Proponents of this theory point out that, with the help of a skilled therapist, people with panic disorder often can learn to recognize the earliest thoughts and feelings in this sequence and modify their responses to them. Patients are taught that typical thoughts such as “That terrible feeling is getting worse!” or “I’m going to have a panic attack” or “I’m going to have a heart attack” can be replaced with substitutes such as “It’s only uneasiness; it will pass” that help to reduce anxiety and ward off a panic attack. Specific procedures for accomplishing this are taught. By modifying thought patterns in this way, the patient gains more control over the problem.
In cognitive therapy, discussions between the patient and the therapist are not usually focused on the patient’s past, as is the case with some forms of psychotherapy. Instead, conversations focus on the difficulties and successes the patient is having at the present time, and on skills the patient needs to learn.
The behavioral portion of cognitive-behavioral therapy may involve systematic training in relaxation techniques. By learning to relax, the patient may acquire the ability to reduce generalized anxiety and stress that often sets the stage for panic attacks.
Breathing exercises often are included in the behavioral therapy. The patient learns to control his or her breathing and avoid hyperventilation—a pattern of rapid, shallow breathing that can trigger or exacerbate some people’s panic attacks.
Another important aspect of behavioral therapy is exposure to internal sensations called interoceptive exposure. During interoceptive exposure the therapist will do an individual assessment of internal sensations associated with panic. Depending on the assessment, the therapist may then encourage the patient to bring on some of the sensations of a panic attack by, for example, exercising to increase heart rate, breathing rapidly to trigger lightheadedness and respiratory symptoms, or spinning around to trigger dizziness. Exercises to produce feelings of unreality may also be used. Then the therapist teaches the patient to cope effectively with these sensations and to replace alarmist thoughts such as “I am going to die,” with more appropriate ones, such as “It’s just a little dizziness; I can handle it.”
Another important aspect of behavioral therapy is “in vivo” or real-life exposure. The therapist and the patient determine whether the patient has been avoiding particular places and situations, and which patterns of avoidance are causing the patient problems. They agree to work on the avoidance behaviors that are most seriously interfering with the patient’s life. For example, fear of driving may be of paramount importance for one patient, while inability to go to the grocery store may be most handicapping for another.
Some therapists will go to an agoraphobic patient’s home to conduct the initial sessions. Often therapists take their patients on excursions to shopping malls and other places the patients have been avoiding. Or they may accompany their patients who are trying to overcome fear of driving a car.
The patient approaches a feared situation gradually, attempting to stay in spite of rising levels of anxiety. In this way the patient sees that as frightening as the feelings are, they are not dangerous, and they do pass. On each attempt, the patient faces as much fear as he or she can stand. Patients find that with this step-by-step approach, aided by encouragement and skilled advice from the therapist, they can gradually master their fears and enter situations that had seemed unapproachable.
Many therapists assign the patient “homework” to do between sessions. Sometimes patients spend only a few sessions in one-on-one contact with a therapist and continue to work on their own with the aid of a printed manual.
Mental Health, N. (2006). Treatment of Panic Disorder. Psych Central. Retrieved on March 11, 2014, from http://psychcentral.com/lib/treatment-of-panic-disorder/000291
Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
Published on PsychCentral.com. All rights reserved.