{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T15:33:00Z","timestamp":1787326380399,"version":"build-2736575974"},"reference-count":44,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Veteran Affairs Rehabilitation Research and Development","award":["1I0 1RX0029"],"award-info":[{"award-number":["1I0 1RX0029"]}]},{"award":["1I0 1RX0029"],"award-info":[{"award-number":["1I0 1RX0029"]}],"id":[{"id":"https:\/\/ror.org\/05dbx6743","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behav. Sci.","Behavioral Sciences"],"abstract":"<jats:p>Panic disorder is a highly prevalent and impairing diagnosis in veterans. Despite consistent efficacy findings in community samples, few studies have investigated evidence-based psychotherapies in veterans with panic disorder, limiting the understanding of their utility and deployment in Veterans Affairs (VA) settings. The present study preliminarily investigated cognitive behavioral therapy (CBT) for panic disorder via a non-controlled design in a treatment-seeking veteran sample with panic disorder at the VA. Of the 41 veterans initiating treatment, 28 (68.3%) participants completed at least eight sessions of psychotherapy. In general, participants evidenced medium-to-large post-treatment effects across disorder-specific symptoms (panic and anxiety symptomatology), comorbid presentations (symptoms of depression and posttraumatic stress disorder), and overall functioning. Disorder-specific symptom effects remained stable for six months after psychotherapy was terminated. In addition, the delivery of CBT for panic disorder was further supported by positive indices of treatment feasibility, including treatment engagement, homework completion and engagement, and high participant satisfaction ratings. While recognizing that this study did not include a control group, the findings provide limited support for CBT treatment of panic disorder in veterans\u2019 settings, findings that will require confirmation in a multisite controlled clinical trial.<\/jats:p>","DOI":"10.3390\/bs16081453","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:20:36Z","timestamp":1787322036000},"page":"1453","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Non-Controlled Study of Cognitive Behavior Therapy for Panic Disorder in Veterans"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3946-6716","authenticated-orcid":false,"given":"Daniel F.","family":"Gros","sequence":"first","affiliation":[{"name":"Mental Health Service, Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC 29401, USA"},{"name":"Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Pavlacic","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5, American Psychiatric Association.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1001\/jamapsychiatry.2017.2164","article-title":"The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial","volume":"74","author":"Barlow","year":"2017","journal-title":"JAMA Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1037\/a0031178","article-title":"Influence of trauma history on panic and posttraumatic stress disorder in returning veterans","volume":"10","author":"Barrera","year":"2013a","journal-title":"Psychological Services"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.comppsych.2012.09.001","article-title":"Impact of panic disorder on quality of life among veterans in a primary care pilot study","volume":"54","author":"Barrera","year":"2013b","journal-title":"Comprehensive Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1037\/pas0000254","article-title":"Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders\u2013fifth edition (PCL-5) in veterans","volume":"28","author":"Bovin","year":"2016","journal-title":"Psychological Assessment"},{"key":"ref_6","unstructured":"Brown, T. A. (2014). Anxiety and related disorders interview schedule for DSM-5RG (ADIS-5)-adult and lifetime version: Clinician manual, Oxford University Press."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1002\/da.20622","article-title":"Clinical and subthreshold panic disorder","volume":"27","author":"Bystritsky","year":"2010","journal-title":"Depression and Anxiety"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1080\/10503307.2021.2022236","article-title":"Comorbidity as a moderator of the differential efficacy of transdiagnostic behavior therapy and behavioral activation for affective disorders","volume":"32","author":"Coyne","year":"2022","journal-title":"Psychotherapy Research"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Craske, M. G., and Barlow, D. H. (2022). Mastery of your anxiety and panic: Therapist guide, Oxford University Press.","DOI":"10.1093\/med-psych\/9780197584057.002.0001"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1016\/j.brat.2006.09.006","article-title":"Cognitive behavioral therapy for panic disorder and comorbidity: More of the same or less of more?","volume":"45","author":"Craske","year":"2007","journal-title":"Behaviour Research and