For a patient with panic disorder unwilling to continue medication, what is the best initial non-pharmacologic treatment option?

Cognitive-behavioral therapy (CBT) is recognized as the best initial non-pharmacologic treatment option for a patient with panic disorder, especially when the individual is unwilling to continue medication. CBT focuses on identifying and changing negative thought patterns and behaviors associated with panic attacks. It incorporates exposure techniques to help patients face feared situations in a controlled manner, reducing their anticipatory anxiety and ultimately helping them manage panic attacks effectively.

Research supports the efficacy of CBT in treating anxiety disorders, including panic disorder, making it a first-line therapeutic approach. The structured nature of CBT aids patients in developing coping strategies and skills that empower them to understand and manage their condition, considerably enhancing their quality of life.

Electroconvulsive therapy is generally reserved for severe cases of depression and other conditions when other treatments have failed. Hypnotherapy lacks sufficient evidence in treating panic disorder and is not a standard recommendation. Repetitive transcranial magnetic stimulation is an emerging treatment option primarily for depression and is not a primary intervention for panic disorder. These therapies do not have the same level of established efficacy as CBT for panic disorder treatment.