Many patients with anxiety disorders have suffered for a very long time and tried a lot of different approaches to cope with their anxiety attacks of find some way to get a little bit relief. So it is very important the the therapist will respect these expierences of the client and offers a very calm and sensitive atmosphore to talk about the problem.

The most important messages for the patient with panic attacks are:

• it is very common = you are not alone !
• it is not life-threatening (but can be very unpleasant !)
• it is treatable!!!!!

To establish a good therapeutic relationsship is mainly done with:

• empathic listening to the patients concerns and indiviudal experiences with the anxiety disorder
• realistic reassurance and instillation of hope for a change for better
• Providing information about the symptoms and orign of panic attacks
• Discussing the different components of panic disorder (panic attacks, anticipatory anxiety, avoidance behaviour) and options to treat these problems

Today most psychotherapists will consider the option to use an additional pharmacotherapy (e.g. using antidepressant medication with SSRI). Pros and Cons of this approach and the patient´s concerns about medication (or the use of alternative or contemplative methods) should be addressed by the therapist.