Cognitive Restructuring for Panic Disorder

How Cognitive Behavioral Therapy Can Help Relieve Panic Disorder

Cognitive Restructuring for Panic Disorder

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If you've decided to go to psychotherapy for panic disorder, you may be wondering what your therapeutic treatment options are. Numerous types of therapy are available, depending on your therapist’s approach and training background.

Panic-focused psychodynamic psychotherapy (PFPP) is one such option that's been shown to be effective in treating panic disorder; another effective psychotherapy—often considered to be the most popular type of therapy for anxiety disorders—is cognitive-behavioral therapy (CBT).

Due to its proven effectiveness, goal-oriented focus, and quick results, professionals who treat panic disorder often prefer CBT to other forms of therapy. The following describes the CBT approach and explains how it's used to treat panic disorder, panic attacks, and agoraphobia.

Cognitive-behavioral therapy, or simply CBT, is a form of psychotherapy used in the treatment of mental health conditions. The underlying concepts of CBT are the notion that a person’s thoughts, feelings, and perceptions influence her actions and behaviors.

According to the tenets of CBT, a person may not always be able to change her life circumstances, but she can choose how she perceives and acts upon life’s ups and downs.

CBT works to help change a person’s faulty or negative thinking, and assists in shifting unhealthy behaviors.

CBT is currently used for the treatment of numerous mental health disorders, including major depressive disorder, phobias, post-traumatic stress disorder (PTSD), and addiction.

 CBT has also been found to be an effective treatment option for some medical conditions, such as irritable bowel syndrome (IBS), fibromyalgia, and chronic fatigue.

Get our printable guide to help you ask the right questions at your next doctor's appointment.

One of the main goals of CBT is to help a client overcome negative thinking patterns so that he may be able to make better choices in his actions and behaviors.

In general, people with panic disorder are often more susceptible to negative thoughts and self-defeating beliefs, which can result in lowered self-esteem and increased anxiety.

 Fearful and negative thinking is often associated with panic attacks, the main symptom of panic disorder.

Panic attacks are frequently experienced through a mix of physical and cognitive symptoms. Typical somatic symptoms include shortness of breath, heart palpitations, chest pain, and excessive sweating. These symptoms are often perceived as frightening and can lead to distressing thoughts, such as a fear of losing control, going crazy or dying.

Fears associated with panic attacks can become so intense that they begin to negatively impact a person’s behaviors. For example, a person may begin to fear having an attack while driving or in front of other people (thoughts).

The person will then avoid driving or being in crowded areas (behaviors). Such behaviors lead to a separate condition known as agoraphobia.

 With agoraphobia, fearful thoughts become instilled over time, and avoidance behaviors only serve to reinforce these fears.

CBT can assist people with panic disorder and/or agoraphobia in developing ways to manage their symptoms. A person may not be able to control when he has a panic attack, but he can learn how to effectively cope with his symptoms. CBT assists the client in achieving lasting change through a two-part process.

  1. Recognize and Replace Negative Thoughts. The CBT therapist will first assist the client in identifying his negative cognitions or thinking patterns. For instance, a person may be directed to contemplate how he perceives himself, views the world or feels during a panic attack. By focusing on the thought process, a person can begin to recognize his typical thought patterns and how it influences his behaviors.
  2. The therapist may use a wide range of activities and exercises to help the client become aware of his negative thoughts, and learn to replace them with healthier ways of thinking. Additionally, homework activities are often assigned between sessions to help the client in continually identifying and eliminating faulty thinking.
  3. Writing exercises can be a powerful way to conquer faulty thinking patterns. These exercises may be used to increase awareness of and replace negative thoughts. Some common CBT writing exercises include journal writing, keeping a gratitude journal, using affirmations, and maintaining a panic diary.
  4. Skill Building and Behavioral Changes. The next step of CBT involves building on healthy coping strategies to change maladaptive behaviors. During this phase, the client will learn to develop skills to help in reducing stress, managing anxiety, and getting through panic attacks. These skills may be rehearsed in session, but it's also important that the client practices new behaviors outside of therapy, too.
  5. Desensitization is a common CBT technique that is used to help the client get past avoidance behaviors. Through systematic desensitization, the CBT therapist gradually introduces the client to anxiety-producing stimuli while teaching him how to manage his feelings of anxiety. The person is slowly introduced to more fear-inducing situations, developing ways to cope with panic symptoms through each feared circumstance.
  6. To help remain calm through anxiety-provoking circumstances, relaxation techniques are also learned. These skills assist in managing fears, lowering heart rate, reducing tension, and improving problem-solving skills. Some common relaxation techniques include deep breathing exercises, progressive muscle relaxation (PMR), yoga, and meditation.

