The large effect sizes confirm
that the therapeutic gains were not only statistically
significant but also clinically meaningful. The subgroup
analysis revealed that younger adults and females
showed greater improvement. Similar patterns have
been observed in other anxiety treatment trials, where
younger participants may demonstrate higher
neuroplasticity and engagement with cognitive
restructuring techniques.17 Gender differences may be
attributed to greater help-seeking behavior and
emotional expressiveness among females.18 The
correlation between higher baseline severity and greater
Effectiveness of Brief CBT for Panic Anxiety
86 J Gandhara Med Dent Sci
October - December 2025
treatment gains suggests that brief CBT may be
beneficial for patients with pronounced symptoms. This
finding aligns with Schmidt and colleagues, who
reported that treatment compliance and severity have a
strong influence on CBT outcomes.19 One of the
notable strengths of this study is its focus on follow-up
outcomes. Maintenance of therapeutic gains is critical,
and our results show only minimal relapse at three
months. This supports the inclusion of relapse-
prevention strategies, even in brief protocols. Future
research should employ randomized controlled trials
comparing brief CBT to pharmacotherapy and standard
CBT. Furthermore, cost-effectiveness analyses would
help policymakers in LMICs prioritize brief
psychotherapeutic interventions.
LIMITATIONS
The absence of a control group prevents ruling out the
effects of a placebo or natural recovery. Self-report
measures, though validated, may introduce bias.
Additionally, the follow-up period was limited to three
months; longer-term effects remain unknown. Despite
these limitations, the findings have significant clinical
implications. In resource-limited settings, brief CBT
provides a feasible, scalable alternative to lengthy
therapy protocols. Incorporating such interventions into
primary care settings could enhance accessibility,
reduce stigma, and decrease reliance on
pharmacological treatments.
CONCLUSIONS
Brief CBT is a highly effective and sustainable
intervention for panic anxiety disorder, leading to
significant reductions in symptom severity with gains
maintained at follow-up. Its brevity, affordability, and
scalability make it especially suitable for resource-
limited settings such as Pakistan. Integrating brief CBT
into clinical practice can improve access to evidence-
based care for individuals with panic disorder.
CONFLICT OF INTEREST: None
FUNDING SOURCES: None
REFERENCES
1. American Psychiatric Association. Diagnostic and Statistical
Manual of Mental Disorders (DSM-5). 5th ed. Washington, DC:
American Psychiatric Publishing; 2013.
2. Bandelow B, Michaelis S. Epidemiology of anxiety disorders in
the 21st century. Dialogues Clin Neurosci. 2015;17(3):327–35.
PMID: 26487813.
3. Kessler RC, Chiu WT, Jin R, Ruscio AM, Shear K, Walters EE.
The epidemiology of panic attacks, panic disorder, and
agoraphobia in the National Comorbidity Survey Replication.
Arch Gen Psychiatry. 2006 Apr;63(4):415–24.
doi:10.1001/archpsyc.63.4.415. PMID: 16585471.
4. Craske MG, Stein MB, Eley TC, Milad MR, Holmes A, Rapee
RM, et al. Anxiety disorders. Nat Rev Dis Primers. 2017 May
18;3:17024. doi:10.1038/nrdp.2017.24. PMID: 28518111.
5. Patel V, et al. The burden of mental disorders in South Asia.
Lancet Psychiatry. 2016;3(10): 979–990. doi:10.1016/S2215-
0366(16)30127-4. PMID: 27650768.
6. Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult
anxiety disorders: a meta-analysis of randomized placebo-
controlled trials. J Clin Psychiatry. 2008 Apr;69(4):621–32.
doi:10.4088/jcp.v69n0415. PMID: 18363421.
7. Cuijpers P, Karyotaki E, Weitz E, Andersson G, Hollon SD, van
Straten A. The effects of psychotherapies for major depression
in adults on remission, recovery, and improvement: a meta-
analysis. J Affect Disord. 2014 Apr;159:118–26.
doi:10.1016/j.jad.2014.02.026. PMID: 24679399.
8. Barlow DH. Clinical handbook of psychological disorders: A
step-by-step treatment manual. 5th ed. New York: Guilford
Press; 2014.
