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By the late 1980s it was well established that exposure-based therapy was highly effective in the treatment of agoraphobia (e.g. Mathews et al., 1981). It was also clear that the co-occurrence of panic attacks was associated with a considerably poorer outcome. Previous work on panic had suggested that it had a biological basis (Klein and Fink, 1962). The suggestion that panic was 'biologically distinct' from other types of anxiety was highly influential in the way the anxiety disorders were defined in the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-III). It was suggested that associated phenomena (such as anticipatory anxiety and avoidance) were subject to psychological intervention, but panic attacks required biological intervention, particularly drugs with noradrenergic action such as the tricyclic antidepressant imipramine. © 2004 Elsevier Ltd. All rights reserved.

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39 - 42