Checkmate! Managing Panic Disorder with Chess Therapy

This mode of therapy, still in its infancy, could be used to analyze and track a patient’s progress during play.


Mr. Tate writes about the health care industry; EHR interventions; and emerging technologies.

According to statistics from the National Institute of Mental Health,1 about 4.7% of Americans suffer from panic disorder as adults.1 During a panic attack, a patient may experience physiological symptoms such as shortness of breath, heart palpitations, and abdominal dysfunction. This condition manifests in many ways and can occur without a known cause or due to fear of heights, social anxiety, and other anxiety-related factors.

Common treatment prevention strategies include therapies such as cognitive behavioral therapy (CBT) and SSRIs. SSRIs have been an effective treatment for panic disorders for over 20 years.2.3 For example, in a first study, 20 mg of fluoxetine was prescribed to a group of 30 study participants whose ages ranged from 18 to 62 years. The researchers found that after eight weeks, about half of the patients (48%) had stopped having panic attacks.2

What if CBT and medication fail?

Playing chess on a smartphone app was found to be effective in a self-reported case study published in the Asian Journal of Psychiatry.4Although chess therapy trials are still in their infancy,5 (pp 160-163) the method gave promising results, at least in this circumstance. The difficulty of the game was gradually increased from level 1 to level 10. The author found levels 2 and 3 to be the most effective for “processing”. These levels were comfortable (defined as the user’s familiarity with the structure of the game) and the challenges faced by the patient in the game. How well did the player understand the game? Has he made significant progress through the different levels? Was he able to play patiently for the duration of the match?

The main challenge was to overcome the obstacles in a timely manner. The real reversal of the situation in this whole experiment rested on the degree of difficulty: the amateur player knows little about how the game works. The author discovered that chess was effective in regulating his level of anxiety. His findings:

• When playing levels 1-3, the author was encouraged to play further as the app did not move the chess pieces too quickly. However, as the player progressed from level 3, resolve wavered and mental anxiety and distress ensued.

• The researcher used different tactics to manage panic symptoms, such as watching TV, taking walks after dinner, and spending time with family

• The chess game acted as a distraction for the researcher. It completely stopped his panic attacks, but the other distractions weren’t as effective in dealing with the physiological response.

The author reported that he managed to “cure” his panic distress through the use of an app. However, there are other possible approaches to this therapy. A therapist could play with the patient, face to face, and as the panic symptoms subside, the activity could shift to a recreational setting. This therapy mode could be used to analyze and monitor patient’s progress during play.

The references:

1. National Institute of Mental Health. Panic disorder. Accessed December 12, 2018.

2. Pecknold JC, Luthe L, Iny L, Ramdoyal D. Fluoxetine in panic disorder: pharmacological and tritiated platelet study of imipramine and paroxetine. J Psychiatry Neurosci. 1995;20:193-198.

3. Luethi M, Meier B, Sandi C. Effects of stress on working memory, explicit memory, and implicit memory for neutral and emotional stimuli in healthy men. Before Behav Neurosci. 2009;2:5.

4. Barzegar K, Barzegar S. Chess therapy: A new approach to curing panic attacks. Asian J Psychiatrist. 2017;30:118-119.

5. Fadul JA. Chess therapy. In Neukrug ES (Editor) The SAGE Encyclopedia of Counseling and Psychotherapy Theory. London: SAGE Publications, Inc.; 2015.

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