Cognitive Behavioral Therapy for Panic Disorder

Cognitive Behavioral Therapy for Panic Disorder

November 22 2024 TalktoAngel 0 comments 252 Views

Panic disorder is a type of anxiety disorder where sudden and intense episodes of fear, known as panic attacks, occur. These attacks may come out of the blue, causing a racing heart, sweating, shortness of breath, dizziness, and a feeling of losing control. They can be frightening, but they’re treatable. Cognitive behavioural therapy (CBT) is one of the best therapies for panic disorder.

What is Cognitive Behavioral Therapy (CBT)?

CBT is a structured, time-limited therapy that focuses on changing unhelpful patterns of thinking and behavior. It is frequently used to treat a variety of mental health conditions, such as anxiety, depression, and stress. For panic disorder, CBT helps individuals understand how their thoughts and feelings contribute to their panic attacks. It teaches coping strategies that reduce the intensity and frequency of panic episodes, ultimately improving emotional well-being.

How CBT Works for Panic Disorder

These are the primary actions that CBT takes to treat panic disorder:

  • Understanding Panic Attacks - The first step in CBT is helping you learn about panic attacks. You’ll understand that while the sensations feel overwhelming, they’re not dangerous. This knowledge alone can help reduce the fear associated with panic attacks.
  • Identifying Unhelpful Thoughts - Panic disorder is often fueled by catastrophic thoughts like "I'm going to die" or "I’m losing control." In CBT, you learn to recognize these unhelpful thoughts that trigger panic attacks. The intention is to swap them out for more sensible and peaceful ideas.
  • Changing Behaviors - People with panic disorder frequently exhibit avoidance behavior, which involves avoiding situations or locations where they could feel threatened by an attack. CBT advises you to confront these anxieties bit by bit in a secure setting. This teaches you that these circumstances are not as dangerous as they first appear to be.
  • Breathing and Relaxation Techniques - Panic attacks often make breathing difficult. CBT teaches you breathing exercises that help you stay calm during an attack. This can greatly lessen how severe your symptoms are.
  • Exposure Therapy - A key part of CBT for panic disorder is exposure therapy. It entails exposing oneself to panic attacks gradually and under supervision. For example, you might start by intentionally increasing your heart rate (e.g., through exercise) and learning to manage the anxiety that follows. This helps reduce the fear of panic sensations, ultimately contributing to resilience and long-term healing.
  • Building Long-term Skills - CBT gives you tools that last a lifetime. Once you learn to manage your thoughts and reactions, you’ll be better equipped to handle future stress or anxiety. The skills gained in therapy can help with not only panic disorder but also with managing workplace conflicts, relationship issues, and other challenges in life.

The CBT Process

The Cognitive Behavioral Therapy (CBT) process for panic disorder involves a series of structured steps designed to help individuals understand, manage, and ultimately reduce their panic attacks. Here’s a simple breakdown of the CBT process:

1.   Assessment and Goal Setting

  • Initial Assessment: The therapist starts by evaluating the individual’s panic symptoms, frequency of attacks, and how they affect daily life, including their impact on mental and physical health.
  • Setting Goals: The therapist and the patient work together to determine the goals of therapy. These goals might include reducing the number of panic attacks, learning to manage a fear of situations, or decreasing avoidance behaviors that could lead to social isolation or substance abuse as coping mechanisms.

2.  Psychoeducation

  • Learning About Panic: This step involves educating the individual about panic disorder, how it works, and why panic attacks happen. Understanding that panic attacks are not life-threatening but are exaggerated responses to fear can be reassuring and empowering.
  • Normalizing Symptoms: The body's "fight-or-flight" reaction includes many panic symptoms, such as a fast heartbeat and lightheadedness. CBT teaches people to see these as normal reactions instead of warning signals.

3.  Identifying Negative Thoughts

  • Thought Awareness: The next step is identifying the unhelpful and automatic thoughts that arise during or before a panic attack. For example, thoughts like "I’m going to faint" or "I’m having a heart attack" often lead to intense anxiety.
  • Thought Record: They might be asked to keep a "thought diary" to track these automatic thoughts during panic episodes. This makes it easier to understand how thoughts, emotions, and behaviors are related.

4.  Challenging and Replacing Negative Thoughts

  • Cognitive Restructuring: In this stage, the therapist works with the individual to challenge irrational thoughts and replace them with more balanced, realistic ones. Instead of thinking "I’m losing control," the new thought might be "This is a panic attack, and it will pass."
  • Evidence Checking: Evidence-based inquiry is a common tool used by therapists to help clients overcome their problems. They might inquire about evidence-related issues, such as "Has anyone ever lost control during a panic attack? Or what particular circumstances are causing it, so that it is feasible to discern between concern and fact? This method supports self-improvement by enabling individuals to uncover the anxiety underlying their thoughts and reframe their reactions.