Being one of the most widely used forms of therapy, CBT may be part of your recovery process. CBT can help in reducing symptoms on its own, but many will find a combination of treatment options to be the most beneficial. Your doctor or therapist can help you determine if CBT is right for you and assist you in developing a treatment plan that will best suit your needs.

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  1. Chambless DL, Milrod B, Porter E, et al. Prediction and moderation of improvement in cognitive-behavioral and psychodynamic psychotherapy for panic disorder. J Consult Clin Psychol. 2017;85(8):803–813. doi:10.1037/ccp0000224

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Additional Reading

  • Fenn K, Byrne M. The key principles of cognitive behavioural therapy. InnovAiT: Education and inspiration for general practice. 2013;6(9):579-585. doi:10.1177/1755738012471029
  • Burns, D. D. (2008). Feeling Good: The New Mood Therapy (2nd ed.). New York: Avon.
  • Greenberger, D. & Padesky, C. (1995). Mind Over Mood: Change How You Feel by Changing the Way You Think. New York; The Gilford Press.

Source: https://www.verywellmind.com/cognitive-behavioral-therapy-2584290

Cognitive behavior therapy in the treatment of panic disorder

Cognitive Restructuring for Panic Disorder

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Cognitive Behavioral Therapy for Panic Disorder | Society of Clinical Psychology

Cognitive Restructuring for Panic Disorder

2015 Criteria
(Tolin et al. Recommendation) Treatment pending re-evaluation 1998 Criteria
(Chambless et al.

EST)

  • Basic premise: Thoughts, feelings and behaviors are inter-related, so altering one can help to alleviate problems in another.
  • Essence of therapy: Cognitive therapy aims to help the person identify, challenge, and modify dysfunctional ideas related to panic symptoms (e.g., catastrophic consequences of bodily sensations). Avoidance of panic and panic-cues is targeted through exposure exercises, including both in vivo (e.g., going to crowded places or driving in traffic) and interoceptive (e.g., bodily sensations) exposures.
  • Length: Approx. 12-16 sessions

Editors: Evan Forman, PhD; Joanna Kaye, BA

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice

Treatment Manuals

  • Anxiety and Panic Disorder: Patient Treatment Manual (Andrews et al.)

Self-help Books

Important Note: The books listed above are empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.

Smartphone Apps

Important Note: The apps listed above are empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.

Clinical Trials

  • Group cognitive-behavioral treatment of panic disorder (Telch et al., 1993)
  • Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial (Barlow, Gorman, Shear, & Woods, 2000)
  • A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder (Roy-Byrne et al., 2005)
  • Behavioral treatment of panic disorder: A two-year follow-up (Craske, Brown, & Barlow, 1991)
  • Alprazolam and exposure alone and combined in panic disorder with agoraphobia (Marks et al., 1993)
  • Brief cognitive-behavioral versus nondirective therapy for panic disorder (Craske, Maidenberg, & Bystritsky, 1995)