Therapy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.jpsychores.2009.05.006","article-title":"Using the Illness Intrusiveness Ratings Scale to understand health-related quality of life in chronic disease","volume":"68","author":"Devins","year":"2010","journal-title":"Journal of Psychosomatic Research"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1037\/a0014699","article-title":"Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric as for classical analysis","volume":"14","author":"Feingold","year":"2009","journal-title":"Psychological Methods"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/S0002-9343(96)00224-0","article-title":"Panic disorder in emergency department chest pain patients: Prevalence, comorbidity, suicidal ideation, and physician recognition","volume":"101","author":"Fleet","year":"1996","journal-title":"The American Journal of Medicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1002\/da.20532","article-title":"Evidence-based guidelines for interpretation of the Panic Disorder Severity Scale","volume":"26","author":"Furukawa","year":"2009","journal-title":"Depression and Anxiety"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/0272-7358(95)00048-8","article-title":"A meta-analysis of treatment outcome for panic disorder","volume":"15","author":"Gould","year":"1995","journal-title":"Clinical Psychology Review"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.psychres.2014.08.018","article-title":"Development and initial evaluation of Transdiagnostic Behavior Therapy (TBT) for veterans with affective disorders","volume":"220","author":"Gros","year":"2014","journal-title":"Psychiatry Research"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1037\/1040-3590.19.4.369","article-title":"Psychometric properties of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA): Comparison to the State-Trait Anxiety Inventory (STAI)","volume":"19","author":"Gros","year":"2007","journal-title":"Psychological Assessment"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.genhosppsych.2011.06.005","article-title":"Prevalence and features of panic disorder and comparison to posttraumatic stress disorder in VA primary care","volume":"33","author":"Gros","year":"2011","journal-title":"General Hospital Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1007\/s10862-023-10082-4","article-title":"Investigating relations between the symptoms of panic, agoraphobia, and suicidal ideation: The significance of comorbid depressive symptoms in veterans with panic disorder","volume":"45","author":"Gros","year":"2023","journal-title":"Journal of Psychopathology and Behavioral Assessment"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Hendriks, S. M., Spijker, J., Licht, C. M., Hardeveld, F., de Graaf, R., Batelaan, N. M., Penninx, B. W., and Beekman, A. T. (2016). Long-term disability in anxiety disorders. BMC Psychiatry, 16.","DOI":"10.1186\/s12888-016-0946-y"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.amepre.2012.07.029","article-title":"Health and health behavior differences: US Military, veteran, and civilian men","volume":"43","author":"Hoerster","year":"2012","journal-title":"American Journal of Preventive Medicine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"101894","DOI":"10.1016\/j.cpr.2020.101894","article-title":"Anxiety disorders and healthcare utilization: A systematic review","volume":"81","author":"Horenstein","year":"2020","journal-title":"Clinical Psychology Review"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1017\/S1352465807004018","article-title":"Outcome prediction of cognitive behaviour therapy for panic disorder: Initial symptom severity is predictive for treatment outcome, comorbid anxiety or depressive disorder, cluster C personality disorders and initial motivation are not","volume":"36","author":"Kampman","year":"2008","journal-title":"Behavioural and Cognitive Psychotherapy"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1001\/archpsyc.63.4.415","article-title":"The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication","volume":"63","author":"Kessler","year":"2006","journal-title":"Archives of General Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"Journal of General Internal Medicine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"317","DOI":"10.7326\/0003-4819-146-5-200703060-00004","article-title":"Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection","volume":"146","author":"Kroenke","year":"2007","journal-title":"Annals of Internal Medicine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1037\/0735-7028.39.4.435","article-title":"The Satisfaction With Therapy and Therapist Scale--Revised (STTS-R) for group psychotherapy: Psychometric properties and confirmatory factor analysis","volume":"39","author":"Oei","year":"2008","journal-title":"Professional Psychology: Research and Practice"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Oster, C., Morello, A., Venning, A., Redpath, P., and Lawn, S. (2017). The