Examining the pitfalls and challenges of standard cognitive behavioral therapy for panic disorder in cardiovascular patient population: A narrative review

Authors

1 Department of Clinical and Health Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran.

2 Associate professor, School of Psychology, Deakin University, Burwood, Victoria, Australia.

3 Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Educational Management and Educational Planning, Faculty of Psychology and Educational Sciences, Tehran University, Tehran, Iran.

10.22038/jfmh.2025.26456

Abstract

Introduction: Panic Disorder (PD) is a common mental health condition that frequently occurs alongside cardiovascular disease (CVD), posing challenges for treatment. Cognitive Behavioral Therapy (CBT) is an established intervention for panic disorder; however, its use in patients with CVD poses challenges based on physiological risks and symptom overlap.
Materials and Methods: This narrative review summarizes the current literature regarding panic disorder in cardiovascular patients, with attention to the inadequacies of standard CBT and potential adaptations.
 Results: Challenges in using CBT to treat panic disorder in patients with cardiovascular disease include difficulty differentiating panic and cardiac symptoms and precautions for exposure therapy due to physiological risks. Challenges in using CBT to treat panic disorder in patients with cardiovascular disease include the difficulty in distinguishing between panic and cardiac symptoms, as well as the need for caution during exposure therapy because of potential physiological risks. A new cognitive behavioral therapy-based protocol, known as Panic Attack Treatment in Comorbid Heart Diseases (PATCHD), has been proposed to address these challenges through modified exposure techniques, supervised exercise, and coping skills training.
Conclusion: Anxiety disorders are common among patients with cardiovascular disease, with adverse effects on disease prognosis. This population requires careful modification of the standard CBT approach in order for it to be both safe and effective. Future studies should evaluate the efficacy of modified interventions like PATCHD to enhance psychological and CVD outcomes.

Keywords

Fundamentals of Mental Health
Volume 27, Issue 3
May and June 2025
Pages 143-147

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