Meta-analyses and Systematic Reviews

  • Cognitive-behavioral therapy and the treatment of panic disorder: Efficacy and strategies (Otto & Deveney, 2005)
  • Treatment of panic (Schmidt & Keough, 2010)
  • A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia (Mitte, 2005)
  • A meta-analysis of treatment outcome for panic disorder (Gould, Otto, & Pollack, 1995)
  • Cognitive-behavioral treatment for panic disorder: Current status (Landon & Barlow, 2004)
  • A meta-analysis of the treatment of panic disorder with or without agoraphobia: A comparison of psychopharmacological, cognitive-behavioral and combination treatments (Van Balkom et al., 1997)
  • Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis (Sánchez-Meca, Rosa-Alcázar, Marín-Martínez, & Gómez-Conesa, 2010)

Other Treatment Resources

  • Cognitive-behavioral therapy for panic disorder: A review of treatment elements, strategies, and outcomes (Rayburn & Otto, 2003)
  • The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: Quality versus quantity (Schmidt & Woolaway-Bickel, 2000)
  • When anxiety symptoms masquerade as physical symptoms: What medical specialists know about panic disorder and available psychological treatments (Teng, Chaison, Hamilton, Bailey, & Dunn, 2008)
  • Treatment of Panic Disorder: A Consensus Development Conference ( Wolfe; Editor: Maser)
  • Panic Disorder and Its Treatment (Editors: Pollack & Rosenbaum)
  • Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic (Barlow)
  • Anxiety Disorders and Phobias: A Cognitive Perspective (Beck, Emery, & Greenberg, 2005)

Source: https://www.div12.org/treatment/cognitive-behavioral-therapy-for-panic-disorder/

Therapy for Anxiety Disorders – HelpGuide.org

Cognitive Restructuring for Panic Disorder

Whether you’re suffering from panic attacks, obsessive thoughts, unrelenting worries, or an incapacitating phobia, it’s important to know that you don’t have to live with anxiety and fear. Treatment can help, and for many anxiety problems, therapy is often the most effective option.

That’s because anxiety therapy—un anxiety medication—treats more than just the symptoms of the problem. Therapy can help you uncover the underlying causes of your worries and fears; learn how to relax; look at situations in new, less frightening ways; and develop better coping and problem-solving skills.

Therapy gives you the tools to overcome anxiety and teaches you how to use them.

Anxiety disorders differ considerably, so therapy should be tailored to your specific symptoms and diagnosis. If you have obsessive-compulsive disorder (OCD), for example, your treatment will be different from someone who needs help for anxiety attacks.

The length of therapy will also depend on the type and severity of your anxiety disorder. However, many anxiety therapies are relatively short-term.

According to the American Psychological Association, many people improve significantly within 8 to 10 therapy sessions.

While many different types of therapy are used to treat anxiety, the leading approaches are cognitive behavioral therapy (CBT) and exposure therapy.

Each anxiety therapy may be used alone, or combined with other types of therapy. Anxiety therapy may be conducted individually, or it may take place in a group of people with similar anxiety problems.

But the goal is the same: to lower your anxiety levels, calm your mind, and overcome your fears.

Cognitive behavioral therapy (CBT) for anxiety

Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions.

CBT addresses negative patterns and distortions in the way we look at the world and ourselves. As the name suggests, this involves two main components:

Cognitive therapy examines how negative thoughts, or cognitions, contribute to anxiety.

Behavior therapy examines how you behave and react in situations that trigger anxiety.

The basic premise of CBT is that our thoughts—not external events—affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation. For example, imagine that you’ve just been invited to a big party. Consider three different ways of thinking about the invitation, and how those thoughts would affect your emotions.

As you can see, the same event can lead to completely different emotions in different people. It all depends on our individual expectations, attitudes, and beliefs.

For people with anxiety disorders, negative ways of thinking fuel the negative emotions of anxiety and fear. The goal of cognitive behavioral therapy for anxiety is to identify and correct these negative thoughts and beliefs.

The idea is that if you change the way you think, you can change the way you feel.

