A nurse is providing interventions for a client with panic disorder. Which interventions should the nurse include in the plan of care? (Select all that apply)

The correct answer is Choice D.

Choice A rationale: Avoidance reinforces fear conditioning and impairs extinction learning; exposure-based strategies are more effective in reducing panic symptoms and restoring functional coping through cognitive-behavioral therapy.

Choice B rationale: Panic attacks are driven by autonomic dysregulation and cognitive misinterpretation, not physical pathology; suggesting physical illness increases somatic focus and health anxiety, worsening panic disorder outcomes.

Choice C rationale: Ignoring panic attacks delays cognitive restructuring and emotional processing; distraction may help short-term but does not address underlying maladaptive beliefs or autonomic hyperarousal.

Choice D rationale: Comorbidity between panic disorder and depression is well-documented; shared neurobiological pathways and chronic distress increase risk for mood disorders, requiring integrated assessment and treatment planning.

Choice A rationale:

The statement "I'm not worried about having another panic attack" indicates a lack of understanding of anticipatory anxiety. Anticipatory anxiety is characterized by the fear of experiencing future panic attacks, so this statement contradicts that concept.

Choice B rationale:

This choice is correct because it reflects an accurate understanding of anticipatory anxiety. Anticipatory anxiety is the fear of being in situations or places where escape might be challenging or embarrassing in the event of a panic attack. This fear often leads to avoidance behavior and can worsen the overall anxiety.

Choice C rationale:

The statement "I don't think my panic attacks are related to my thought patterns" suggests a misunderstanding of the connection between thoughts and panic attacks. In reality, panic attacks are often triggered by anxious thoughts and thought patterns.

Choice D rationale:

The statement "I believe my panic attacks are caused by a substance I'm using" indicates a different perspective on the origin of panic attacks. While substance use can contribute to anxiety or trigger panic attacks in some cases, anticipatory anxiety specifically refers to the fear of future panic attacks, not their immediate causes.