A recently-published study examined the role of cognitive change (change in catastrophic misinterpretations of bodily sensations) in the treatment of panic disorder. Participants were 43 adults diagnosed with panic disorder who received 12 weeks of panic control treatment (a CBT approach developed by Barlow and colleagues). Researchers assessed panic disorder severity weekly and assessed catastrophic misinterpretations, agoraphobia, and peak anxiety prior to sessions 1, 3, 6, 9, and 12. They found that change in catastrophic misinterpretations was associated with later reduction in overall symptom severity, frequency of panic attacks, distress and apprehension, and avoidance. The researchers note that their results showed better outcomes when cognitive change preceded symptomatic improvement.

This, of course does not suggest that a purely cognitive approach to treating panic disorder would be a good idea. First, behavioral experiments can be an important part of achieving cognitive change. Second, if you achieve cognitive change and don't follow up with in-vivo exposure to avoided situations and avoided sensations, you aren't likely to achieve lasting improvement. However, it does provide fairly clear evidence that achieving cognitive change can be an important part of effective treatment.

Teachman, B. A., Marker, C. D., & Clerker, E. M. (2010) Catastrophic misinterpretations as a predictor of symptomatic change during treatment for panic disorder. Journal of Clinical and Consulting Psychology, 78, 964-973.