Thought challenging in CBT for anxiety

Thought challenging—also known as cognitive restructuring—is a process in which you challenge the negative thinking patterns that contribute to your anxiety, replacing them with more positive, realistic thoughts. This involves three steps:

  1. Identifying your negative thoughts. With anxiety disorders, situations are perceived as more dangerous than they really are. To someone with a germ phobia, for example, shaking another person’s hand can seem life threatening. Although you may easily see that this is an irrational fear, identifying your own irrational, scary thoughts can be very difficult. One strategy is to ask yourself what you were thinking when you started feeling anxious. Your therapist will help you with this step.
  2. Challenging your negative thoughts. In the second step, your therapist will teach you how to evaluate your anxiety-provoking thoughts. This involves questioning the evidence for your frightening thoughts, analyzing unhelpful beliefs, and testing out the reality of negative predictions. Strategies for challenging negative thoughts include conducting experiments, weighing the pros and cons of worrying or avoiding the thing you fear, and determining the realistic chances that what you’re anxious about will actually happen.
  3. Replacing negative thoughts with realistic thoughts. Once you’ve identified
    the irrational predictions and negative distortions in your anxious thoughts, you can replace them with new thoughts that are more accurate and positive. Your therapist may also help you come up with realistic, calming statements you can say to yourself when you’re facing or anticipating a situation that normally sends your anxiety levels soaring.

To understand how thought challenging works in cognitive behavioral therapy, consider the following example: Maria won’t take the subway because she’s afraid she’ll pass out, and then everyone will think she’s crazy. Her therapist has asked her to write down her negative thoughts, identify the errors—or cognitive distortions—in her thinking, and come up with a more rational interpretation. The results are below.

Challenging Negative Thoughts
Negative thought #1: What if I pass out on the subway?
Cognitive distortion: Predicting the worstMore realistic thought: I’ve never passed out before, so it’s unly that I will on the subway.
Negative thought #2: If I pass out, it will be terrible!
Cognitive distortion: Blowing things proportionMore realistic thought: If I faint, I’ll come to in a few moments. That’s not so terrible.
Negative thought #3: People will think I’m crazy.
Cognitive distortion: Jumping to conclusionsMore realistic thought: People are more ly to be concerned if I’m okay.

Replacing negative thoughts with more realistic ones is easier said than done. Often, negative thoughts are part of a lifelong pattern of thinking. It takes practice to break the habit. That’s why cognitive behavioral therapy includes practicing on your own at home as well. CBT may also include:

Learning to recognize when you’re anxious and what that feels in the body

Learning coping skills and relaxation techniques to counteract anxiety and panic

Confronting your fears (either in your imagination or in real life)

Exposure therapy for anxiety

Anxiety isn’t a pleasant sensation, so it’s only natural to avoid it if you can. One of the ways that people do this is by steering clear of the situations that make them anxious. If you have a fear of heights, you might drive three hours your way to avoid crossing a tall bridge.

Or if the prospect of public speaking leaves your stomach in knots, you might skip your best friend’s wedding in order to avoid giving a toast. Aside from the inconvenience factor, the problem with avoiding your fears is that you never have the chance to overcome them.

In fact, avoiding your fears often makes them stronger.

Exposure therapy, as the name suggests, exposes you to the situations or objects you fear. The idea is that through repeated exposures, you’ll feel an increasing sense of control over the situation and your anxiety will diminish.

The exposure is done in one of two ways: Your therapist may ask you to imagine the scary situation, or you may confront it in real life. Exposure therapy may be used alone, or it may be conducted as part of cognitive behavioral therapy.

Systematic desensitization

Rather than facing your biggest fear right away, which can be traumatizing, exposure therapy usually starts with a situation that’s only mildly threatening and works up from there. This step-by-step approach is called systematic desensitization. Systematic desensitization allows you to gradually challenge your fears, build confidence, and master skills for controlling panic.

Systematic desensitization involves three parts:

Learning relaxation skills. First, your therapist will teach you a relaxation technique, such as progressive muscle relaxation or deep breathing.

You’ll practice in therapy and on your own at home.

Once you start confronting your fears, you’ll use this relaxation technique to reduce your physical anxiety response (such as trembling and hyperventilating) and encourage relaxation.

