A cognitive behavioral approach to panic disorder

A definition of panic disorder is that it involves recurrent, unexpected panic attacks, where the sufferer between attacks still lives in fear of another one happening. In this article, I wish to describe briefly the cognitive behavioural theory of panic disorder (one of the most evidence based models) and to provide some ideas about how it can be tackled according to this framework.

The cognitive behavioural model supplies a relatively straightforward explanation of panic disorder: according to this framework, the sufferer has unwittingly misinterpreted the nature of their anxiety, and it is this misinterpretation that is primarily responsible for the anxiety escalating into an attack. The nature of the misinterpretation is that the sufferer believes that their uncomfortable body sensations are intimations of some imminent catastrophe (in essence, they are taken as signifying danger), and they also underestimate their ability to cope with the anxiety. Thus, the misreading of their bodily sensations depends on two key interpretations: those sensations are seen as heralding danger and a danger that will be impossible to handle. Once someone thinks in this fashion when they are anxious, it is quite possible - although not always inevitable - that they can descend into panic.

Given this explanation of how anxiety can escalate into a panic attack, cognitive behavioural approaches tend to emphasise four main ways for treatment of panic disorder to proceed:

1) Panic education.
2) Cognitive restructuring.
3) Respiratory control.
4) Exposure.

Let us look at each in turn:

Panic education

The rationale behind panic education is to provide the client with information about the nature of panic attacks, so that they can see that these attacks are not intimations of something dangerous, but they are instead reactions to how they interpret their anxiety. While education alone will rarely suffice, it can still help the client to have less dread of future panic attacks, to begin the process of re-interpreting their anxious bodily sensations, and to realise that a panic attack is never going to kill them.

Cognitive restructuring

This name refers to the process of helping the client to amend their thinking about their anxiety. Essentially it involves encouraging the client to see their bodily sensations in non-catastrophic terms, i.e. as uncomfortable but not dangerous.

Respiratory control

Panic usually involves an amendment to the usual style of breathing in the form of hyperventilation. Practicing how to breathe in a more relaxed way when anxious can provide a good way of coping with panic attacks, as the slower, relaxed pace of breathing can prevent hyperventilation and encourage the body to move out of the fight/flight mode sooner.

Exposure

One of the most common forms of tackling panic is known as 'exposure'. What this involves is the client confronting in a graduated way situations that tend to induce panic, and learning through experience that the situations are not dangerous and that the client, even though they might feel terribly anxious to begin with, can nevertheless withstand them.

If you suffer from panic disorder, and feel that you need more help with tackling it, please get in touch with a therapist who can help you tackle the issue in a safe and manageable fashion.