Binh Pham DO MPH MS^1,, Paige Porter MS LPCC¹

A 49-year-old man with longstanding anxiety, recurrent panic attacks, significant trauma exposure, and severe freeway-driving avoidance presented for psychiatric treatment. His baseline regimen included quetiapine extended release, aripiprazole, buspirone, and clonazepam during a supervised taper. Treatment incorporated medication restructuring and weekly multimodal psychotherapy. Aripiprazole was discontinued, sertraline was initiated and titrated, and quetiapine was temporarily reduced but restored after worsening baseline anxiety. Psychotherapy included eye movement desensitization and reprocessing (EMDR) targeting childhood memories and maladaptive beliefs involving self-worth, helplessness, control, and safety, while driving avoidance was addressed more directly through graded exposure, cognitive-behavioral strategies, somatic techniques, mindfulness, and related skills. Driving activity increased progressively from brief exposures to several hours at a time. At approximately six months of follow-up, the patient reported driving long distances on freeways, maintaining highway speeds, and passing large trucks without panic attacks or significant anxiety. Clonazepam was successfully discontinued, and mood remained stable without documented manic or hypomanic symptoms. Baseline brain perfusion single-photon emission computed tomography demonstrated mixed relative cortical and subcortical tracer-distribution differences and was included only as a descriptive adjunct to the clinical evaluation. This case illustrates meaningful functional recovery during coordinated multimodal psychotherapy and pharmacotherapy, while the contribution of any individual intervention cannot be determined.

panic attacks, driving avoidance, eye movement desensitization and reprocessing, graded exposure, pharmacotherapy, clonazepam taper, brain perfusion SPECT, functional recovery