Creating a step-by-step list. Next, you’ll create a list of 10 to 20 scary situations that progress toward your final goal. For example, if your final goal is to overcome your fear of flying, you might start by looking at photos of planes and end with taking an actual flight. Each step should be as specific as possible, with a clear, measurable objective.

Working through the steps. Under the guidance of your therapist, you’ll then begin to work through the list. The goal is to stay in each scary situation until your fears subside. That way, you’ll learn that the feelings won’t hurt you and they do go away.

Every time the anxiety gets too intense, you will switch to the relaxation technique you learned. Once you’re relaxed again, you can turn your attention back to the situation.

In this way, you will work through the steps until you’re able to complete each one without feeling overly distressed.

Complementary therapies for anxiety disorders

As you explore your anxiety disorder in therapy, you may also want to experiment with complementary therapies designed to bring your overall stress levels down and help you achieve emotional balance.

Exercise is a natural stress buster and anxiety reliever. Research shows that as little as 30 minutes of exercise three to five times a week can provide significant anxiety relief. To achieve the maximum benefit, aim for at least an hour of aerobic exercise on most days.

Relaxation techniques such as mindfulness meditation and progressive muscle relaxation, when practiced regularly, can reduce anxiety and increase feelings of emotional well-being.

Biofeedback uses sensors that measure specific physiological functions—such as heart rate, breathing, and muscle tension—to teach you to recognize your body’s anxiety response and learn how to control it using relaxation techniques.

Hypnosis is sometimes used in combination with CBT for anxiety. While you’re in a state of deep relaxation, the hypnotherapist uses different therapeutic techniques to help you face your fears and look at them in new ways.

Making anxiety therapy work for you

There is no quick fix for anxiety. Overcoming an anxiety disorder takes time and commitment. Therapy involves facing your fears rather than avoiding them, so sometimes you’ll feel worse before you get better.

The important thing is to stick with treatment and follow your therapist’s advice. If you’re feeling discouraged with the pace of recovery, remember that therapy for anxiety is very effective in the long run.

You’ll reap the benefits if you see it through.

You can also support your own anxiety therapy by making positive choices. Everything from your activity level to your social life affects anxiety. Set the stage for success by making a conscious decision to promote relaxation, vitality, and a positive mental outlook in your everyday life.

Learn about anxiety. In order to overcome anxiety, it’s important to understand the problem. That’s where education comes in. Education alone won’t cure an anxiety disorder, but it
will help you get the most therapy.

Cultivate your connections with other people. Loneliness and isolation set the stage for anxiety. Decrease your vulnerability by reaching out to others. Make it a point to see friends; join a self-help or support group; share your worries and concerns with a trusted loved one.

Adopt healthy lifestyle habits. Physical activity relieves tension and anxiety, so make time for regular exercise. Don’t use alcohol and drugs to cope with your symptoms, and try to avoid stimulants such as caffeine and nicotine, which can make anxiety worse.

Reduce stress in your life. Examine your life for stress, and look for ways to minimize it. Avoid people who make you anxious, say no to extra responsibilities, and make time for fun and relaxation in your daily schedule.

Authors: Melinda Smith, M.A., Robert Segal, M.A., and Jeanne Segal, Ph.D. Last updated: November 2019.

Source: https://www.helpguide.org/articles/anxiety/therapy-for-anxiety-disorders.htm

Panic attacks: Help sufferers recover with cognitive-behavioral therapy

Cognitive Restructuring for Panic Disorder

With panic attacks, alarming physiologic symptoms mount swiftly—tachycardia, chest pain, sweating, trembling, smothering or choking, dizziness, fear of losing control or going crazy—even fear of dying.1 Patients constantly fear the next attack, worry about its consequences, and change their behaviors to avoid or withdraw from anxiety-provoking situations.