9. Rahman A, et al. Cognitive behaviour therapy-based
intervention by community health workers for mothers with
depression and their infants in rural Pakistan: a cluster-
randomised controlled trial. Lancet. 2008 Sep
13;372(9642):902–9. doi:10.1016/S0140-6736(08)61400-2.
PMID: 18790313.
10. Sánchez-Meca J, Rosa-Alcázar AI, Marín-Martínez F.
Psychological treatment of panic disorder with or without
agoraphobia: a meta-analysis. Clin Psychol Rev. 2010
Feb;30(1):37–50. doi:10.1016/j.cpr.2009.08.011. PMID:
19729226.
11. Clark DM, et al. Cognitive therapy versus exposure and applied
relaxation in social phobia: a randomized controlled trial. J
Consult Clin Psychol. 2006 Jun;74(3):568–78.
doi:10.1037/0022-006X.74.3.568. PMID: 16822112.
12. Öst LG. One-session treatment for specific phobias. Behav Res
Ther. 1989 Jan;27(1):1–7. doi:10.1016/0005-7967(89)90113-7.
PMID: 2914009.
13. Otto MW, Smits JA, Reese HE. Combined psychotherapy and
pharmacotherapy for mood and anxiety disorders in adults:
review and analysis. Clin Psychol Sci Pract. 2005;12(1):72–86.
doi:10.1093/clipsy.bpi009.
14. Shafran R, Clark DM, Fairburn CG, Arntz A, Barlow DH,
Ehlers A, et al. Mind the gap: Improving the dissemination of
CBT. Behav Res Ther. 2009 Nov;47(11):902–9.
doi:10.1016/j.brat.2009.07.003. PMID: 19664756.
15. Shear MK, Brown TA, Barlow DH, Money R, Sholomskas DE,
Woods SW, et al. Multicenter collaborative panic disorder
severity scale. Am J Psychiatry. 1997 Nov;154(11):1571–5.
doi:10.1176/ajp.154.11.1571. PMID: 9356566.
16. Beck AT, Epstein N, Brown G, Steer RA. An inventory for
measuring clinical anxiety: Psychometric properties. J Consult
Clin Psychol. 1988 Dec;56(6):893–7. doi:10.1037/0022-
006X.56.6.893. PMID: 3204199.
17. Yonkers KA, Bruce SE, Dyck IR, Keller MB. Chronicity,
relapse, and illness course of panic disorder, social phobia, and
generalized anxiety disorder: findings in men and women from
8 years of follow-up. Depress Anxiety. 2003;17(3):173–9.
doi:10.1002/da.10106. PMID: 12768651.
18. McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender
differences in anxiety disorders: Prevalence, course of illness,
comorbidity and burden of illness. J Psychiatr Res. 2011
Aug;45(8):1027–35. doi:10.1016/j.jpsychires.2011.03.006.
PMID: 21439576.
19. Schmidt NB, Woolaway-Bickel K. The effects of treatment
compliance on outcome in cognitive-behavioral therapy for
panic disorder: quality versus quantity. J Consult Clin Psychol.
2000 Feb;68(1):13–8. doi:10.1037//0022-006X.68.1.13. PMID:
10710836.
Effectiveness of Brief CBT for Panic Anxiety
87J Gandhara Med Dent Sci
October - December 2025
LICENSE: JGMDS publishes its articles under a Creative Commons Attribution Non-Commercial Share-Alike license (CC-BY-NC-SA 4.0).
COPYRIGHTS: Authors retain the rights without any restrictions to freely download, print, share and disseminate the article for any lawful purpose.
It includes scholarlynetworks such as Research Gate, Google Scholar, LinkedIn, Academia.edu, Twitter, and other academic or professional networking sites.
20. National Institute for Health and Care Excellence (NICE).
Generalised anxiety disorder and panic disorder in adults:
management. NICE guideline [CG113]. 2011.
Sherayub Dawar - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Supervision;
Final Approval
Safia Bibi - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical
Revision; Final Approval
AUTHORS CONTRIBUTION
The authors accept responsibility for all aspects of the work
and will ensure that any concerns regarding the accuracy or
integrity of any part are properly investigated and resolved.
Effectiveness of Brief CBT for Panic Anxiety