Panic Disorder


What are Panic Attacks?

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Panic attacks are sudden, intense bursts of anxiety typically lasting anywhere between a few minutes up to an hour.  Rather than the individual recognising that this burst of anxiety is simply that, they will commonly misinterpret the anxiety as being an indication of something much more catastrophic.  Beliefs such as “I’m going to have a heart attack,” “I’m going to lose control,” and “I’m going to faint,” are typical of this misinterpretation.  1 in 3 people who have panic disorder will also have agoraphobia.  This may occur when an individual experiences a panic attack in a specific location, in a supermarket or on the high street for example, and then attributes the cause of the panic attack to being in this location.  To avoid further panic attacks, the individual will then avoid similar potential trigger situations, ultimately leading to a significantly impaired level of lifestyle functioning.

CBT for Panic.

Cognitive-Behavioural Therapy has been shown to be an effective treatment for Panic disorder and is recommended by the National Institute for Health and Care Excellence (NICE) as a first choice treatment for the problem.  It would be expected that you therapist would use an evidence based model of treatment, such as that developed by Clark (1986), which has been demonstrated to treat panic in research studies.

 

A typical course of CBT treatment for Panic would consist of:

  1. Education about anxiety, panic and CBT – The key to successful treatment is the individual understanding and accepting that the physical symptoms they experience in a panic episode are attributable to Anxiety, rather than the feared catastrophe (e.g., heart attack, stroke).  In this stage of treatment, the therapist will teach the individual all about the anxiety response.  You can find out all about the anxiety response and the physiological and cognitive changes that go with it here.
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  3. Socialisation to the model – This is when the therapist introduces the possibility that all of the clients symptoms can be explained by anxiety, rather than it being the feared catastrophic belief.  I’ve found that gains made from this stage of therapy are hugely significant for the client.
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  5. Cognitive restructuring and behavioural experiments – As the individual with panic may believe that they are, for example, going to have a heart attack during the episode, they are likely to engage in certain types of behaviour which they believe keep them safe. If I sit down when I feel the panic attack kick in, and my anxiety subsides, I may develop the belief that “the only reason I didn’t have a heart attack this time was because I sat down when the episode started – sitting down when I feel my heart beat faster keeps me safe.”  How does sitting down stop a heart attack?  It doesn’t.  It simply gives the individual a sense of relief from anxiety in the short term, and the illusory belief that it keeps them safe from catastrophe.  The thing is, the catastrophe was never going to happen in the first place – it was just anxiety.  The therapist assists the client to identify these “safety behaviours”, understand how they contribute to keeping the problem going, and to develop experiments to test out whether they actually prevent catastrophe from happening.


 

Ultimately, it is expected that the client will no longer believe that the symptoms they experience are evidence that something catastrophic is occurring, and that they understand that it is simply an anxiety response, and most importantly, nothing to be feared.