To relieve their suffering, cognitive-behavioral therapy (CBT) may offer benefits you would not realize with medication alone. CBT can:

  • improve long-term patient outcomes
  • enhance medication management
  • boost treatment response when medication alone is inadequate
  • ease drug discontinuation.2

Whether you or a CBT-trained psychotherapist guides the sessions, you can achieve optimal results for your patients with panic disorder.

Panic disorder is chronic, often disabling, and characterized by spontaneous, unpredictable panic attacks (Boxes 1 and 23-11). When treated with CBT, about three-quarters of patients become panic-free and maintain treatment gains at follow-up, and one-half become both panic-free and free of excess anxiety.9

Typical therapy is 12 individual, once-weekly visits for psycho-education, relaxation, and breathing training; cognitive restructuring; and exposure therapies.

Briefer protocols, “reduced therapist contact,”12 and group therapy13 also can help patients and in some studies have been as beneficial as 12 weeks of individual therapy. Although trained psychotherapists have higher success rates than nonbehaviorists when treating panic patients, nonbehaviorists also can provide effective therapy after relatively brief training.14

American Psychiatric Association15 treatment guidelines recommend medications—such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and benzodiazepines—as well as CBT as first-line therapies for panic disorder. Other treatment guidelines concur16 and note that CBT is more cost-effective than medications.

In comparison studies, CBT has been at least as effective for panic symptoms as SSRIs,17,18 TCAs,19 and alprazolam.20 Antidepressants are the preferred drug for panic disorder16 because they lack benzodiazepines’ dependence and abuse potential.

Providing medication during CBT may maintain patients’ therapeutic gains better than CBT alone if the medication is continued after CBT is completed. Interestingly, patients who use benzodiazepines during CBT may have higher relapse rates than those who do not use benzodiazepines, particularly when the benzodiazepines are withdrawn.9

CBT produces improvement rates similar to those of pharmacologic treatment at one-quarter to one-half the cost in the first year. Patients also appear to have better clinical outcomes if they receive CBT while SSRIs or benzodiazepines are being discontinued, compared with simply stopping the medications.8

Box 1

Panic attacks typically begin between ages 10 and 40. The cause is unknown, but evidence points to multiple factors, including heredity, neurobiology, provocations, and psychological conditioning (Box 2).3-9 prevalence is approximately 5%,10 and about three-fourths of panic disorder patients are female.11

Comorbidity. Up to 50% of persons with panic disorder also experience agoraphobia.1 Depression, other anxiety disorders, and substance abuse may complicate the clinical picture.

Box 2

BIOLOGICAL THEORIES

Genetics. About 10% of persons who experience panic attacks have first-degree relatives with panic disorder. Twin studies suggest heritability of up to 43%

Neurobiology. Anxiety responses appear to be organized at different neuroanatomic levels:

  • automatic responses by periaqueductal grey matter or locus coeruleus
  • practiced responses by the amygdala and septohippocampal regions
  • cognitively complex responses by higher cortical regions.

The hypothalamus mediates neurohormonal responses. Panic disorder patients’ response to SSRIs, tricyclic antidepressants, and benzodiazepines suggest a link with neurotransmitters serotonin, norepinephrine, and GABA. Adenosine, cannabinoids, neuropeptides, hormones, neurotrophins, cytokines, and cellular mediators may also be involved.

Provocation. Panic disorder may have a physiologic mechanism.

When exposed in the laboratory to panicogenic substances (such as carbon dioxide, sodium lactate, yohimbine, and caffeine), persons with panic disorders experience greater numbers of panic attacks than do those without panic disorders. These laboratory-induced panic attacks resemble real attacks, and anti-panic medications block the induced panic attacks.

PSYCHOLOGICAL THEORIES

The cognitive-behavioral model postulates that panic disorder patients:

  • have a predisposed vulnerability to respond with physiologic arousal to negative stressors
  • tend to see anxiety symptoms as harmful
  • have negative and catastrophizing cognitions about those symptoms.