5.   Exposure Therapy

  • Facing Fears Gradually: Avoidance of situations or activities that might trigger panic is common. Exposure treatment is used in CBT to gradually and carefully face these concerns. For example, if someone fears crowded places, they may first visit a less crowded area and gradually work up to more challenging situations.
  • Interoceptive Exposure: This specific type of exposure focuses on confronting physical sensations that trigger panic (e.g., increased heart rate). By purposely inducing these sensations in a safe environment (like through exercise), individuals learn that they can tolerate them without fear.

6.  Learning Coping Strategies

  • Breathing Techniques: Anxiety levels are raised when panic attacks cause shallow or hyperventilated breathing. During an attack, cognitive behavioural therapy (CBT) offers deep breathing and relaxation techniques to help the victim regain control.
  • Mindfulness and Relaxation: Mindfulness techniques help individuals stay present and observe their symptoms without judgment, reducing the impact of anxious thoughts and promoting emotional self-esteem. By practicing mindfulness, individuals can develop healthier habits for managing loneliness and improve their overall emotional well-being.

7.  Behavioral Experiments

  • Testing Beliefs: In this step, individuals engage in behavioral experiments to test the accuracy of their fears. For example, if someone fears they’ll faint during a panic attack, the therapist might have them perform activities like standing up quickly to observe that the feared outcome doesn’t happen.
  • Building Confidence: These experiments gradually weaken the connection between physical sensations and fear, building confidence in handling panic situations.

8.  Preventing Relapse

  • Building Long-Term Skills: As therapy progresses, the focus shifts to maintaining gains and preventing future panic attacks. The therapist may teach relapse prevention strategies, such as recognizing early signs of panic and using learned skills to manage them. These techniques are invaluable in preventing chronic pain or emotional distress that might come with future anxiety.
  • Creating a Plan: The individual and therapist create a personalized plan to cope with potential triggers and challenges in the future, ensuring that they continue to use CBT tools after therapy ends.

Why CBT is Effective for Panic Disorder

  • CBT is highly effective in reducing panic attacks and preventing relapses.
  • While some people may use medication, CBT often works well on its own.
  • CBT teaches you real-life skills that you can apply whenever anxiety strikes.

Conclusion

For panic disorder, cognitive behavioural counselling is a very useful and successful treatment. CBT is one of the most popular types of therapy and may play a critical role in your healing. While CBT alone can help reduce symptoms, many people find that a mix of treatments works best. In addition to assisting you in creating a treatment plan that best meets your needs, your counselor or therapist may help you decide if CBT is the appropriate option for you. One of the first steps toward recovery if you or someone you love experiences panic attacks is to speak with a CBT-trained therapist. You can also seek online counselling services like TalktoAngel, which connects you with the best psychologist in India for expert guidance. Online counselling provides a flexible and accessible option for managing stress, anxiety, and depression, especially for those dealing with loneliness or other mental health struggles.

Contribution: Dr (Prof) R K Suri, Clinical Psychologist, life coach & mentor TalktoAngel & Ms Swati Yadav, Counselling Psychologist.


References

  • Rayburn NR, Otto MW. Cognitive-behavioral therapy for panic disorder: a review of treatment elements, strategies, and outcomes. CNS Spectr. 2003 May;8(5):356-62. DOI: 10.1017/s1092852900018617
  • Pompoli A, Furukawa TA, Efthimiou O, Imai H, Tajika A, Salanti G. Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychol Med. 2018 Sep;48(12):1945-1953.  doi: 10.1017/S0033291717003919


SHARE


Leave a Comment:

Related Post



Categories

Related Quote

“Anxiety is a thin stream of fear trickling through the mind. If encouraged, it cuts a channel into which all other thoughts are drained.”

“Anxiety is a thin stream of fear trickling through the mind. If encouraged, it cuts a channel into which all other thoughts are drained.” - Arthur Somers Roche

"It is okay to have depression, it is okay to have anxiety and it is okay to have an adjustment disorder. We need to improve the conversation. We all have mental health in the same way we all have physical health."

"It is okay to have depression, it is okay to have anxiety and it is okay to have an adjustment disorder. We need to improve the conversation. We all have mental health in the same way we all have physical health." - Prince Harry

“You say you’re ‘depressed’ – all I see is resilience. You are allowed to feel messed up and inside out. It doesn’t mean you’re defective – it just means you’re human.”

“You say you’re ‘depressed’ – all I see is resilience. You are allowed to feel messed up and inside out. It doesn’t mean you’re defective – it just means you’re human.” - David Mitchell, Cloud Atlas

"A positive attitude gives you power over your circumstances instead of your circumstances having power over you."

"A positive attitude gives you power over your circumstances instead of your circumstances having power over you." - Joyce Meyer

"Mental health and physical health are one in the same for me - they go hand in hand. If you aren't physically healthy, you won't be mentally healthy either - and vice versa. The mind and body is connected and when one is off, the other suffers as well"

"Mental health and physical health are one in the same for me - they go hand in hand. If you aren't physically healthy, you won't be mentally healthy either - and vice versa. The mind and body is connected and when one is off, the other suffers as well" - Kelly Gale

Best Therapists In India


Self Assessment



GreenWave