Table 3 Paxonline panic disorder treatment

Introductory module. Anxiety, from normality to pathology

Psychoeducation concerning fear, anxiety, fight or flight response, the brain circuits involved in the fear response, etiology of anxiety and treatment directions. Normalizes patients’ reactions and sets correct expectancies.

Module 1. Understand what’s happening with you

Introductory information on panic attacks, panic symptoms and how panic disorder develops. Study cases and video illustrations. Patients begin to register PD related behaviors and thoughts using online worksheets.

Module 2. Understand what you have to do

Introducing treatment strategies, the treatment plan and boosting confidence and motivation for change.

Module 3. Reduce hyperactivation through breathing retraining

Information on the effects of hyperventilation, breathing regulation and abdominal breathing exercises.

Modules 4 and 5. Reduce hyperactivation through autogenic training

Inducing relaxation by using autogenic training exercises. Videos and audio files are provided for practice.

Module 6. Reduce hyperactivation through physical exercises

Psychological and biological benefits of physical exercises are presented; how to use them regularly.

Module 7. Optimizing attentional functioning

Attention biases in anxiety and panic disorder. Retraining attention away from the body and panic-like thoughts.

Module 8. Changing maladaptive conscious cognitions

The importance of catastrophic thoughts and attitudes. ICAR technique for cognitive restructuring:

Identify catastrophic cognitions

Challenge each dysfunctional cognition

Find the Alternative cognition

Repeat the procedure

Module 9. Changing maladaptive unconscious cognitions

Cognitive restructuring techniques for unconscious beliefs. Identify personal values and live by them.

Module 10. Avoidance reduction through interoceptive exposure

Explain the mechanism of avoidance and prepare for exposure exercises. Reduce fear of bodily sensations through interoceptive exposure.

Module 11. Avoidance reduction through exteroceptive exposure

Reduce avoidance behaviors through gradual exposure to feared situations.

Module 13. Positive emotions development

Increase positive emotions in daily life through cognitive and behavioral exercises drawn from positive psychology practices.

Module 14. Relapse prevention

Resume the intervention strategies, set the correct expectancies and make a plan to continue improvement and deal with relapse situations.

Module 12. You learn how to solve problems (optional)

Learn to organize problems according to importance and urgency. Implement problem-solving technique.

Module 15. Reducing depressive symptoms associated with panic – behavioral activation (optional)

Depression symptoms co-morbid to panic disorder. Behavioral activation techniques.

Module 16. Reducing depressive symptoms associated with panic – cognitive restructuring (optional)

ICAR technique for cognitive restructuring of dysfunctional cognitions that induce and maintain depression.