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The authors discuss several psychotherapy techniques that mix well and are often indispensable adjuncts in the behavioral therapy of treatment-resistant anxiety-disorder patients. These include psychoeducation, family therapy, psychodynamic interpretations, paradoxical injunctions, and assertiveness training. Multimodal approaches are often indicated with patients who would otherwise not tolerate exposure treatment.

Six patients with panic disorder who had panicked during sodium lactate infusion were given cognitive-behavioral treatment for 12-24 weeks. After treatment they underwent another lactate infusion, and four patients were rates as having no panic, suggesting that reduced vulnerability to lactate accompanies remission of panic. Controlled trials of cognitive-behavioral therapy and use of lactate infusion as a measure of remission are recommended.

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