With conditioning, patients associate early physiologic arousal with other panic symptoms as the arousal progresses. Ultimately, they become hypervigilant for symptoms and develop a learned escalation of anxiety and apprehension (with accompanying negative cognitions) when the early symptoms re-occur.

Source: References 3-9

To diagnose panic disorder, conduct a thorough psychiatric evaluation that includes assessing for comorbid mental and substance use disorders.

The history and physical exam are essential to rule out medical causes of the patient’s symptoms, such as heart disease causing dizziness or palpitations.

Asking patients to keep panic attack records can help you identify panic symptoms’ frequency and triggers.9

An assessment tool such as the Albany Panic and Phobia Questionnaire (Figure) can be a useful starting point.

It has 27 items and three subscales to quantify a patient’s fear of agoraphobic situations, social phobia situations, and situations that produce bodily sensations (interoceptive symptoms).

Items on the interoceptive subscale include activities such as exercising vigorously, ingesting caffeine, and experiencing intense emotion.21 Using the Anxiety Sensitivity Index is another assessment option.22

Source: https://www.mdedge.com/psychiatry/article/61967/panic-attacks-help-sufferers-recover-cognitive-behavioral-therapy

CBT for Panic Attacks Panic Attack Treatment Without Medication — Cognitive Behavioral Therapy Los Angeles

Cognitive Restructuring for Panic Disorder

Significant research has proven cognitive behavioral therapy (CBT) to be the most effective treatment for panic attacks and panic disorder. In numerous studies, CBT has far outperformed all other psychological treatments, including anti-anxiety medication.

Scientific studies have consistently found that CBT is more effective at reducing symptoms, the treatment is briefer in duration, and the results last longer for more people, than traditional talk therapy.

Follow this link to a chart comparing the effectiveness of different treatments for anxiety disorders.

Cognitive behavioral therapy for panic attacks and panic disorder lasts about twelve sessions for most people, with most people reporting improvement after the first few sessions. Some people respond more quickly, needing fewer sessions, while others need more than twelve sessions due to other complicating factors such as depression or OCD.

Cognitive behavioral treatment for panic attacks and panic disorder usually involves some combination of the following interventions:

  • Relaxation Training: Relaxation training can be helpful in beginning stages of treatment for panic.

    Often people have become increasingly anxious over time, so much so that their bodies are overwrought with muscle tension, making them even more susceptible to additional anxiety.

    Usually relaxation training involves relaxation breathing or progressive muscle relaxation, ways of decreasing physiological anxious arousal. This then helps to reduce future vulnerability to anxiety.

  • Cognitive Restructuring: Cognitive Restructuring is a method of becoming more aware of anxiety-provoking thought patterns, and replacing them with more balanced, less anxious thinking. By reducing the intensity of your reactions to panic symptoms and feared situations, you can further reduce your anxiety, and decrease the frequency, intensity, and duration of panic symptoms.

  • Mindfulness: A meditative technique borrowed from eastern traditions of meditation, mindfulness as a tool for overcoming anxiety is increasingly becoming the focus of a great deal of scientific research. In treatment for panic disorder, it is used to help teach people to experience unpleasant physical sensations without reacting negatively to them, thus short-circuiting the vicious cycle of fear and panic.

  • Exposure treatment: Once people feel less anxious about future panic attacks due to using relaxation training, mindfulness, and cognitive restructuring, they are more able to confront anxiety-provoking situations.

    Systematic exposure is an intervention that helps people face what they normally avoid.

    By purposely putting themselves in challenging situations, they defuse the fear associated with them, and no longer fear the situations in the future.

  • Stress Reduction: For some people, reducing stressors can be an important part of treatment for anxiety. A combination of 1) learning to react to different situations more calmly and 2) reducing unnecessary stress, can be helpful in reducing overall anxiety and improving quality of life.

At Cognitive Behavioral Therapy Los Angeles, we are experts in brief treatment for anxiety, using only the most cutting-edge, scientifically proven treatments. Call or email today for an appointment with an anxiety specialist. 

Source: http://cogbtherapy.com/cbt-for-panic-attacks