health and wellbeing needs of veterans: A rapid review. BMC Psychiatry, 17.","DOI":"10.1186\/s12888-017-1547-0"},{"key":"ref_29","first-page":"28","article-title":"Cognitive-behavioral therapy and the treatment of panic disorder: Efficacy and strategies","volume":"66","author":"Otto","year":"2005","journal-title":"Journal of Clinical Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1037\/amp0001320","article-title":"No client left behind: A meta-analysis of premature termination from psychotherapy in US service members and veterans","volume":"80","author":"Swift","year":"2025","journal-title":"American Psychologist"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.cpr.2015.09.004","article-title":"A systematic review of predictors and moderators of improvement in cognitive-behavioral therapy for panic disorder and agoraphobia","volume":"42","author":"Porter","year":"2015","journal-title":"Clinical Psychology Review"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1017\/S1092852900018617","article-title":"Cognitive-behavioral therapy for panic disorder: A review of treatment elements, strategies, and outcomes","volume":"8","author":"Rayburn","year":"2003","journal-title":"CNS Spectrums"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1017\/S1352465808004232","article-title":"Distinguishing cognitive and somatic dimensions of state and trait anxiety: Development and validation of the state-trait inventory for cognitive and somatic anxiety (STICSA)","volume":"36","author":"Ree","year":"2008","journal-title":"Behavioural and Cognitive Psychotherapy"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.psychres.2017.08.091","article-title":"Psychiatric comorbidity pattern in treatment-seeking veterans","volume":"258","author":"Richardson","year":"2017","journal-title":"Psychiatry Research"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S0140-6736(06)69418-X","article-title":"Panic disorder","volume":"368","author":"Craske","year":"2006","journal-title":"The Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S0165-0327(99)00030-0","article-title":"Quality of well being in panic disorder: The assessment of psychiatric and general disability","volume":"57","author":"Rubin","year":"2000","journal-title":"Journal of Affective Disorders"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"McHugh, R. K., and Barlow, D. H. (2012). Implementation of evidence-based psychological treatments in veterans health administration. Dissemination and implementation of evidence-based psychological interventions, Oxford University Press.","DOI":"10.1093\/med:psych\/9780195389050.001.0001"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1037\/ser0000490","article-title":"Acceptability of a transdiagnostic behavior therapy in veterans with affective disorders","volume":"18","author":"Shapiro","year":"2021","journal-title":"Psychological Services"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1176\/ajp.154.11.1571","article-title":"Multicenter collaborative panic disorder severity scale","volume":"154","author":"Shear","year":"1997","journal-title":"American Journal of Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1001\/jama.2015.8370","article-title":"Psychotherapy for military-related PTSD: A review of randomized clinical trials","volume":"314","author":"Steenkamp","year":"2015","journal-title":"JAMA"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1037\/0022-006X.76.4.710","article-title":"Treating comorbid panic disorder in veterans with posttraumatic stress disorder","volume":"76","author":"Teng","year":"2008","journal-title":"Journal of Consulting and Clinical Psychology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.janxdis.2015.04.002","article-title":"Intensive weekend group treatment for panic disorder and its impact on co-occurring PTSD: A pilot study","volume":"33","author":"Teng","year":"2015","journal-title":"Journal of Anxiety Disorders"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1007\/s00127-022-02411-x","article-title":"Military veterans and civilians\u2019 mental health diagnoses: An analysis of secondary mental health services","volume":"58","author":"Williamson","year":"2023","journal-title":"Social Psychiatry and Psychiatric Epidemiology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1002\/cpp.703","article-title":"Psychometric properties of the panic disorder severity scale: Clinician-administered and self-report versions","volume":"18","author":"Wuyek","year":"2011","journal-title":"Clinical Psychology & Psychotherapy"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/16\/8\/1453\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:30:33Z","timestamp":1787322633000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/16\/8\/1453"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":44,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["bs16081453"],"URL":"https:\/\/doi.org\/10.3390\/bs16081453","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]}}}