Longstanding Panic and Driving Avoidance With Functional Recovery During Multimodal Psychotherapy and Pharmacotherapy: A Case Report

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

¹Amen Clinics, Costa Mesa, USA

Cite this paper:
Binh Pham DO MPH MS and Paige Porter MS LPCC. Longstanding Panic and Driving Avoidance With Functional Recovery During Multimodal Psychotherapy and Pharmacotherapy: A Case Report. American Journal of Medical Case Reports. 2026; 14(8):74-78. doi: 10.12691/ajmcr-14-8-2

Abstract

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.

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

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Hollifield M, Katon W, Skipper B, et al. Panic disorder and quality of life: variables predictive of functional impairment. Am J Psychiatry. 1997; 154: 766-772.
[2]	Taylor J, Deane F, Podd J. Driving-related fear: a review. Clin Psychol Rev. 2002; 22: 631-645.
[3]	Papola D, Ostuzzi G, Tedeschi F, et al. Comparative efficacy and acceptability of psychotherapies for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials. Br J Psychiatry. 2022; 221: 507-519.
[4]	Chawla N, Anothaisintawee T, Charoenrungrueangchai K, et al. Drug treatment for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2022; 376: e066084.
[5]	Rasines-Laudes P, Serrano-Pintado I. Efficacy of EMDR in post-traumatic stress disorder: a systematic review and meta-analysis of randomized clinical trials. Psicothema. 2023; 35: 385-396.
[6]	Goldstein AJ, de Beurs E, Chambless DL, et al. EMDR for panic disorder with agoraphobia: comparison with waiting list and credible attention-placebo control conditions. J Consult Clin Psychol. 2000; 68: 947-956.
[7]	Horst F, Den Oudsten B, Zijlstra W, et al. Cognitive behavioral therapy vs. eye movement desensitization and reprocessing for treating panic disorder: a randomized controlled trial. Front Psychol. 2017; 8: 1409.
[8]	Kapucu OL, Nobili F, Varrone A, et al. EANM procedure guideline for brain perfusion SPECT using 99mTc-labelled radiopharmaceuticals, version 2. Eur J Nucl Med Mol Imaging. 2009; 36: 2093-2102.
[9]	Brunner E, Chen CYA, Klein T, et al. Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits. J Gen Intern Med. 2025; 40: 2814-2859.