Relapse

Panic Disorder can be a chronic clinical problem with periods of intense symptomatology and periods of remission of symptoms. Longitudinal studies of treatment effectiveness suggest that approximately 70% of patients treated for panic disorder benefited from therapy. However, almost 30% of patients who undertook therapy remained unresponsive to major therapeutic approaches (such as Cognitive-Behavioral Therapy). As many as 30% of responsive patients relapsed approximately 2 years after treatment. In addition, epidemiological research suggests that, although the overt symptomatology of panic can be removed with a psychotherapeutic intervention, anxiety is a life-long trait that may lead to relapse and calls for concurrent treatment.

The most problematic aspect of relapse is the sufferer’s loss of faith in a lasting cure. Many patients who successfully negotiated the first episode of panic disorder in their treatment and relapsed after the end of treatment, entered therapy a second time with the silent certainty that the gains of therapy cannot last for long. Therefore, even if the second therapeutic intervention were successful, but the suspicion of a non-lasting cure remained in their organism, they unperceptively entered a vicious meta-cycle that facilitated relapse. The vicious meta-cycle was not centered on how one symptom lead to the next, during an active episode of Panic Disorder. It was centered on the solid but subtle conviction of the inevitability of progressive deterioration, after the end of a successful treatment. This conviction, if untreated or unresponsive to the relapse prevention component of a therapeutic intervention, can contaminate the remission phase.

Incidences of relapse can have “deleterious” effects on the patients’ cognitive schemas, particularly if they are combined with comorbidity and elevated general anxiety levels. Clinicians should be aware of the manifestations of vicious meta-cycling in relapsed patients and therapeutic protocols should carefully assess and sensitively deliver effective relapse prevention techniques.